Assessing treatment response using daily measures of physical activity, fear, and avoidance in youth with chronic pain
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This study assessed physical activity levels and subjective measures of fear and avoidance in youth with chronic pain, and examined the effects of graded exposure-based treatment on these relations. Children and adolescents with chronic pain participated in a series of individualized treatment sessions involving a parent, physical therapist and psychologist. The early sessions consisted of psychoeducation and the later sessions consisted of exposure activities in which patients were gradually exposed to activities they had been avoiding due to pain or fear. While in treatment each participant wore an actigraph, a wrist watch used to monitor physical activity, and completed daily diaries in which they reported fear and avoidance ratings. Actigraph data were used to calculate mean and peak activity per minute. Data were examined across treatment phases. Participants in this study were 10 children and adolescents (ranging in age from 8-17) with chronic pain. The study was divided into Baseline, Education and Exposure periods. Treatment ranged from 9 to 15 sessions. Across time, mean and peak activity remained at baseline levels, while avoidance reports decreased over the course of treatment. Curvilinear regression models estimated moderate relationships between physical activity levels and reports of avoidance and pain, with more activity observed at lower and higher (rather than moderate) levels of self-reported avoidance and pain. Linear mixed models did not demonstrate any interactions between physical activity and avoidance, and physical activity and fear, by treatment phase. These findings suggest that the relations between physical activity, pain perception, fear, and activity avoidance in youth with chronic pain is complex and warrants further inquiry.