Functional Assessment for Children Hospitalized for Sickle Cell Pain: A New Paradigm.

Functional assessment methods have not been previously utilized in the acute care setting for children with sickle cell disease, but may provide a more valid means to evaluate pain and recovery in children hospitalized with vasoocclusive episodes (VOE).

To evaluate the FIM^TM instrument, a well validated measure of motor and cognitive functioning, as a measure of functional recovery in children hospitalized with sickle cell pain, by correlating it with established measures of pain and affect. This information will be used to inform subsequent research, with the goal of generating a functional assessment instrument specific to sickle cell disease.

Patients between 7 and 21 years of age admitted for a VOE were eligible to participate. During their hospitalization, patients were evaluated daily for opiate use, pain (11 point numerical rating score (NRS), and adolescent pediatric pain tool [APPT]), mood (Positive and Negative Affect Scale for Children [PANAS-C]), and function (FIM instrument).

Twenty-four patients were enrolled in the study. Mean age was 16.3±3.1 (range: 7.3 – 20.3) years, and mean length of stay was 6.9±5.6 (range: 2.2 – 28.3) days. Most patients were female (N=18) and most were African American (N=18). Over the course of the hospitalization (from day 1 to study completion), patients showed: decreases in total opiate use (mg/kg/hr) (.05±.02 vs. .04±.03; p=.03) and average pain intensity on the NRS (6.3±1.4 vs.5.0±2.4; p=0.005); improvement in function as measured by the FIM instrument (86.1±16.2 vs. 99.5±14.2; p=0.004) and FIM motor sub-score (53.8±12.1 vs. 64.6±14.3; p=.005). No significant change was found in the FIM cognitive sub-scale (34.9±.3 vs. 34.9±.3; p=.33), positive affect (23.8±11.5 vs. 28.9±15.6; p=0.074), negative affect (29.8±10.6 vs. 25.5±14.1; p=.134), or pain as measured by the APPT (10.7±10.6 vs. 10.0±11.0; p=.607).

Bivariate correlations using Pearson Correlation Coefficients were performed to assess the association between the change (Day 1 vs. study completion) in FIM total scores and each of the validity indicators. (Table 1)

These findings suggest that functional assessment may provide a valid method to evaluate physical recovery in children with sickle cell disease hospitalized with VOE. Our data demonstrate preliminary evidence for the responsiveness of the FIM‘, in particular the motor scale, for detecting changes in clinical course of children hospitalized with VOE. Correlations were demonstrated between change in the FIM score and change in pain scores as well as positive affect. These analyses suggest that our future evaluations of function in children hospitalized with VOE and development of functional assessment measures should focus on motor activities. Our long term goal is to develop a new functional assessment instrument which would be utilized in clinical and research settings as an outcome measure of VOE in patients with sickle cell disease.

No relevant conflicts of interest to declare.