A pilot implementation study of a chronic pain core outcome set and decision tree for children and young people with cerebral palsy.

Abstract

This study aimed to (i) develop a decision tree to guide clinicians to use a core outcome set (COS) of chronic pain assessment tools specific to children and young people with cerebral palsy and (ii) pilot test the implementation of the decision tree and core set in clinical practice. The study involved two stages. Stage one was the development of the decision tree using a focus group with clinicians. Stage two implemented the decision tree and COS in one rehabilitation service over three months. Evaluation involved an online survey with clinicians (physiotherapists, occupational therapists, nurses and doctors). The Capability, Opportunity, Motivation-Behaviour model was used to guide qualitative analysis of survey responses and identify barriers and enablers to use of the decision tree. Eight clinicians participated, completing 103 pain assessments on 82 children during the implementation period. All clinicians reported increased knowledge and confidence after using the decision tree (capability) and ease of access to assessment tools (opportunity) as primary enablers to assessing pain in the clinic. Lack of time for pain assessment was the most common barrier reported. The decision tree showed promise in assisting clinicians to include pain assessment in clinical care.