Multi-center improvement in screening for pain that affects activities in adults with cerebral palsy
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Purpose
Increase screening for pain in adults with cerebral palsy (CP) across three centers and examine factors associated with pain that affect activities.
Materials and Methods
Using the quality improvement (QI) infrastructure of the Cerebral Palsy Research Network (CPRN), we implemented interventions to improve screening at clinic visits for pain that affects activities for adults with CP. Three physicians from two CPRN centers performed interventions August 2021- June 2023 before spreading to a fourth physician at a third CPRN center October 2022. To track progress, we collected visit data cross sectionally every two weeks. Descriptive statistics, analysis of variance, and logistic regression evaluated relationships in a sample cohort of all visits after screening practices had been established.
Results
Screening improved from 42% at baseline to over 90%. After three months of sustained screening, we assessed 423 unique visits. Pain was reported at 185/423 (44%) of the visits. Of the 185 with pain reported, 100 (54%) reported pain that affected activities. Increasing age, female gender, and motor function were associated with pain (p<.001) and pain that affects activities (p<.01). Females reported pain 3.4 and pain that affects activity 2.2 times more than males.
Conclusion
QI methodology was successful at improving screening for pain that affects activities in adults with CP at clinic visits. Lower rates of pain were found (44%) than previous reports, with similar findings about pain affecting activities and associated characteristics. We propose continued screening with improvement in differentiating proxy vs self-report and including other domains of pain important to guide care such as location and chronicity.
