Validation of the scale on Satisfaction of Adolescents with Postoperative pain management - idiopathic Scoliosis (SAP-S)

What's New in Pain Management for Pediatric Orthopaedic Surgery

BACKGROUND

Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery.

METHODS

An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery. Search results were filtered by publication date for articles published between January 1, 2015 and December 1, 2020 and yielded 404 papers.

RESULTS

A total of 32 papers were selected for review based upon new findings and significant contributions in the following categories: risk factors for increased opioid usage, opioid overprescribing and disposal, nonpharmacologic interventions, nonsteroidal anti-inflammatory drugs, peripheral nerve blocks, spine surgery specific considerations, surgical pathway modifications, and future directions.

CONCLUSIONS

There have been many advances in pain management for pediatric patients following orthopaedic surgery. Rapid recovery surgical care pathways are associated with shorter length of stay and improved pain control in pediatric spine surgery. Opioid overprescribing continues to be common and information regarding safe opioid disposal practices should be routinely provided for pediatric patients undergoing surgery.

LEVEL OF EVIDENCE

Level IV-literature review.

Reliability and Validity of the Adapted Chinese Version of the Satisfaction of Adolescents with Postoperative Pain Management - Idiopathic Scoliosis (SAP-S) Scale

Study Design

A prospective study.

Objective

The aim of this study was to evaluate the internal reliability and structure validity of an adapted simplified Chinese version of the Satisfaction of Adolescents with Postoperative pain management – idiopathic Scoliosis (SAP-S) scale in mainland China.

Summary of Background Data

Pain management is a major issue for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusions. There is a lack of valid scales for evaluating patients’ satisfaction with postoperative pain management. The SAP-S was proven to be a valid and reliable measure in English and French.

Methods

The SAP-S was translated into Chinese according to the internationally recognized guidelines. A total of 95 AIS patients undergoing posterior fusion surgery completed the CSAP-S, along with other self-reported questionnaires, including the 36-Item Short Form Health Survey (SF-36) and Scoliosis Research Society-22 (SRS-22) questionnaires. The internal consistency, test–retest reliability, and construct validity of the CSAP-S were determined.

Results

The SAP-S was successfully translated into Chinese. All patients completed the CSAP-S twice and the other instruments. The CSAP-S had good internal consistency and test–retest reliability with Cronbach’s alpha coefficient measuring 0.895 and intraclass correlation coefficient (ICC) measuring 0.97. Elimination of any one item did not result in a value of Cronbach’s alpha of <0.80. A good construct validity was shown by good correlation with bodily pain (r=0.883, p=0.004) and social functioning (r=0.786, p=0.002) domains of SF-36 and pain (r=0.752, p=0.001) and satisfaction with management (r=0.746, p=0.005) domains of SRS-22.

Conclusion

The CSAP-S demonstrated good internal consistency, reliability, and construct validity, and may be used for the evaluation of AIS patients’ satisfaction with postoperative pain management in mainland China.

The Experience of Pain and Pain Tool Preferences of Hospitalized Youth

BACKGROUND

An accurate holistic pediatric pain assessment is necessary for quality pain management. Evidence continues to be published indicating inadequacies in pediatric pain management. It is important for clinicians to consider the pain assessment process while caring for youth.

AIM

The purpose of this study was to understand the pain experience through focused interviews and to explore how youth use, interpret and understand self-report pain assessment tools including their tool preferences.

DESIGN

A qualitative descriptive study using a research developed semi-structured interview guide was conducted with 40 hospitalized youth, 10-17 years (M: 13yr; S.D. 2.4); 21 (52.5%) female on a medical inpatient unit. Interview questions focused on: current pain experience; pain related symptoms; evaluation of pain treatment and preferences for select pain assessment tools: 0-10 Numeric Rating Scale, The Oucher, Faces Pain Scale-Revised, and Adolescent Pediatric Pain Tool (APPT).

SETTING

Large tertiary and quaternary care pediatric hospital located in northeastern United States.

