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Witt, S., Escherich, G., Rutkowski, S., Kappelhoff, G., Frygner Holm, S., Russ, S., . . . Quitmann, J. (2019). Exploring the Potential of a Pretend Play Intervention in Young Patients With Leukemia. Journal of Pediatric Nursing: Nursing Care of Children and Families, 44, E98-E106
Open this publication in new window or tab >>Exploring the Potential of a Pretend Play Intervention in Young Patients With Leukemia
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2019 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 44, p. E98-E106Article in journal (Refereed) Published
Abstract [en]

Purpose: The aims of the study are 1) to gain knowledge of parents' and professionals' perceptions about cancer stricken children's resources, burdens, and ability to pretend play, and 2) to prepare the initiation of a pretend play intervention based on children's needs and included parents' and professionals' feedback.

Design and Methods: Qualitative design using semi-structured interviews with 13 parents of children diagnosed with leukemia and 15 professionals in the field of pediatric oncology. Themes were derived with content analysis via deductive and inductive coding.

Results: Analysis resulted in five topics. (1) Ability to play in the context of leukemia (2) ways of coping with leukemia (3) difficulty in transition to normality (4) parental quality of life and parents' needs (5) perceptions of the potential of pretend play.

Conclusion: Study results indicate the potential of pretend play interventions for young cancer patients and the need for additional professional support of parents.

Practice Implications: Pretend play is a tool children carry with them regardless of their circumstances. If we can enhance their ability to play, doing so should give them an advantage in creative problem solving and creative expression as they deal with a life threatening disease. 

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
Keywords
Pediatric oncology, Pretend play intervention, Children, Parents, Professionals
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-376887 (URN)10.1016/j.pedn.2018.11.010 (DOI)000456444800016 ()30503254 (PubMedID)
Available from: 2019-02-13 Created: 2019-02-13 Last updated: 2019-05-13Bibliographically approved
Frygner-Holm, S., Russ, S., Quitmann, J., Ring, L., Zyga, O., Hansson, M. G., . . . Höglund, A. T. (2019). Pretend Play as an Intervention for Children With Cancer: A Feasibility Study. Journal of Pediatric Oncology Nursing, 37(1), 65-75
Open this publication in new window or tab >>Pretend Play as an Intervention for Children With Cancer: A Feasibility Study
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2019 (English)In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 37, no 1, p. 65-75Article in journal (Refereed) Published
Abstract [en]

Children with cancer suffer from symptoms and burdensome treatments that often cause distress to children and their families. Mortality is one aspect of cancer diagnosis, while another is the quality of life and well-being during and after the treatment. By supporting children's communication, self-efficacy and coping ability in the care situation, children are given the possibilities for increased independence and participation and are allowed to develop an influence over their care. The aim of this study was to develop and evaluate the feasibility and acceptability of an adult-facilitated pretend play intervention for children with cancer. Five children with ongoing treatment for cancer were invited to a play intervention that consisted of six to eight sessions of structured pretend play aimed at increasing participation, independence, and well-being. A mixed method design was used to evaluate the feasibility and acceptability of the play intervention. Measures were collected before and after interventions, and in conjunction with every play session. Results suggest that the children enjoyed the play intervention. Findings indicate small improvements regarding self-efficacy in care situations and equal or increased quality of life for participants. A main finding was that no adverse events or increased worrying was reported in conjunction with play sessions. Therefore, the intervention is regarded as safe, feasible, and acceptable as reported by participants and their primary caregivers and a possible means of increasing participation and independence in children with a cancer diagnosis.

