Age and Sex Differences in Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: A Scoping Review.

BACKGROUND: Age and sex differences may exist in the frequency (incidence, prevalence) or symptoms of neuropathic pain (NP) and complex regional pain syndrome (CRPS) due to biopsychosocial factors (eg, neurodevelopment, physiological and hormonal changes, psychosocial differences) that evolve through childhood and adolescence. Age and sex differences may have implications for evaluating screening and diagnostic tools and treatment interventions. OBJECTIVE: To map the existing literature on pediatric NP and CRPS with respect to age and sex distributions, and age and sex differences in symptomology and frequency. METHODS: A scoping literature review was conducted. Databases were searched from inception to January 2023. Data were collected on study design, setting, demographics, and age and sex differences in frequency and symptoms. RESULTS: Eighty-seven studies were included. Distribution of participants with CRPS (n=37 studies) was predominantly early adolescence (10 to 14 y) and female sex, while NP (n=42 studies) was most commonly reported throughout adolescence (10 to 19 y) in both sexes. Forty-one studies examined age and sex differences in frequency; 6 studies reported higher frequency in adolescence. Very few studies (n=11) examined differences in symptomology. DISCUSSION: Large epidemiological studies are required to further understand age and sex differences in frequency of pediatric NP and CRPS. Age and sex differences must be considered when evaluating screening and diagnostic tools and treatment interventions to ensure relevance and validity to both sexes and across ages. Validated tools will improve understanding of age-dependent and sex-dependent differences in symptoms, pathophysiology, and psychosocial impact of pediatric NP and CRPS.

Sensibility and measurement properties of the Tampa Scale of Kinesiophobia to measure fear of movement in children and adults in surgical settings.

Purpose: Fear of movement, or kinesiophobia, is a risk factor for developing chronic post-surgical pain (CPSP) and may impede recovery. Identifying people with kinesiophobia peri-operatively is potentially valuable to intervene to optimize rehabilitation and prevent CPSP. This narrative review aims to describe and critically appraise the sensibility and measurement properties of the Tampa Scale of Kinesiophobia (TSK) in the surgical setting in both pediatric and adult populations.Material and methods: PubMed was searched for relevant articles using search terms related to the TSK and measurement properties; the search was restricted to articles published in English. COSMIN guidelines were used to rate measurement property sufficiency and study quality.Results: Four articles examined the measurement properties of the TSK-17 in the surgical setting. Included studies demonstrated sufficient internal consistency, structural validity, construct validity, but insufficient predictive validity. Study quality was variable. Although the TSK was not originally intended for the surgical setting, with minor modification, it appears sensible to use in this population.Conclusions: The TSK is a sensible tool to measure fear of movement in children and adults undergoing, or who underwent, surgery. Future studies are needed to test content validity, test-retest reliability, measurement error, and responsiveness in the surgical setting.IMPLICATIONS FOR REHABILITATIONFear of movement is a predictor of developing chronic post-surgical pain in children and adults.Rehabilitation interventions can address fear of movement in hopes to optimize surgical outcomes and prevent chronic post-surgical pain.The Tampa Scale of Kinesiophobia (TSK), with minor modification, is a sensible tool to measure fear of movement in surgical settings.There is some evidence that the TSK is reliable and valid to use with older children, adolescents, and adults who are undergoing or underwent surgery.

Signs and symptoms of pediatric complex regional pain syndrome - type 1: A retrospective cohort study.