PARTICIPANTS/SUBJECTS

Hospitalized youth, 10-17 years of age.

RESULTS

Analysis of transcribed interviews yielded 3 themes: My Pain Now, Pain Treatment Expectations, and Telling Healthcare Providers about My Pain. Additionally, pain tools preference, assessment frequency, and discussion of how behavior, activity level, and pain expression was different for each youth. APPT was the preferred pain assessment tool. Descriptive words such as sharp, throbbing, and aching were identified most often. Youth identified that activity and pain level often do not match.

CONCLUSIONS

Because pain is multi-dimensional, assessing each dimension (quality, location, intensity, and meaning) is key to thorough assessment. Results provide insight into youth preferences influencing clinical practice such as offering options for interventions and having a voice in the pain management process. All nurses caring for children should discuss available pain tools preferably before the child is in pain and assure the child knows how to use the tool.

Child and parent pain catastrophizing and pain from presurgery to 6 weeks postsurgery: examination of cross-sectional and longitudinal actor-partner effects

Child and parent pain catastrophizing are reported preoperative risk factors for children's acute and persistent postsurgical pain. This study examined dyadic relations between child and parent pain catastrophizing and child and parent ratings of child pain prior to (M = 4.01 days; "baseline") and following surgery (M = 6.5 weeks; "acute follow-up"), as well changes in pain catastrophizing during this time in 167 youth (86% female; Mage = 14.55 years) undergoing spinal fusion surgery and 1 parent (89% mothers). Actor-partner interdependence models assessed cross-sectional and longitudinal intra- and interpersonal effects. Cross-sectionally, child pain catastrophizing was positively associated with child pain at baseline and acute follow-up (actor effects: βbaseline = 0.288 and βfollow-up = 0.262; P < 0.01), and parents' ratings of child pain at baseline (partner effect: βbaseline = 0.212; P < 0.01). Parent pain catastrophizing was not cross-sectionally associated with ratings of child pain. Longitudinally, higher pain catastrophizing at baseline predicted higher pain catastrophizing at acute follow-up for children (actor effect: β = 0.337; P < 0.01) and parents (actor effect: β = 0.579; P < 0.01) with a significantly smaller effect for children (respondent × actor interaction: β = 0.121; P < 0.05). No longitudinal partner effects for catastrophizing were observed. Baseline child and parent pain catastrophizing did not predict child pain at acute follow-up. In conclusion, child, not parent, pain catastrophizing was associated with children's pre- and postsurgical pain, and showed significantly less stability over time. There is a need to better understand contributors to the stability or changeability of pain catastrophizing, the prospective relation of catastrophizing to pain, and contexts in which child vs parent pain catastrophizing is most influential for pediatric postsurgical pain.

Développement et validation de la version canadienne-française de l’échelle de Satisfaction des Adolescents de la gestion de la Douleur postopératoire – Scoliose idiopathique (SAD-S)

Background: Spinal fusion for scoliosis generates moderate to severe pain intensity. There are currently no instruments available to measure adolescents’ satisfaction regarding post-spinal fusion pain management.

Aims: To develop and validate a scale on satisfaction of adolescents regarding pain management following spinal fusion for scoliosis.

Methods: A methodological design was used to develop and validate the French-Canadian scale “Satisfaction des Adolescents de la gestion de la Douleur postopératoire – Scoliose idiopathique (SAD-S)”. A modified Delphi method, with seven healthcare professionals and 10 adolescents, was used to establish content validity of the SAD-S. A pre-test of the scale was conducted with 10 adolescents post-spinal fusion. The final version of the scale was validated through a pilot study with 98 adolescents following their surgery.

Results: The SAD-S scale includes a total of 13 items. Principal component analysis yielded a two-factor structure (2 subscales): 1) Pain management education and 2) Education regarding medication. These two factors explained 47,8% of the total variance for satisfaction. A Cronbach’s alpha of 0,84 was obtained for internal consistency.

Conclusion: Validation of the SAD-S scale showed that it has good psychometric properties with this population. Further validation is required with a larger sample to pursue its validation.