Ostojic Katarina, Sharp Nicole, Paget Simon, Khut George, Morrow Angela
Children's Hospital Westmead Clinical School The University of Sydney Sydney NSW Australia.
Kids Rehab The Children's Hospital at Westmead Sydney NSW Australia.
Paediatr Neonatal Pain. 2021 Oct 15;4(1):34-43. doi: 10.1002/pne2.12062. eCollection 2022 Mar.
Chronic pain is estimated to impact one-in-three children with cerebral palsy (CP). Psychological interventions including behavioral and cognitive strategies play a key role in chronic pain management, but there is a paucity of research exploring their use in children with CP.
To investigate the acceptability and feasibility of biofeedback assisted relaxation training (BART) for chronic pain management in children with CP using a mixed-methods study design.
Biofeedback assisted relaxation training was delivered via BrightHearts, an iOS application. Inclusion criteria were as follows: CP; self-reported chronic pain; age 9-18 years; and fluent English speaker. Children used BrightHearts for ten minutes daily, over four weeks. Qualitative post-intervention interviews were undertaken (child, parent) and quantitative pre-post measures (child) were gathered including pain intensity (numerical rating scale), and anxiety intensity (numerical rating scale). Content analysis was conducted for qualitative data. Descriptive statistics and exploratory analyses were performed for quantitative data.
Ten children participated (n = 3 male, mean age = 13.1 years SD = 2.5 years, GMFCS level I = 4, II = 2, III = 3, IV = 1). Predominant movement disorder was spasticity (n = 7) and dyskinesia, mainly dystonia (n = 3). Content analysis suggested an overarching theme "BrightHearts is a good thing to put in my toolbox" providing an overall representation of participants' experiences. For many, BrightHearts was a valuable supplement to children's pain management strategies: "The source of the pain is still there, but the actual effect of the pain isn't so relevant." Four sub-themes were identified: "Managing my pain;" "Managing my anxiety and stress," "Helping me do what I need to do;" and "Fitting it into my life." Some participants reported improvements in their anxiety management, and others described benefits in sleep and school following improved pain/anxiety management. A range of practical and personal factors within this heterogeneous group presented barriers to using BrightHearts including limited time, attention, and boredom. Seven-out-of-eight children would recommend BrightHearts to others with chronic pain and six-out-of-eight noticed a difference in their pain since using BrightHearts (n = 2 missing data). Non-significant reductions in pain or anxiety intensity scores were found following the intervention.
This pilot suggests BrightHearts is an acceptable and feasible intervention for chronic pain management in children with CP and may be useful for some children as part of a multimodal approach.
据估计，慢性疼痛影响着三分之一的脑瘫（CP）儿童。包括行为和认知策略在内的心理干预在慢性疼痛管理中起着关键作用，但探索其在CP儿童中的应用的研究却很少。
采用混合方法研究设计，调查生物反馈辅助放松训练（BART）用于CP儿童慢性疼痛管理的可接受性和可行性。
通过一款iOS应用程序BrightHearts进行生物反馈辅助放松训练。纳入标准如下：CP；自我报告有慢性疼痛；年龄9至18岁；英语流利。儿童每天使用BrightHearts十分钟，持续四周。干预后进行了定性访谈（儿童、家长），并收集了定量的前后测数据（儿童），包括疼痛强度（数字评分量表）和焦虑强度（数字评分量表）。对定性数据进行了内容分析。对定量数据进行了描述性统计和探索性分析。
十名儿童参与（n = 3名男性，平均年龄 = 13.1岁，标准差 = 2.5岁，GMFCS水平I = 4名，II = 2名，III =
3名，IV = 1名）。主要的运动障碍是痉挛（n = 7）和运动障碍，主要是肌张力障碍（n = 3）。内容分析表明有一个总体主题“BrightHearts是一件可以放进我工具箱的好东西”，这全面反映了参与者的经历。对许多人来说，BrightHearts是儿童疼痛管理策略的宝贵补充：“疼痛的根源仍然存在，但疼痛的实际影响没那么重要了。”确定了四个子主题：“管理我的疼痛”；“管理我的焦虑和压力”，“帮助我做我需要做的事”；以及“融入我的生活”。一些参与者报告说他们在焦虑管理方面有改善，其他人描述了在疼痛/焦虑管理改善后在睡眠和学业方面的益处。这个异质性群体中的一系列实际和个人因素对使用BrightHearts构成了障碍，包括时间有限、注意力不集中和无聊。八分之七的儿童会向其他有慢性疼痛的人推荐BrightHearts，八分之六的儿童注意到自从使用BrightHearts后他们的疼痛有了变化（n = 2个缺失数据）。干预后疼痛或焦虑强度评分没有显著降低。
这项试点研究表明，BrightHearts是一种可接受且可行的CP儿童慢性疼痛管理干预措施，作为多模式方法的一部分，可能对一些儿童有用。
