Readiness to change in pediatric chronic pain: Initial validation of adolescent and parent versions of the Pain Stages of Change Questionnaire

Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Pain (Impact Factor: 5.21). 07/2011; 152(10):2301-11. DOI: 10.1016/j.pain.2011.06.019
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Despite the clinical importance of readiness to change in predicting treatment outcomes among adults, no studies have examined this construct among pediatric pain patients. Because parents play a key role in adolescent pain management, both adolescent and parent readiness to adopt a self-management approach to pain merit further study. The primary goal of the current study was to validate adolescent and parent-report adaptations of the adult Pain Stages of Change Questionnaire (PSOCQ). Participants included 259 adolescent patients with chronic pain syndromes and their parents presenting to 2 pediatric pain management clinics. Using confirmatory factor analytic techniques, a 4-factor solution was supported for the parent version (PSOCQ-P) that included Precontemplation, Contemplation, Action, and Maintenance factors, whereas the adolescent version (PSOCQ-A) version supported a three-factor model that combines the Action and Maintenance scales. Within both versions, each of the factors was found to be internally consistent. The PSOCQ-A and PSOCQ-P showed evidence of criterion validity through significant correlations with coping strategies and pain catastrophizing. Stability findings at 4 and 8 weeks after a multidisciplinary pain clinic evaluation are reported. Associations between pediatric PSOCQ scores and demographic, pain, and functional domains were explored to inform future research. Further validation of the PSOCQ-A and PSOCQ-P measures with new, separate samples of pediatric pain patients and parents are needed before use in clinical contexts.

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    • " the PPRC group included increased child action / maintenance and parent action scores on the pain readiness to change measure . Based on the transtheoretical model of behavior change ( Prochaska & Velicer , 1997 ) and the stages of change conceptualized for adult ( Kerns , Rosenberg , Jamison , Caudill , & Haythornthwaite , 1997 ) and pediatric ( Guite et al . , 2011 ) chronic pain patients , Action reflects an active involvement in learning self - management strategies and Maintenance reflects a sense of established personal responsibility for pain control . The specific improvements observed for the PPRC likely reflect the therapeutic emphasis of learning self - management strategies and pain mana"
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    ABSTRACT: Objectives: This study compared outcomes between day hospital pain rehabilitation patients and patients engaged in outpatient multidisciplinary pain treatment. Methods: This study included 100 children who presented for an initial tertiary care pain clinic evaluation. 50 patients enrolled in intensive day hospital pain rehabilitation and 50 patients pursued outpatient multidisciplinary treatment. Across 2 time points, children completed measures of functional disability, pain-related fear, and readiness to change and parents completed measures of pain-related fear and readiness to change. Results: Across both treatment modalities, patients and parents reported improvements. Patients enrolled in intensive pain rehabilitation had significantly larger improvements in functional disability, pain-related fear, and readiness to change. Parents of day hospital patients reported larger declines in child pain-related fear and increased readiness to change compared with their outpatient counterparts. Discussion For patients with high levels of pain-related disability and distress, intensive pain rehabilitation provides rapid, dramatic improvements in functioning.
    Journal of Pediatric Psychology 10/2012; 38(2). DOI:10.1093/jpepsy/jss109 · 2.91 Impact Factor
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    • "Furthermore, the Contemplation subscale of the measure has been found to be difficult to interpret in the context of intensive pain rehabilitation treatment [10] [11]. The validation of the youth version of the PSOCQ found that a single subscale combining action and maintenance was more stable and reliable than separate subscales [6]. For ease of comparison, we created a parallel composite Action/Maintenance score for the parent PSOCQ, following the strategy of Jensen et al. [11] of averaging the scores on the 2 separate subscales into a single score. "
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    ABSTRACT: The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. A total of 157 children ages 10 to 18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pretreatment, posttreatment, and short-term follow-up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children's readiness to self-manage pain from pretreatment to posttreatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents' readiness to adopt a pain self-management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pretreatment willingness to self-manage pain and posttreatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being.
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