Keywords
Intervention, pediatric oncology, pretend play, self-efficacy
National Category
Cancer and Oncology Pediatrics
Research subject
Oncology; Pediatrics; Psychology
Identifiers
urn:nbn:se:uu:diva-399071 (URN)10.1177/1043454219874695 (DOI)000498992800006 ()31540566 (PubMedID)
Funder
Swedish Childhood Cancer Foundation, PR2013-0123
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2020-01-08Bibliographically approved
Holm, S., Ljungman, G., Åsenlöf, P., Linton, S. J. & Söderlund, A. (2016). Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises.. European Journal of Pain, 20(4), 626-638
Open this publication in new window or tab >>Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises.
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2016 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 4, p. 626-638Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the efficacy of tailored behavioural medicine treatment within a physical therapy framework.

METHODS: The study was a randomized controlled study (RCT): tailored behavioural medicine treatment (EXT) delivered by physical therapists (PTs) was compared with exercise-based treatment (CT). Thirty-two adolescents (mean age 14.3 years) with persistent pain participated. Data on pain-related disability and school attendance (primary outcomes), pain intensity, catastrophizing, fear of movement and self-efficacy were collected.

RESULTS: The pain-related disability measured by the Functional Disability Inventory (FDI) resulted in mean score change of EXT = -18 and CT = -11, respectively. A significant change within both groups was found (EXT p = 0.003, CT p = 0.001), and a large effect size for FDI between the conditions was demonstrated (AUC of 0.77). For school attendance post-treatment, no difference was found between conditions. For secondary outcomes, a significant improvement in pain intensity and pain catastrophizing was found for the EXT and self-efficacy for the CT groups but no statistically significant difference between the two conditions was detected. Caution should be given to the small sample size, as it may affect the interpretation and generalizability of the results.

CONCLUSION: In this study, differences between tailored behavioural medicine treatment delivered by PTs and exercise-based treatment could not be demonstrated, although the effect size was large. Patients who received either treatment demonstrated significant changes over time in pain-related disability. The low number of participants and suboptimal tailoring of the psychological components may partly explain the failure to demonstrate differences between groups, and future studies are warranted.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-271402 (URN)10.1002/ejp.780 (DOI)000372516800015 ()26399225 (PubMedID)
Funder
Swedish Research CouncilSven Jerring Foundation
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2019-05-13Bibliographically approved
Holm, S. (2014). Children and Adolescents with Pain in Primary care: Biopsychosocial determinants and behavioral medicine treatment in a physical therapy framework. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Children and Adolescents with Pain in Primary care: Biopsychosocial determinants and behavioral medicine treatment in a physical therapy framework
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Pain during childhood and adolescents is prevalent and longstanding pain can have severe consequences for children, their families and in the long run for the society. Persisting pain influences many aspects of life and pain-related disability is often associated with impairment, decreased health-related quality of life, school functioning, participation in social life, emotional well-being, and with increased healthcare utilization. The overall aim was to explore, with cross-sectional design, pain conditions, to identify biopsychosocial determinants and their association with pain-related disability, and to study the feasibility of applying a behavioral medicine treatment for adolescents experiencing musculoskeletal pain using randomized controlled design and multimethod approach. Samples of children and adolescents and their parents seeking primary care physical therapy for a pain condition, and a sample of treating physical therapists were included.

The results showed that some children had profiles of biopsychosocial determinants that could increase the risk for long-term pain-related disability. Many had long pain duration and multiple pain locations. Girls reported higher levels of catastrophizing compared to boys, who in turn used more behavioral distraction generally regarded as a positive coping strategy.

Behavioral medicine treatment, based on a biopsychosocial approach, targeting adolescents with pain was shown to be feasible for use in primary care, with promising outcomes. Tailoring of the treatment was suboptimal but the effect of behavioral medicine treatment in pain-related disability exceeded the effect of the control treatment. The satisfaction with treatment content and results were high for both the control- and experimental condition, significantly higher for the experimental condition as rated by participants. Learning and delivering the behavioral medicine intervention was perceived challenging but rewarding by the treating physical therapists. The biopsychosocial approach in tailoring the treatment, and dialogs with parents were identified as key aspects in the behavioral medicine treatment program.

