Care-related pain and discomfort in children with motor disabilities in rehabilitation centres

Background: Pain is one of the symptoms reported most by children with motor disabilities particularly during daily living activities in institutions and during rehabilitation. Despite the care and consideration of professionals, a wide range of motor and cognitive disabilities, limited communication skills, the presence of chronic pain and frequent care interventions place such children at high risk of experiencing induced pain. Objectives: We aimed to identify care-related pain and discomfort in children with motor disabilities in rehabilitation centres and the characteristics of children at risk of induced pain. A further aim was to evaluate the validity of a method for the continuous assessment of care-related pain. Methods: Patients were recruited from 2 paediatric rehabilitation centres. The level of pain or discomfort experienced during each daily care activity was evaluated for 5 days and 1 night by using the FLACC-r scale and a visual analog scale (VAS) rated by the caregiver (VAS caregiver) and the patient (VAS patient). Results: We included 32 children (mean age: 8.5 +/- 5 years, range: 1-15 years) with 1302 care activities evaluated. Overall, 3.6% of the activities were rated as painful and 11% uncomfortable. The most frequent painful activities were mouth care, transfers standing and dressing. The most frequent uncomfortable activities were passive limb mobilisation, dressing and transfers. Children with neurological disorders were at increased risk of induced pain. Conclusions: Children with motor disabilities experienced pain during daily care activities. The methodology we propose is valid and can be used in any type of institution for children with motor disability to evaluate and reduce the frequency of care-related pain. (C) 2016 Elsevier Masson SAS. All rights reserved.