Functional outcomes of pediatric patients in Short-term Pediatric Rehabilitation Intensive Therapy (SPRINT) while receiving acute oncologic and hematologic care.

BACKGROUND: Pediatric patients with oncologic and hematologic diagnoses who experience newly acquired functional deficits during a hospitalization may benefit from intensive therapies. However, acute medical issues or disease treatment plans may prevent a safe transfer to the inpatient rehabilitation unit. Accordingly, Short-term Pediatric Rehabilitation Intensive Therapy (SPRINT), a 2-week inpatient intensive therapy program, was developed for pediatric patients on an acute care service. OBJECTIVE: To assess functional outcomes of SPRINT participants, adverse events associated with the program, and measures of patients' fatigue, sadness, nervousness, and pain by parents and patients at the start and end of SPRINT. DESIGN: Retrospective cohort study. SETTINGS: Hematology-Oncology and Bone Marrow Transplant units at regional pediatric tertiary care hospital. PARTICIPANTS: Eighteen pediatric patients (50% female, age 1.9-17.8 years) participated in SPRINT, and 11 parents and 4 children completed questionnaires. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes of SPRINT participants measured by Caregiver Assistance section of the Pediatric Evaluation of Disability Inventory (PEDI), adverse events identified on chart review, and inquiry of participants' symptoms before and after SPRINT with a questionnaire. RESULTS: Common diagnoses included leukemia and lymphoma (N = 9, 50%) and central nervous system tumor (N = 6, 33%). Deconditioning (N = 18, 100%) and peripheral neuropathy (N = 8, 44.4%) were common rehabilitation diagnoses. Significant gains were found in tasks in self-care and mobility domains of PEDI (all P < .05), as well as functional expression in social function domain (P = .03). No adverse events related to SPRINT participation were identified. There was no significant difference between pre- and post-SPRINT questionnaire responses. CONCLUSIONS: SPRINT is an alternative model for intensive rehabilitation care delivery. Data suggested that SPRINT participation was safe and resulted in significant gains in mobility, self-care, and functional expression for pediatric patients with hematologic and oncologic diagnoses while receiving acute care. No difference was found in questionnaire responses after SPRINT participation.

Expanding Application of the Long-Term Quality of Life Instrument to the Population of Women Undergoing Treatment of Advanced Breast Cancer.

BACKGROUND: The Long-Term Quality of Life (LTQL) instrument was designed for female cancer survivors who have completed treatment and includes an existential spirituality subscale that is omitted in many other quality of life scales. Women with advanced breast cancer are now living longer, while also expressing greater spiritual concerns. OBJECTIVE: The objective of this analysis was to test the psychometric properties of the LTQL among women undergoing treatment of advanced breast cancer. METHODS: This secondary analysis was based on a sample of 385 women. Validity was evaluated using a confirmatory factor analysis and associations with Functional Assessment of Cancer Therapy-Breast Cancer. Internal consistency reliability was assessed using Cronbach's α for each subscale of the LTQL. RESULTS: The mean age was 56 years, 84% of participants were white, and 69% had metastasis. Model fit indices for the confirmatory factor analysis were acceptable, with the root mean square error of approximation of 0.076 (90% confidence interval, 0.071-0.081) and a comparative fit index of 0.91. The LTQL subscale scores were significantly correlated with the subscales of the Functional Assessment of Cancer Therapy-Breast Cancer of similar conceptual content. Internal consistency reliability for the subscales ranged from 0.80 to 0.86. CONCLUSIONS: The factor structure of the LTQL was consistent with previous findings in long-term female cancer survivors. The instrument has adequate psychometric properties for use among women with advanced breast cancer. IMPLICATIONS FOR PRACTICE: The LTQL can be used to assess the physical, psychosocial, and existential spiritual domains of quality of life among women with advanced breast cancer as well as in long-term female cancer survivors.

Spasticity and pain in adults with cerebral palsy.

AIM: To evaluate whether spasticity measures are related to pain in adults with cerebral palsy (CP). METHOD: This cross-sectional study recruited individuals aged 16 to 89 years with a diagnosis of CP. Participants completed the Penn Spasm Frequency Scale (PSFS), Brief Pain Inventory (BPI), and PROMIS Pain Interference measures. The Modified Ashworth Scale (MAS) and Tardieu spasticity angles of six joints were rated and summed to composite MAS and Tardieu scores for each participant. Associations between spasticity and pain measures were evaluated. RESULTS: Forty-seven participants (27 females, 20 males) with a mean age of 35 years 7 months (range 18-77y) spanning all Gross Motor Function Classification System (GMFCS) levels were included. Twenty-six participants reported their average pain level on BPI as greater than 0 over the past week (median pain level 4.0). Median PSFS was 1.0 (range 0.0-1.0) and this correlated with average BPI and Pain Interference T scores (median 40.7; ρ=0.33 and ρ=0.31 respectively [both p=0.01]). When adjusted for pain medication use and age, MAS correlated with BPI (ρ=0.30; p=0.04). Other pain and spasticity measures, or GMFCS level, were not significantly related with pain interference or BPI rating. Age was weakly associated with BPI (slope=0.10; p<0.01). INTERPRETATION: PROMIS Pain Interference was lower than population-based norms. Patient-rated spasm frequency demonstrated better association with pain levels and interference than physician-rated MAS and Tardieu. WHAT THIS PAPER ADDS: Pain was not associated with Gross Motor Function Classification System level. Pain increased with age, as anticipated. Self-reported spasm scores were associated with increased pain in contrast to clinical examination scales. Adjusted, summed spasticity on the Modified Ashworth Scale was associated with pain scores on the Brief Pain Inventory. Although pain is experienced by adults with cerebral palsy, pain did not interfere with activities.

Spiritual Perspectives on Pain in Advanced Breast Cancer: A Scoping Review.

OBJECTIVES: The aim of the present review was to characterize how pain and spirituality have been conceptualized, assessed, and addressed and how these concepts may be related among women with advanced breast cancer. DESIGN: A scoping review was conducted including publications of various methodologies. DATA SOURCES: Searches were conducted in PubMed, CINAHL, PsycINFO, Cochrane Library, OpenGrey, OAIster, and a large university library database (published 2006-2018). REVIEW/ANALYSIS METHODS: Research questions and criteria were formulated at the outset, followed by identification of publications, charting data, and collating results. RESULTS: Forty-two publications met the inclusion criteria. Most (n = 33) focused exclusively on pain, five pain and spirituality, and four exclusively spirituality. Conceptual definitions were not explicitly provided but were implied. Most assessments used the 0-10 Numeric Rating Scale (pain) and qualitative methods (spirituality). Pain management primarily focused on radiotherapy and pharmaceuticals, and two publications identified spiritual interventions. No publications directly examined the impact of spirituality on pain. Findings of qualitative studies including both concepts suggest the potential value of spirituality as a mechanism to cope with pain. CONCLUSIONS: This review identified significant unmanaged pain in women with advanced breast cancer. Women identified dimensions of spirituality as important for coping with their disease. A gap in understanding spirituality and its potential influence on pain in this population was identified.