Background: Complex regional pain syndrome (CRPS) presents with an array of symptoms that can vary from child to child, making it difficult to diagnose and differentiate from other pain conditions such as chronic musculoskeletal (MSK) pain. Thirteen symptoms and signs are outlined in the Budapest criteria for CRPS (developed and validated for adults) but have not been well described in pediatrics. Aims: The aim of this study was to describe the signs and symptoms of pediatric CRPS type 1 (CRPS 1) and determine whether a cluster of symptoms can differentiate CRPS 1 from chronic MSK pain. Methods: A retrospective cohort study of pediatric patients with CRPS 1 and MSK pain in a pediatric pain program was conducted. Descriptive statistics were used to report demographics and pain characteristics. The chi-square test was used to evaluate differences in signs and symptoms between patients with CRPS and MSK pain. A logistic regression model was used to evaluate whether a cluster of symptoms could predict a diagnosis of CRPS 1. Results: The sample included 187 patients (99 with CRPS 1 and 88 with MSK pain); 81% were female with a mean age 14.1 years. The most prevalent CRPS symptoms were hyperalgesia (54%) and allodynia (52%). A cluster of symptoms (hyperalgesia, color changes, and range of motion) predicted the probability of a diagnosis of CRPS 1. Conclusions: A cluster of symptoms may be critical in differentiating pediatric CRPS 1 and MSK pain. Future research is needed to determine if this model is valid in external populations and to explore whether a similar model can differentiate CRPS 1 from other pain conditions (e.g., neuropathic pain).

Contexte: Le syndrome douloureux régional complexe présente un éventail de symptômes qui peuvent varier d'un enfant à l'autre, ce qui rend difficile le diagnostic et la différenciation des autres affections douloureuses telles que la douleur musculo-squelettique chronique. Treize symptômes et signes sont décrits dans les critères de Budapest pour le syndrome douloureux régional complexe (développés et validés pour les adultes) mais ceux-ci n'ont pas encore été bien décrits en pédiatrie.Objectifs: L'objectif de cette étude était de décrire les signes et symptômes du syndrome douloureux régional complexe pédiatrique de type 1 et de déterminer si un groupe de symptômes pouvait le différencier de la douleur musculo-squelettique chronique.Méthodes: Une étude de cohorte rétrospective de patients pédiatriques atteints de syndrome douloureux régional complexe de type 1 et de douleur musculo-squelettique chronique dans le cadre d'un programme de lutte contre la douleur pédiatrique a été mis en place. Des statistiques descriptives ont été utilisées pour rendre compte des données démographiques et des caractéristiques de la douleur. Le test du chi carré a été utilisé pour évaluer les différences dans les signes et les symptômes entre les patients souffrant de syndrome douloureux régional complexe et de douleur musculo-squelettique chronique. Un modèle de régression logistique a été utilisé pour évaluer si un groupe de symptômes pourrait prédire un diagnostic de syndrome douloureux régional complexe de type 1 en pédiatrie.Résultats: L'échantillon comprenait 187 patients pédiatriques (99 atteints de syndrome douloureux régional complexe de type 1 et 88 atteints de douleur musculo-squelettique chronique); 81 % étaient de sexe féminin, avec un âge moyen de 14,1 ans. Les symptômes de syndrome douloureux régional complexe de type 1 pédiatrique les plus fréquents étaient l'hyperalgésie (54 %) et l'allodynie (52 %). Un groupe de symptômes (hyperalgésie, changements de couleur et amplitude de mouvement) prédisait la probabilité d'un diagnostic de syndrome douloureux régional complexe d type 1 pédiatrique.Conclusions: Un groupe de symptômes peut être essentiel pour différencier le syndrome douloureux régional complexe de type 1 pédiatrique de la douleur musculo-squelettique chronique. D'autres études sont nécessaires pour déterminer si ce modèle est valide parmi les populations externes et pour déterminer si un modèle similaire peut différencier le syndrome douloureux régional complexe de type 1 pédiatrique d'autres conditions douloureuses (p. ex., la douleur neuropathique).

Virtual multidisciplinary pain treatment: Experiences and feedback from children with chronic pain and their caregivers.

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) necessitated a rapid transition to virtual care for chronic pain treatment. OBJECTIVE: This study examined experiences of patients and caregivers who received virtual multidisciplinary pain treatment (MDT) for pediatric chronic pain between March 2020 and August 2021. METHODS: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Satisfaction surveys were administered to a convenience sample of patients (aged 8 to 18; N = 20) and their caregivers (N = 20) who received MDT through an outpatient hospital pediatric chronic pain program. Interviews were conducted with a subset of these patients and their caregivers (n = 6). RESULTS: Analysis of interviews revealed four themes: 1) benefits of virtual care; 2) challenges of virtual care; 3) recommendations and evaluation of virtual care; and 4) patient preferences. Analysis of the satisfaction survey data revealed that while patients and caregivers were satisfied with many aspects of virtual care, 65% (n = 13) of patients reported a preference for in-person appointments, with caregivers showing equal preference for in-person and virtual appointments, though this was a non-significant difference (p = .37). Overall, both patients and caregivers stated a stronger preference for in-person physiotherapy sessions but were willing to have psychology sessions provided virtually. Finally, the most reported preference was for a hybrid model of care incorporating at least some in-person contact with providers. CONCLUSION: This study provides a rich exploration of virtual care for multidisciplinary pediatric chronic pain treatment. The current results may inform the future development of guidelines for virtual care delivery with pediatric chronic pain populations.

Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?

Introduction: Neuropathic pain (NP) arises from nerve damage or disease, and when not defined, it can impair function and quality of life. Early detection allows for interventions that can enhance outcomes. Diagnosis of NP can be difficult if not properly evaluated. PainDETECT is a NP screening tool developed and successfully used in adults. Objectives: We evaluated the validity of painDETECT in a pediatric population. Methods: Adolescents and young adults (10-19 years old) completed painDETECT and quantitative sensory testing (QST), which assessed mechanical allodynia and hyperalgesia, common symptoms of NP. Pain diagnoses, including neuropathic pain (n = 10), were collected through documentation in the medical chart. Descriptive statistics were used to examine age, gender, pain diagnoses, and painDETECT scores. Kruskal-Wallis H tests were conducted to examine differences in QST results across painDETECT categorizations. Results: Youth with chronic pain (N = 110, Mage = 15.08 ± 2.4 years, Nfemale = 88) and peers without pain (N = 55, Mage = 15.84 ± 3.9 years, Nfemale = 39) completed the painDETECT. The painDETECT scores for youth with pain (M = 12.7 ± 6.76) were significantly higher than those for peers without pain (M = 2.05 ± 2.41). PainDETECT demonstrated 80% sensitivity and 33% specificity in a pediatric population. Individuals who screened positively on the PainDETECT had significantly higher mechanical allodynia (M = 0.640 ± 0.994) compared with those who screened negatively (M = 0.186 ± 0.499; P = 0.016). Conclusion: PainDETECT demonstrated the ability to screen for NP, and QST mechanical allodynia results were consistent with a positive NP screen. Results of the study offer preliminary support for the ongoing assessment of the painDETECT as a brief, inexpensive, and simple-to-use screening tool for pediatric patients with primary pain complaints.

"Working Together": Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic.

BACKGROUND: The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. METHODS: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample of healthcare professionals (HCPs; n = 6) who had provided multidisciplinary treatment (MDT) through an outpatient hospital pediatric chronic pain program. Satisfaction surveys were distributed to all MDT professionals employed by the clinic in April 2021 (n = 13 of 20 eligible; 65% response rate). Participants represented medicine, rehabilitation, and mental health professionals. RESULTS: Analysis of interviews generated five themes: (1) adaptation to virtual care, (2) benefits of virtual care, (3) limitations of virtual care, (4) shifting stance on virtual care over time, and (5) considerations for implementing virtual care. The satisfaction survey data revealed that respondents were able to effectively provide appropriate diagnoses, recommendations, and/or care plans for pediatric chronic pain via virtual care (n = 12, 92.3%). Detailed survey responses are presented by discipline. CONCLUSIONS: This study provides a rich exploration of HCPs' experiences in providing MDT for pediatric chronic pain within a virtual care model. The current results may contribute to the future development of guidelines for virtual care delivery with pediatric chronic pain populations.

Canadian surveillance study of complex regional pain syndrome in children.

ABSTRACT: This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program reported new cases of CRPS aged 2 to 18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed, and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment because of pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines.

State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients.

Purpose of Review: This review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology's (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics. Recent Findings: Researchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the use of augmented reality for preoperative anxiety. Most studies showed that virtual reality intervention is effective and safe for perioperative anxiety, acute, and chronic pain. However, the studies are heterogeneous with relatively small sample sizes. Summary: This review shows that more high-quality studies (i.e., randomized controlled trials with larger sample sizes and standardized methods for measuring and reporting outcomes) are needed to examine the effectiveness and adverse effects of virtual reality intervention on perioperative anxiety, acute, and chronic pain in pediatrics.

