"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.

The process of integrating psychology into medical clinics: Pediatric psychology as an example.

The integration of psychological services in medical settings has numerous benefits but a process for systematic integration and system wide evaluation is needed. A process model was created and evaluated for integrating services in 32 outpatient subspecialty clinics. Levels of satisfaction in caregivers (n = 98), physicians (n = 27), and non-physicians (n = 45) were assessed. Most caregivers rated psychology services at the highest level of satisfaction (85%) and would recommend these services to others (100%). Teammates indicated that services should continue in their clinic (85% non-physician; 96% physician) and have improved patient care (71% non-physician; 81% physician). These findings demonstrate positive outcomes associated with the process model and support its utility in integrating psychology services across a health system.

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.