Cerebral palsy pain instruments: Recommended tools for clinical research studies by the National Institute of Neurological Disorders and Stroke Cerebral Palsy Common Data Elements project

Abstract

Aim: This study describes the process of updating the cerebral palsy (CP) common data elements (CDEs), specifically identifying tools that capture the impact of chronic pain on children's functioning.

Method: Through a partnership between the American Academy for Cerebral Palsy and Developmental Medicine and the National Institute of Neurological Disorders and Stroke (NINDS), the CP CDEs were developed as data standards for clinical research in neuroscience. Chronic pain was underrepresented in the NINDS CP CDEs version 1.0. A multi-step methodology was applied by an interdisciplinary professional team. Following an adapted CP chronic pain tools' rating system, and a review of psychometric properties, clinical utility, and compliance with inclusion/exclusion criteria, a set of recommended pain tools was posted online for external public comment in May 2022.

Results: Fifteen chronic pain tools met inclusion criteria, representing constructs across all components of the International Classification of Functioning, Disability and Health.

Interpretation: This paper describes the first condition-specific pain CDEs for a pediatric population. The proposed set of chronic pain tools complement and enhance the applicability of the existing pediatric CP CDEs. The novel CP CDE pain tools harmonize the assessment of chronic pain, addressing not only intensity of chronic pain, but also the functional impact of experiencing it in everyday activities.

FIGURE 1

(a) Options that researchers/clinicians may use to select appropriate cerebral palsy pain tools for research study or in the clinical setting. The chart provides options to select tools by ages (preschool, school age, adolescence) and pain domains (quality and location, intensity, behavior, self-efficacy, and interference), leading to decision ‘diamonds’ indicating pain tools to use. (b) Examples of International Classification of Functioning, Disability and Heal (ICF) content analysis by ICF domain, for specific items of the pain tools, allowing the researcher/clinician to streamline the process of identifying appropriate measures when it is important to assess chronic pain.