Screening and diagnostic tools for complex regional pain syndrome: a systematic review.

ABSTRACT: Complex regional pain syndrome (CRPS) is a severely painful condition that presents with a constellation of symptoms. The understanding of the pathophysiology of CRPS has evolved over time, as have the diagnostic criteria. Our primary objective was to identify screening and diagnostic tools for CRPS and summarize their feasibility, measurement properties, and study quality. A secondary objective was to identify screening and diagnostic tools used for CRPS in pediatric populations (0-21 years of age). A systematic review of English articles in electronic databases (PsycINFO, MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science) was conducted with the aid of a librarian in November 2018 and updated in July 2020. Studies were included if the tool was a screening or diagnostic tool, the tool included self-report or physical examination, and the primary objective of the study was to evaluate the measurement properties or feasibility of use. For each study, data were extracted for quality indicators using the QUADAS-2 tool. No screening tools were identified. Four diagnostic tools were identified: the Veldman criteria, International Association for the Study of Pain criteria, Budapest Criteria, and Budapest Research Criteria. There are no diagnostic tools validated for use in pediatric CRPS. Because there are no extant screening tools for CRPS, all people with suspected disease should undergo rapid diagnostic assessment by a clinician. For adults, the Budapest Criteria are the preferred diagnostic tool. Future research is recommended to develop a diagnostic tool for pediatric populations and screening tools for both pediatric and adults.

Exploring physiotherapy practice within hospital-based interprofessional chronic pain clinics in Ontario.

Background: Chronic pain affects one in five persons and is a leading contributor to years lived with disability and high health care costs. In 2016, the government of Ontario increased public funding for pediatric and adult hospital-based interprofessional chronic pain clinics (HICPCs) in Ontario, Canada, expanding the role of physiotherapy in chronic pain management in the province. This role has yet to be described in the literature. Aim: The aim of this study was to explore physiotherapy practice within HICPCs in Ontario. Methods: We conducted an interpretive description qualitative study based on semistructured interviews with physiotherapists employed in pediatric and adult HICPCs in Ontario. Interviews were audio recorded, transcribed verbatim, and reviewed for accuracy. We analyzed interview data using thematic analysis. Results: Ten physiotherapists who practiced in pediatric and adult HICPCs (n = 4 pediatric; n = 6 adult) in Ontario were interviewed between February and April 2020. We constructed five themes related to physiotherapy practice in this setting. Themes included (1) contributing a functional lens to care; (2) empowering through pain education; (3) facilitating participation in physical activity and exercise; (4) supporting engagement in self-management strategies; and (5) implementing a collaborative approach to whole-person care. Conclusions: Our results illuminate how physiotherapy practice within HICPCs in Ontario focuses on providing a collaborative and whole-person approach to care, with an emphasis on supporting patients to increase their functional capacity by promoting engagement in active chronic pain management strategies.

Contexte: La douleur chronique touche une personne sur cinq et est l'un des principaux contributeurs au nombre d'années vécues avec un handicap, ainsi qu'aux coûts de soins de santé élevés. En 2016, le gouvernement de l'Ontario a augmenté le financement public des cliniques interprofessionnelles de la douleur chronique (HICPC) pédiatriques et pour adultes en milieu hospitalier en Ontario, Canada, élargissant le rôle de la physiothérapie dans la prise en charge de la douleur chronique dans la province. Ce rôle n'a pas encore été décrit dans la littérature.Objectif: Le but de cette étude est d'examiner la pratique de la physiothérapie au sein des HICPC en Ontario.Méthodes: Nous avons mené une étude qualitative descriptive interprétative fondée sur des entrevues avec des physiothérapeutes employés dans des HICPC pédiatriques et pour adultes en Ontario. Les entrevues ont fait l'objet d'un enregistrement audio, puis elles ont été transcrites textuellement et vérifiées pour assurer leur exactitude. Nous avons analysé les données des entrevues en ayant recours à une analyse thématique.Résultats: Dix physiothérapeutes qui ont exercé dans des HICPC pédiatriques et pour adultes (n = 4 pédiatriques; n = 6 pour adultes) en Ontario ont été interviewés entre février et avril 2020. Nous avons construit cinq thèmes liés à la pratique de la physiothérapie dans ce contexte. Les thèmes comprenaient (1) l'apport de l'angle fonctionnel aux soins; (2) l'autonomisation grâce à l'éducation sur la douleur; (3) faciliter la participation à une activité physique et à l'exercice; (4) soutenir l'engagement dans des stratégies d'autogestion; et (5) la mise en œuvre d'une approche collaborative des soins à la personne globale.Conclusions: Nos résultats illustrent la façon dont la pratique de la physiothérapie au sein des HICPC en Ontario se concentre sur une approche de soins collaborative et globale, qui met l'accent sur le soutien aux patients pour augmenter leur capacité fonctionnelle en favorisant l'engagement dans les stratégies actives de prise en charge de la douleur chronique.