In conclusion, in children seeking primary care for pain, the factors associated with pain-related disability were complex and interrelated. The findings highlight the importance for primary care health care providers to apply a biopsychosocial approach in assessment and treatment, for improvement of activities and participation, and thereby helping children and adolescents regain health.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. p. 100
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 988
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-220957 (URN)978-91-554-8920-5 (ISBN)
Public defence
2014-05-23, Universitetshuset, sal IX, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-04-28 Created: 2014-03-24 Last updated: 2019-05-13
Holm, S., Ljungman, G., Åsenlöf, P. & Söderlund, A. (2013). How children and adolescents in primary care cope with pain and the biopsychosocial factors that correlate with pain-related disability. Acta Paediatrica, 102(10), 1021-1026
Open this publication in new window or tab >>How children and adolescents in primary care cope with pain and the biopsychosocial factors that correlate with pain-related disability
2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 10, p. 1021-1026Article in journal (Refereed) Published
Abstract [en]

Aim: To describe how children and adolescents cope with pain and to examine the biopsychosocial factors that correlate with pain-related disability (PRD) in a sample of primary care patients. Methods: This cross-sectional study included 133 patients, aged from eight to 16 years, who consulted primary care physiotherapy on a pain-related problem. Data were collected with the Functional Disability Inventory, the Pain Coping Questionnaire and a study-specific questionnaire. Linear multivariate regression analyses were applied to study the associations between PRD and (i) pain coping, (ii) individual-, pain-related and psychosocial variables. Results: Behavioural distraction, externalizing and catastrophizing explained 13% of the variance in PRD (regression model 1). In addition, pain intensity, worrying and the ability to reduce pain explained 21% of the variance in PRD (regression model 2). Conclusion: Variance in PRD was partly explained by pain intensity, worrying and ability to reduce pain and by behavioural distraction, externalizing and catastrophizing. Future prospective longitudinal studies are needed to identify possible additional variables explaining PRD, establish causality and the potential benefits of addressing these variables in interventions in primary care.

Keywords
Children, Pain coping, Pain-related disability, Primary care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-208633 (URN)10.1111/apa.12352 (DOI)000323886300032 ()
Available from: 2013-10-08 Created: 2013-10-07 Last updated: 2019-05-13Bibliographically approved
Holm, S., Ljungman, G. & Söderlund, A. (2012). Pain in children and adolescents in primary care: chronic and recurrent pain is common. Acta Paediatrica, 101(12), 1246-1252
Open this publication in new window or tab >>Pain in children and adolescents in primary care: chronic and recurrent pain is common
2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 12, p. 1246-1252Article in journal (Refereed) Published
Abstract [en]

Aim: 

The aim of this study was to describe a paediatric primary care pain sample and examine associations between pain, health-related quality of life and disability.

Methods: 

The study design is descriptive and cross-sectional. One hundred and fifty-four consecutive children and adolescents between the ages of 8 and 16 seeking care for a pain-related conditions participated in this study. Pain characteristics, health-related quality of life and disability were investigated.

Results: 

Eighty-seven per cent of participants had a pain duration of 3 months or more, and almost half of the group studied had a pain duration of ≥ 12 months. The disability levels in the study group as a whole were low, with a mean FDI of 10.4 (SD 7.6). However, 35% of the study group had moderate disability levels and reported a mean FDI of 18.7 (SD 4.8). Single pain location was reported in 42%, whereas 58% had two or more pain locations. The children with multiple pain locations reported lower health-related quality of life and higher disability than children with single pain location.

Conclusion:

Paediatric pain patients in primary care consist partly of patients only slightly influenced by pain and partly of patients for whom pain has a great impact on their lives.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-187141 (URN)10.1111/j.1651-2227.2012.02829.x (DOI)000310868300029 ()22924888 (PubMedID)
Available from: 2012-12-03 Created: 2012-12-03 Last updated: 2019-05-13Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-0609-5683

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