Robyn Lewis Claar

Functional assessment of pediatric pain patients: Psychometric properties of the Functional Disability Inventory

Abstract The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39–58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. This study evaluated the psychometric properties of the FDI in pediatric pain patients. Participants included 596 patients with chronic abdominal pain, ages 8–17, and a subset of their parents (n = 151) who completed the FDI and measures of pain, limitations in school activities, and somatic and depressive symptoms at a clinic visit. Test–retest reliability was high at 2 weeks (child report, .74; parent‐report, .64) and moderate at 3 months (child report, .48; parent report, .39). Internal consistency reliability was excellent, ranging from .86 to .91. Validity was supported by significant correlations of child‐ and parent‐report FDI scores with measures of school‐related disability, pain, and somatic symptoms. Study results add to a growing body of empirical literature supporting the reliability and validity of the FDI for functional assessment of pediatric patients with chronic pain.

The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain.

Prior investigations of the relation between stressors and symptoms in children with recurrent abdominal pain (RAP) have focused on major negative life events. This study used consecutive daily telephone interviews to assess daily stressors and symptoms in 154 pediatric patients with RAP and 109 well children. Results showed that patients with RAP reported more frequent daily stressors than well children reported both at home and at school. Idiographic (within-subject) analyses indicated that the association between daily stressors and somatic symptoms was significantly stronger for patients with RAP than for well children. In contrast, the relation between daily stressors and negative affect did not differ between the groups. The relation between daily stressors and somatic symptoms was stronger for patients with RAP who had higher levels of trait negative affectivity.

Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain.

&NA; The Functional Disability Inventory (FDI) is a well‐established and commonly used measure of physical functioning and disability in youth with chronic pain. Further validation of the measure has been called for, in particular, examination of the clinical utility and factor structure of the measure. To address this need, we utilized a large multicenter dataset of pediatric patients with chronic pain who had completed the FDI and other measures assessing pain and emotional functioning. Clinical reference points to allow for interpretation of raw scores were developed to enhance clinical utility of the measure, and exploratory factor analysis was performed to examine its factor structure. Participants included 1300 youth ages 8 to 18 years (mean = 14.2 years; 76% female) with chronic pain. Examination of the distribution of FDI scores and validation with measures of depressive symptoms and pain intensity yielded 3 distinct categories of disability: No/Minimal Disability, Moderate Disability, and Severe Disability. Factor analysis of FDI scores revealed a 2‐factor solution representing vigorous Physical Activities and non‐physically strenuous Daily Activities. The 3‐level classification system and factor structure were further explored via comparison across the 4 most commonly encountered pain conditions in clinical settings (head, back, abdominal, and widespread pain). Our findings provide important new information regarding the clinical utility and validity of the FDI. This will greatly enhance the interpretability of scores for research and clinical use in a wide range of pediatric pain conditions. In particular, these findings will facilitate use of the FDI as an outcome measure in future clinical trials. Clinical reference points and a preliminary factor structure for the Functional Disability Inventory (FDI) increase the clinical and research utility of the measure.

Testing a Model of Pain Appraisal and Coping in Children With Chronic Abdominal Pain.

This prospective study of children with recurrent abdominal pain (N=133; ages 8--15 years) used path analysis to examine relations among dispositional pain beliefs and coping styles, cognitions and behavior related to a specific pain episode, and short- and long-term outcomes. Children believing they could not reduce or accept pain appraised their episode-specific coping ability as low and reported passive coping behavior. Dispositional passive coping had direct effects on both episode-specific passive coping and long-term symptoms and disability. Accommodative coping (acceptance and self-encouragement) was associated with reduced episode-specific distress, which itself predicted reduced depressive symptoms 3 months later. Results suggest that coping-skill interventions for children with chronic pain should target reductions in passive coping and consider the potential benefits of accommodative coping strategies.

Parental response to children's pain: The moderating impact of children's emotional distress on symptoms and disability

&NA; Parental responses play a central role in the development and maintenance of children’s pain behavior. Previous studies examining the impact of parental responses on children’s pain have focused mainly on protective or solicitous responses. This study examined the impact of parental responses, including protectiveness, minimization of pain, and encouraging and monitoring responses, on children’s functional disability and somatic symptoms. Participants included 327 patients with chronic pain, ages 8–17, who completed measures of pain, disability, somatic symptoms, depression, and anxiety. Patients’ parents completed a measure assessing parental responses to their children’s pain. Results show that for children with higher levels of emotional distress, maladaptive parental responses to pain (e.g., criticism, discounting of pain, increased attention to pain, and granting of special privileges) were associated with increased disability and somatic symptoms. Results of this study demonstrate the important ways in which parents can influence how their children cope with and manage chronic pain. Children whose parents are overly protective or critical of their pain may experience more impairment or somatic symptoms, particularly those children who are already at risk for difficulties due to higher levels of emotional distress.

Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients.

&NA; The objective of this study was to investigate associations between social desirability response bias and self‐report of pain, disability, and psychological distress (depression, anxiety, and somatic symptoms) in a sample of children presenting to a multidisciplinary pediatric chronic pain clinic. A retrospective review was conducted on 414 consecutive clinic patients, ages 12–17 years, with chronic pain complaints of at least 3 months’ duration. As part of a clinical battery, children completed self‐report psychological questionnaires including the Children’s Depression Inventory, Children’s Somatization Inventory, and Revised Children’s Manifest Anxiety Scale including the Lie Scale, an indicator of social desirability influence. Children also provided self report of pain intensity, pain duration and functional disability. Clinician ratings of anxiety and depressive symptoms also were collected. Results show that children scoring high on the measure of social desirability reported fewer symptoms of depression and anxiety compared to children scoring low on the social desirability index. No differences arose between these groups on reports of somatic symptoms, pain duration, or pain‐related disability. These findings suggest that social desirability response bias may have implications for the self‐report of psychological distress among pediatric chronic pain patients. The limits of self‐report of symptoms should be considered in the clinical and research contexts.

Pain coping profiles in adolescents with chronic pain

Abstract This study sought to evaluate the extent to which the pain coping profiles observed by Walker and colleagues [28] in a sample of patients with chronic abdominal pain also were evident in a sample of adolescent patients who presented to a tertiary care clinic for evaluation of a variety of diverse pain conditions. In addition, we aimed to evaluate the relation of these pain coping profiles to patients’ emotional and physical functioning. Participants (n = 254) were adolescent patients aged 12–17 years. Patients completed the Pain Response Inventory (PRI) as well as measures of pain, somatic symptoms, anxiety and depressive symptoms, and functional disability. Using the PRI classification algorithm developed by Walker and colleagues [28], we successfully classified all the patients in our sample. We also found that the pain coping profiles successfully differentiated among patients with different levels of symptoms, disability, and emotional distress, further demonstrating the external validity of these profiles. Results have implications for tailoring pain treatment interventions to patients’ particular coping profiles.

Anxiety and Functional Disability in a Large Sample of Children and Adolescents with Chronic Pain

BACKGROUND: Anxiety is the most common psychiatric condition in children and adolescents, and is linked to significant disruptions across domains of function. Due to the avoidant nature of anxiety and pain-related disability, studying anxiety symptoms in children with chronic and recurrent pain conditions is important.

Anxiety, Coping, and Disability: A Test of Mediation in a Pediatric Chronic Pain Sample

OBJECTIVE To evaluate pain coping as a mediator of associations between anxiety and functional disability and anxiety and somatic symptoms in adolescents with chronic pain. METHOD Participants (mean age = 14.76 years, range: 12-17 years) included 280 patients (212 girls) with chronic pain who underwent multidisciplinary evaluation at a tertiary pain clinic in a northeast pediatric hospital. Patients completed measures of current pain, anxiety, active, passive, and accommodative pain coping, functional disability, and somatic symptoms. RESULTS Structural equation modeling was employed. The association between anxiety and disability was fully mediated by passive coping. The association between anxiety and somatic symptoms was not mediated by coping. CONCLUSIONS Links between anxiety symptoms and pain-related outcomes in adolescents with chronic pain are complex. Assessing how an adolescent copes with his/her pain provides further understanding of this relationship.

Testing Gender as a Moderator of Associations Between Psychosocial Variables and Functional Disability in Children and Adolescents with Chronic Pain

OBJECTIVE To evaluate gender as a moderator of associations between psychosocial variables and functional disability in children and adolescents with chronic pain. METHOD Participants included 266 patients (177 girls; mean age = 13.3 years) with chronic or recurrent headache or abdominal pain who were evaluated at a pediatric chronic pain clinic. Patients completed measures of pain intensity, anxiety, depression, pain coping, and functional disability. Parents completed a measure of protective behavior. RESULTS Girls and boys reported similar levels of pain intensity. Girls were more likely to endorse depressive symptoms, and internalizing symptoms were associated with disability in girls, not in boys. No gender differences were found in links between coping and protective parenting and disability. CONCLUSIONS In general, psychosocial factors influenced functional disability similarly in girls and boys, although some gender differences were found. Findings highlight the importance of considering child gender when evaluating factors that contribute to functional disability.