Development of a Screening Tool for Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: Pediatric PainSCAN.

OBJECTIVE: Neuropathic pain (NP) and complex regional pain syndrome (CRPS) in children can result in significant disability and emotional distress. Early assessment and treatment could potentially improve pain, function, quality of life, and reduce costs to the health care system. Currently, there are no screening tools for pediatric NP and CRPS. This research aimed to develop and establish the content validity of a screening tool for pediatric NP and CRPS using a phased approach. MATERIALS AND METHODS: Phase I surveyed clinical experts using a modified Delphi procedure to elicit disease concepts for inclusion. In phase II, a consensus conference including clinicians, researchers, and people with lived experience, informed the initial item pool. Consensus for item inclusion was achieved using a nominal group technique for voting. Phase III used iterative rounds of cognitive interviews with children aged 8 to 18 years with CRPS or NP to evaluate the tool's comprehensiveness and individual item relevance and comprehensibility. Descriptive statistics were used to describe participant characteristics. Content analysis was used to analyze patient interviews. RESULTS: Phase I (n=50) generated an initial item pool (22 items). Phase II generated a comprehensive item pool (50 items), after which an initial version of the screening tool was drafted. Following phase III (n=26) after item revision and elimination, 37 items remained. DISCUSSION: The Pediatric PainSCAN is a novel screening tool that has undergone rigorous development and content validity testing. Further research is needed to conduct item reduction, determine scoring, and test additional measurement properties.

Rapid mobilization of a virtual pediatric chronic pain clinic in Canada during the COVID-19 pandemic.

BACKGROUND: Studies have been conducted describing the potential for using virtual care software during disasters and public health emergencies. However, limited data exist on ways in which the Canadian health care system utilizes virtual care during disasters or public health emergencies. AIMS: Due to the need for social distancing and reduction of nonessential ambulatory services during the COVID-19 pandemic, the SickKids Chronic Pain Clinic sought to transition care delivery from in person to virtual. The virtual clinic aimed to reduce risks associated with physical contact and environmental exposure without reducing access to care itself. METHODS: Harnessing of various digital tools including Ontario Telemedicine Network Guestlink, Zoom, and Microsoft Teams. The Chronic Pain Clinic Team worked together to communicate with patients and families, schedule virtual visits, establish remote access to clinical data collection tools, digitize the after-visit summary, and add resources on pain self-management to the clinic's website. RESULTS: The Chronic Pain Clinic successfully transitioned all clinic appointments (multidisciplinary and individual; 77 appointments) over a 2-week period to virtual care. Virtual clinics did not surpass the usual time taken pre-COVID-19, suggesting that the clinic workflow was readily adaptable to virtual care. CONCLUSIONS: Access to quality virtual care is essential to prevent chronic pain from taking a toll on the lives of patients and families. Rapid establishment of a virtual clinic without gaps in service delivery to patients is possible given institutional support and a team culture centered around collaboration and flexibility.

