Measurement of joint motion: A guide to goniometry

Objective To conduct an evidence-based review of pediatric pain measures. Methods Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as “Well-established,” “Approaching well-established,” or “Promising” according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). Results Eleven measures met criteria for “Well-established,” six “Approaching well-established,” and zero were classified as “Promising.” Conclusions There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain.

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Evidence-based Assessment of Pediatric Pain

Objective: To examine mothers' responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response. Design: Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity. Participants: A convenience sample of 30 mothers of high-risk premature infants. Interventions: None. Main Outcome Measures: A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being—neonatal intensive-care unit stress, depressive symptoms, and worry about the infant—and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults. Results: All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms. Conclusions: These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed to provide a basis for interventions with these highly vulnerable mothers and infants.

https://www.jognn.org/article/S0884-2175(15)34052-1/pdf

Posttraumatic Stress Symptoms in Mothers of Premature Infants

Interventions to improve team effectiveness: a systematic review.

In 1992, Dillon published his critical review of the empirical literature on reading from paper vs. screen. However, the debate concerning the equivalence of computer- and paper-based tasks continues, especially with the growing interest in online assessment. The current paper reviews the literature over the last 15 years and contrasts the results of these more recent studies with Dillon's findings. It is concluded that total equivalence is not possible to achieve, although developments in computer technology, more sophisticated comparative measures and more positive user attitudes have resulted in a continuing move towards achieving this goal. Many paper-based tasks used for assessment or evaluation have been transferred directly onto computers with little regard for any implications. This paper considers equivalence issues between the media by reviewing performance measures. While equivalence seems impossible, the importance of any differences appears specific to the task and required outcomes.

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Computer- vs. paper-based tasks: Are they equivalent?

In this study, we assessed the coping process in 35 mothers of premature and at-risk infants using a cognitive-behavioral theory to examine the relation among the stressful event, appraisal of the event, coping, and psychological symptomatology. Results show that 60% of the participants presented with clinically significant levels of distress. Tests of additional hypotheses and research questions addressed the role of appraisals and coping strategies. Hierarchical regression analysis revealed that 58% (adjusted R&sub2) of the variance in distress was explained by four variables. The appraisal of uncontrollability, confrontive coping, and escape-avoidant coping were predictive of increased distress. The coping strategy of accepting responsibility was predictive of decreased distress. Satisfaction with the child's physician was a significant indicator of better functioning.

Stress Appraisal and Coping in Mothers of NICU Infants

A cross-sectional survey was employed to assess parenting stress, family satisfaction, and parental concerns and to determine predictors of stress in parents of children with port-wine stains (PWSs). The participants were 46 parents of 24 children receiving treatment with pulsed dye laser photocoagulation for facial PWS at an outpatient dermatology clinic based at a university medical center. Outcome measures used were self-report instruments assessing psychosocial adjustment (Parenting Stress Index, Family Satisfaction Scale, and Parental Concerns Questionnaire). As a group, parents scored in the average range on the stress and family satisfaction measures when compared with a normative sample; five parents (11%) scored in the clinical range for stress. Forty-nine percent of the variance in parenting stress was accounted for by four variables: the child's age (beta = 0.34; p = 0.031), the parents' degree of family satisfaction (beta = -0.27; p = 0.077), the level of parental concern regarding the child's facial PWS (beta = 0.45; p = 0.005), and the parents' satisfaction with staff communication (beta = -0. 51; p = 0.002). The data suggest that while, as a group, parents of children with a facial PWS report to be in the average range for psychological stress, some do not fare as well as others. Factors associated with lower stress include younger children, more family cohesion and adaptation, fewer parental concerns, and greater satisfaction with parent-staff communication. The potential for the development of medical complications and psychological problems over time suggests the need for treatment of the PWS at an early age. Health care providers should be prepared to screen for clinical levels of distress and to refer parents for psychological intervention when needed.

Stress and family satisfaction in parents of children with facial port-wine stains.

https://www.archives-pmr.org/article/S0003-9993(98)90145-9/pdf

Team Approaches to Treating Children With Disabilities: A Comparison

Assessed pain, anxiety, physical functioning, and cooperativeness in 32 children with spastic cerebral palsy. This is the first study to assess children throughout rehabilitation following selective posterior rhizotomy. Results of the Observational Scale of Behavioral Distress and observer Likert ratings confirmed the hypothesis that children's pain and anxiety decrease over time. Children's physical functioning and cooperativeness improve over time. No significant correlation was found between pain and changes in physical functioning. Cognitive impairment, parental involvement, and children's pain behaviors explained 77% and 56% of the variance in two forms of cooperativeness. Research and clinical implications are discussed, and special considerations regarding pain assessment and management in this population are addressed.

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A. Cate Miller

Papers

Stress Appraisal and Coping in Mothers of NICU Infants

Stress and family satisfaction in parents of children with facial port-wine stains.

Team Approaches to Treating Children With Disabilities: A Comparison

Pain, Anxiety, and Cooperativeness in Children with Cerebral Palsy After Rhizotomy: Changes Throughout Rehabilitation

Assessment training and team functioning for treating children with disabilities