198: Physical Activity Prescribing By Community Paediatricians for Children with Chronic Pain: A Vignette Based Study

Abstract

Background: Regular physical activity (PA) promotes optimum health and development. Youth with chronic pain are less physically active than healthy peers. Recommendation by a health care provider is a key factor influencing the decision to initiate a regular program. The Canadian Paediatric Society provides general fitness guidelines and some diseasespecific recommendations. Little is known about PA prescribing behaviors of paediatricians working with children and youth with chronic pain. Objective(s): Describe PA prescribing behaviors of paediatricians for children and youth with chronic pain. Examine patient/provider characteristics that influence PA prescribing. Design/Methods: Ethics approval was obtained. The survey was developed on FluidSurveys. A survey link was distributed to 360 paediatricians on the Canadian Paediatric Society Community Paediatrics listserv. Ten vignettes varied on eight factors (age, sex, income level, pain intensity, pain frequency, pain duration, location and current physical activity participation). No vignette patient achieved recommended PA levels and all were safe to increase PA. Analysis included descriptive analysis and Generalized Estimating Equations with confidence as the dependent. Result(s): Eighteen paediatricians participated, providing 122 completed vignette responses; 67% of participants were female, 50% of participants indicated they were regularly active, 78% worked in a unidisciplinary setting. The mean duration of practice was 17 years. Paediatricians recommended the following activity for vignette patients with chronic pain: restrict or reduce PA (2.5%), continue current level (13.1%), general activity increase recommendations (26.2%), specific advice to increase (27%), refer to other provider for advice on increasing level (31.1%). Paediatricians (n=121) had the following level of confidence in their recommendations: 2.5% were not at all confident, 38.8% were not so confident, 47.1% were confident and 11.6% were highly confident. Paediatricians (n=119) had the following level of confidence that their recommendations would be followed: 9.8% were not at all confident, 41% were not so confident, 34.4% were confident and 12.3% were highly confident. Factors significantly associated with confidence in PA prescribing included regular physician PA practices (P=0.035), multi-disciplinary setting (P=0.014) and fewer years of practice (P=0.024). Conc lusions : Most participants' recommended increased PA. Higher physician activity level, multidisciplinary practice and fewer years in practice were associated with increased confidence in recommendations. Development of supports such as educational material or clinical decision tools for PA prescribing for children and youth with chronic pain may benefit community paediatricians and their patients.