Contexte: Des études ont été menées pour décrire le potentiel d'utilisation des logiciels de soins virtuels lors de catastrophes et d'urgences de santé publique. Toutefois, il existe peu de données sur les moyens par lesquels le systéme de soins de santé canadien utilise les soins virtuels lors de catastrophes ou d'urgences de santé publique.But: En raison de la nécessité d'une distanciation sociale et de la réduction des services ambulatoires non essentiels pendant la pandémie de COVID-19, la clinique de douleur chronique de SickKids a cherché à assurer une transition de la prestation des soins en personne vers des soins virtuels. La clinique virtuelle visait à réduire les risques liés au contact physique et à l'exposition environnementale sans réduire l'accès aux soins en tant que tels.Méthodes: Exploitation de divers outils numériques, dont le Réseau de télémédecine de l'Ontario Guestlink, Zoom et Microsoft Teams. L'équipe de la Clinique de la douleur chronique a travaillé ensemble pour communiquer avec les patients et les familles, programmer des visites virtuelles, établir un accès à distance aux outils de collecte de données cliniques, numériser le résumé après la visite et ajouter des ressources sur l'auto-prise en charge de la douleur sur le site web de la clinique.Résultats: La Clinique de la douleur chronique a réussi à faire passer tous les rendez-vous de la clinique (multidisciplinaires et individuels; 77 rendez-vous) sur une période de deux semaines à des soins virtuels. Les cliniques virtuelles n'ont pas dépassé le temps habituel avant la COVID-19, ce qui indique que le flux de travail de la clinique était facilement adaptable aux soins virtuels.Conclusions: L'accès à des soins virtuels de qualité est essentiel pour éviter que la douleur chronique ne fasse des ravages dans la vie des patients et des familles. L'établissement rapide déune clinique virtuelle sans interruption dans la prestation des services aux patients est possible grâce à un soutien institutionnel et à une culture d'èquipe centrèe sur la collaboration et la souplesse.

Evidence-Based Practice: Physiotherapy for Children and Adolescents with Motor Symptoms of Conversion Disorder.

Clinical Case: A boy aged 14 years with conversion disorder who presented with an ataxic gait pattern experienced complete symptom resolution after engaging in physiotherapy (PT) as part of interdisciplinary treatment. Clinical Question: Is there evidence to support the use of PT in children and adolescents with motor symptoms of conversion disorder? Evidence: All the extant paediatric literature consists of case studies and case series. Some exciting research has been published in the adult literature that suggests the potential positive benefits of PT. Limitation of the Evidence and Future Research: The paediatric literature is limited in quantity and quality. In the adult literature, most studies are limited in that they do not control for the type of motor symptoms and do not evaluate PT independent of interdisciplinary treatment. In future research, it would be pertinent to (1) evaluate PT independent of interdisciplinary treatment, (2) control for the type of motor symptoms, and (3) describe theoretical models. Recommendation for Clinical Question: Expert consensus and emerging evidence suggest that PT may be beneficial in adults with conversion disorder, but the evidence in the paediatric population is insufficient.

Cas clinique : un garçon de 14 ans ayant un trouble de conversion qui a consulté à cause d'une démarche ataxique, a présenté une résolution totale de ses symptômes après avoir intégré la physiothérapie à son traitement interdisciplinaire. Question clinique : des données probantes appuient-elles le recours à la physiothérapie chez les enfants et les adolescents ayant des symptômes moteurs de troubles de conversion? Données probantes : en pédiatrie, toutes les publications sur le sujet sont des études et des séries de cas. Des recherches intéressantes parues dans des publications sur les adultes laissent croire aux bienfaits de la physiothérapie. Limites des données probantes et futures recherches : la quantité et la qualité des publications en pédiatrie sont limitées. Dans les publications sur les adultes, la plupart des études sont limitées parce qu'elles ne contrôlent pas le type de symptômes moteurs ni n'évaluent la physiothérapie indépendamment du traitement interdisciplinaire. Lors de futures recherches, il serait pertinent de 1) évaluer la physiothérapie de manière indépendante du traitement interdisciplinaire, 2) contrôler le type de symptômes moteurs et 3) décrire les modèles théoriques. Recommandation de la question clinique : selon le consensus d'experts et des données probantes émergentes, la physiothérapie peut être bénéfique chez des adultes présentant un trouble de conversion, mais les données probantes sont insuffisantes pour tirer la même conclusion dans la population pédiatrique.

Clinical Features of Pediatric Complex Regional Pain Syndrome: A 5-Year Retrospective Chart Review.

