Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond

Birnie, Kathryn A.; Killackey, Tieghan; Stinson, Jennifer; Noel, Melanie; Lorenzetti, Diane; Marianayagam, Justina; Jordán, Isabel; Jordan, Evie; Neville, Alexandra; Pavlova, Maria; Campbell, Fiona; Lalloo, Chitra

doi:10.1097/pr9.0000000000000935

Cited by 15 publications

(14 citation statements)

References 73 publications

(211 reference statements)

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“…Barriers to implementation were similar to those reported elsewhere on telehealth implementation [ 13 , 15 , 27 ], namely technology, internet access, and digital literacy; however, these barriers could be overcome. The collaborative problem-solving to address barriers in the group by adaptation of what was planned, formed a core part of the learning experience to guide problem-solving.…”

Section: Discussionsupporting

confidence: 72%

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“So, you must understand that that group changed everything”: perspectives on a telehealth group intervention for individuals with chronic pain

Ernstzen

Keet

Louw

et al. 2022

BMC Musculoskelet Disord

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Background The Patient Education Empowerment Programme (PEEP) is an interdisciplinary group intervention for people living with chronic pain. As a result of the COVID-19 pandemic, lockdown and restrictions on in-person group-based health care delivery in South Africa, PEEP was modified to a telehealth electronic format (ePEEP) and offered to patients on a waiting list at two interdisciplinary chronic pain clinics in Cape Town, South Africa. The purpose of this study was to explore the feasibility and acceptability of ePEEP through the perspectives of individuals with chronic pain who participated in ePEEP. Methods A qualitative, exploratory descriptive study was conducted. One month after completion of the 6-week ePEEP programme, individuals who participated, were recruited for the study. Data were collected through semi-structured interviews. Data analysis followed an iterative process of inductive content analysis. Results Six individuals, all women, consented and participated in the study. Three main themes emerged from the data. Theme one focussed on how ePEEP initiated a journey of personal development and discovery within the participants. In theme two, participants reflected on the importance and value of building peer and therapeutic relationships as part of ePEEP. In theme 3, participants shared that the online learning environment had features which influenced learning about pain in different ways. Conclusion ePEEP was found to be acceptable, feasible and valuable for the participants. ePEEP facilitated self-discovery, empowerment, relationship building and transformation in the participants, through experiential learning. Although barriers and facilitators to learning were present, both enhanced the learning experience. The positive reception of this telehealth initiative indicates potential for enhanced access to chronic pain management services in the South African setting.

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Section: Discussionsupporting

confidence: 72%

“…Telehealth should therefore be considered for inclusion in under- and postgraduate curricula. Additionally, health policies, clinical guidelines and care pathways should consider and include telehealth to enhance its uptake into practice [ 27 ].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“So, you must understand that that group changed everything”: perspectives on a telehealth group intervention for individuals with chronic pain

Ernstzen

Keet

Louw

et al. 2022

BMC Musculoskelet Disord

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“…However, virtual care interventions must be designed to specifically meet the needs of the pediatric chronic pain population along the care continuum. 5 While virtual care may remove barriers for some families and provide solutions in the short-term, as noted by families in this study, it is not sufficient to meet the needs of every family living with pain. In the current study, in addition to changes in pain care itself, the closure of other nonessential services, such as schools and recreational activities, also had a detrimental impact on youth in terms of their ability to cope with their pain on a daily basis.…”

Section: Discussionmentioning

confidence: 80%

Pediatric Chronic Pain in the Midst of the COVID-19 Pandemic: Lived Experiences of Youth and Parents

Neville

Lund

Soltani

et al. 2022

The Journal of Pain

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During the coronavirus 2019 (COVID-19) pandemic youth with chronic pain have experienced additional barriers to accessing treatment and managing their pain. This study explored the experiences of youth with chronic pain and their parents during the COVID-19 pandemic. Individual semi-structured interviews were conducted with 20 youth with chronic pain (aged 13-20 years) and one of their parents, recruited from a tertiary level pediatric chronic pain program. Interviews occurred between the months of June-August 2020 and enabled participants to describe their experiences of the COVID-19 pandemic according to their own unique perspectives. Transcripts were analysed using inductive reflexive thematic analysis. Four themes were generated and labelled: ‘temporality, mental health, and pain’, ‘coping with pain during a global pandemic’, ‘impact on care’, and ‘re-appraisal in the context of development and pandemic life’. Across these themes, youth and parents described their unique challenges of living with pain as they adapted to changing circumstances of the COVID-19 pandemic. Notably, youth experienced increased difficulties managing their mental health and pain, which were intricately connected and related to social isolation, temporality, and uncertainty exacerbated by the COVID-19 pandemic. Restrictions due to the COVID-19 pandemic impacted youth's access to care and their abilities to engage in coping strategies to manage their pain. The COVID-19 pandemic was also perceived to have interrupted youth's development and growing autonomy, prompting youth to re-appraise their current circumstances and imagined futures. Perspective: This manuscript provides an in-depth understanding of the impact of the COVID-19 pandemic on youth with chronic pain and their parents. Youth and their parents perceived the COVID-19 pandemic to have impacted youth's mental health, pain, socio-emotional development, and access to care.

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“…Furthermore, some HCP felt their institutions lacked information technologies and administrative support, electronic medical records system and the space and equipment to adequately implement virtual care [ 9 , 26 , 31 , 32 ]. A recent systematic review found that virtual care was under-utilized in pediatric chronic pain care, and outlined strategies for how and where virtual care can be better leveraged [ 33 ]. The gaps in current knowledge outlined in that review are consistent with the findings of this study, for example the need for a better understanding of the limitations of virtual care for all aspects of chronic pain care and identify potential impacts on therapeutic relationships.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study

et al. 2022

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Chronic pain affects 1 in 5 youth, many of whom manage their pain using a biopsychosocial approach. The COVID-19 pandemic has impacted the way that healthcare is delivered. As part of a larger program of research, this study aimed to understand the impact of the pandemic on pediatric chronic pain care delivery including impact on patients’ outcomes, from the perspective of pediatric healthcare providers. A qualitative descriptive study design was used and 21 healthcare providers from various professional roles, clinical settings, and geographic locations across Canada were interviewed. Using a reflexive thematic analysis approach 3 themes were developed: (1) duality of pandemic impact on youth with chronic pain (i.e., how the pandemic influenced self-management while also exacerbating existing socioeconomic inequalities); (2) changes to the healthcare system and clinical practices (i.e., triaging and access to care); (3) shift to virtual care (i.e., role of institutions and hybrid models of care). These findings outline provider perspectives on the positive and negative impacts of the pandemic on youth with chronic pain and highlight the role of socioeconomic status and access to care in relation to chronic pain management during the pandemic in a high-income country with a publicly funded healthcare system.

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Best practices for virtual care to support youth with chronic pain and their families: a rapid systematic review to inform health care and policy during COVID-19 and beyond

Abstract: Supplemental Digital Content is Available in the Text. Evidence-informed guidance to better leverage, implement, and select virtual care platforms for pediatric chronic pain, and identified knowledge gaps are in need of additional research.

Cited by 15 publications

References 73 publications

“So, you must understand that that group changed everything”: perspectives on a telehealth group intervention for individuals with chronic pain

“So, you must understand that that group changed everything”: perspectives on a telehealth group intervention for individuals with chronic pain

Pediatric Chronic Pain in the Midst of the COVID-19 Pandemic: Lived Experiences of Youth and Parents

Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study

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