OBJECTIVES: Complex regional pain syndrome (CRPS) is a painful condition of a limb characterized by a constellation of symptoms. Little is known about the clinical features of pediatric CRPS, with fewer than a dozen studies published to date. The aim of this study was to explore the clinical course of pediatric CRPS, with emphasis on clinical features and disease outcomes. A secondary aim was to discern differences in clinical features of pediatric CRPS with and without related movement disorders, and between children who had a favorable and unfavorable outcome. MATERIALS AND METHODS: We carried out a retrospective chart review of children with CRPS who presented to a pediatric Chronic Pain Clinic in Canada over a 5-year period (2012 to 2016). RESULTS: The study identified 59 children with CRPS (mean age: 12.7±2.5; 74.6% female; 72.9% lower extremity). In total, 87% (n=48) of children experienced complete resolution or significant improvement of CRPS, with a relapse rate of 15%. Overall, 25% (n=15) had a CRPS-related movement disorder. There were no differences in the clinical features of pediatric CRPS with or without related movement disorders. Children who experienced a favorable outcome had a significantly shorter symptom duration at the initial visit in comparison with children who experienced an unfavorable outcome. DISCUSSION: In this cohort, pediatric CRPS was most common in girls around the age of 12, usually in the lower extremity, and most experienced a favorable outcome. Further research is needed to better understand the prognosis and relapse rate of pediatric CRPS.

Enhanced Patient-Centred Care: Physiotherapists' Perspectives on the Impact of International Clinical Internships on Canadian Practice.

PURPOSE: To explore the perspectives of physiotherapists who participated in an international clinical internship (ICI) in low- or middle-income countries (LMICs) during their physiotherapy (PT) training in a Canadian PT programme regarding the ICI's impact on their PT practice in Canada. METHODS: This qualitative descriptive study used in-depth semi-structured interviews. Data were organized using NVivo; inductive and deductive coding were used to analyze data and develop broader themes. RESULTS: The 13 practising Canadian physiotherapists interviewed described three enhanced capacities: (1) critical reflection on culture, values and practice; (2) communication skills; and (3) creativity and resourcefulness. These capacities were perceived to transfer to Canadian practice by enhancing participants' ability to deliver patient-centred care, specifically through an enhanced understanding of patients' values and social determinants of health, regardless of the Canadian setting or patient population. CONCLUSIONS: For PT students considering an ICI, the study findings provide insight into the perceived impact of ICIs on Canadian practice. For PT academic programmes, the findings can guide decisions on the extent of investment in ICIs as learning opportunities that will enhance practice in Canada.

Objectif : Explorer les perspectives des physiothérapeutes ayant participé à un stage clinique à l'étranger dans un pays à revenu faible ou intermédiaire dans le cadre de leur formation en physiothérapie dans un programme d'études canadien afin d'évaluer l'incidence de ce stage sur leur pratique de la physiothérapie au Canada. Méthodes : Cette étude descriptive qualitative s'est faite à partir d'entrevues semi-structurées détaillées. Les données ont été organisées au moyen de Nvivo, tandis qu'un codage inductif et déductif a été utilisé pour analyser les données et élargir les thèmes. Résultats : Les 13 physiothérapeutes exerçant au Canada qui ont été interviewés ont décrit trois compétences renforcées par leur stage: (1) la réflexion critique sur la culture, les valeurs et la pratique; (2) les aptitudes à communiquer et (3) la créativité et la débrouillardise. Il semble que ces compétences se seraient transférées dans la pratique canadienne en améliorant la capacité des participants à offrir des soins axés sur le client, plus précisément grâce à une meilleure compréhension des valeurs et des déterminants sociaux de la santé des clients, quelle que soit la région du Canada ou la clientèle. Conclusions : Pour les étudiants en physiothérapie qui envisagent un stage clinique à l'étranger, les conclusions de l'étude montrent l'incidence que pourrait avoir un tel stage sur la pratique canadienne. Pour les programmes universitaires de physiothérapie, les conclusions de l'étude peuvent orienter les décisions quant à l'ampleur des investissements dans les stages cliniques à l'étranger en tant qu'occasions d'apprentissage destinées à améliorer la pratique au Canada.