Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory – pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation.
Methods
A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted.
Results
Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, p = < .001 where BPI and physical performance measures were consistently statistically significant predictors, p < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement (p = < .0005).
Conclusions
The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.
HeeSWMistryDMistryT, et al.Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain. BMC Muscoskel Disord2021; 22: 191. DOI: 10.1186/s12891-021-04028-8
CranerJRSperryJAKoballAM, et al.Unique contributions of acceptance and catastrophizing on chronic pain adaptation. Int J Behav Med2017; 24(4): 542–551. DOI: 10.1007/s12529-017-9646-3
9.
BoonstraAMRenemanMFWaaksmaBR, et al.Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain. Disabil Rehabil2015; 37(14): 1242–1250. DOI: 10.3109/09638288.2014.961657
10.
FranceCRYsidronDWSlepianPM, et al.Pain resilience and catastrophizing combine to predict functional restoration program outcomes. Health Psychol2020; 39(7): 573–579. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32324002
11.
AnamkathNSPalyoSAJacobsSC, et al.An interdisciplinary pain rehabilitation program for veterans with chronic pain: description and initial evaluation of outcomes, Pain Res Manag2018; 2018: 1–9. Available from: https://www.hindawi.com/journals/prm/2018/3941682/
12.
KnightLDGuildfordBJDaly-EichenhardtA, et al.Assessment and patient selection process for a pain management programme: a case study in specialty care. Br J Pain2019; 13: 74–81.
13.
HeelasLBarkerKL. One size does not fit all: enabling choice and patient-centred care in a chronic pain rehabilitation service. Physiother2021; 113: e184.
McCrackenLMSatoAWainwrightD, et al.A feasibility study of brief group-based acceptance and commitment therapy for chronic pain in general practice: recruitment, attendance, and patient views. Prim Health Care Res Dev2014; 15(03): 312–323. Available from: http://www.journals.cambridge.org/abstract_S1463423613000273
16.
DennenyDFrijdal (nee Klapper)ABianchi-BerthouzeN, et al.The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain. Physiother2019; 106; 163–173. DOI: 10.1016/j.physio.2019.01.014
17.
WilsonSChalonerNOsbornM, et al.Psychologically informed physiotherapy for chronic pain: patient experiences of treatment and therapeutic process. Physiother2017; 103(1): 98–105. DOI: 10.1016/j.physio.2015.11.005
18.
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management, 2016. Available from: https://www.nice.org.uk/guidance/ng59
19.
GewandterJSDworkinRHTurkDC, et al.Research design considerations for chronic pain prevention clinical trials. Pain2015; 156(7): 1184–1197. Available from: https://journals.lww.com/00006396-201507000-00006
20.
TanGJensenMPThornbyJI, et al.Validation of the brief pain inventory for chronic nonmalignant pain. J Pain2004; 5: 133.
21.
PatelKVAmtmannDJensenMP, et al.Clinical outcome assessment in clinical trials of chronic pain treatments. Pain Rep2021; 6(1):e784. DOI: 10.1097/PR9.0000000000000784
22.
ZidarovDZidarova-CarriéAViscaR, et al.Core patient-reported outcome domains for routine clinical care in chronic pain management: patients’ and healthcare professionals’ perspective. Qual Life Res2020; 29(7): 2007–2020. DOI: 10.1007/s11136-020-02459-9
23.
KroenkeKKrebsEETurkD, et al.Core outcome measures for chronic musculoskeletal pain research: recommendations from a veterans health administration work group. Pain Med2019; 20(8): 1500–1508.
24.
JensenMPKarolyP. Self-report scales and procedures for assessing pain in adults. In: TurkDCMelzackR (eds) Handbook of pain assessment. New York, NY: The Guilford Press, 2011, pp. 19–44.
25.
KroenkeKSpitzerRL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann2002; 32(9): 509–515. DOI: 10.3928/0048-5713-20020901-06
26.
KroenkeKSpitzerRLWilliamsJBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med2001; 16: 606–613.
27.
JordanPShedden-MoraMCLöweB. Psychometric analysis of the generalized anxiety disorder scale (GAD-7) in primary care using modern item response theory. PLoS One2017; 12(8): e0182162. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28771530
28.
SpitzerRLKroenkeKWilliamsJBW, et al.A brief measure for assessing generalized anxiety disorder. Arch Intern Med2006; 166: 1092–1097.
29.
FrenchDJFranceCRVigneauF, et al.Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa Scale for Kinesiophobia (TSK). Pain2007; 127(1): 42–51. Available from: https://journals.lww.com/00006396-200701000-00008
30.
RoelofsJGoubertLPetersML, et al.The tampa scale for kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. Eur J Pain2004; 8: 495–502.
31.
FishRAMcGuireBHoganM, et al.Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8. Pain2010; 149(3): 435–443. Available from: https://journals.lww.com/00006396-201006000-00009
32.
CellaMChalderT. Measuring fatigue in clinical and community settings. J Psychosom Res2010; 69: 17–22.
TaylorSFrostHTaylorA, et al.Reliability and responsiveness of the shuttle walking test in patients with chronic low back pain. Physiother Res Int2001; 6(3): 170–178. DOI: 10.1002/pri.225
35.
ParsonsSHardingGBreenA, et al.The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain2007; 23(1): 91–98.
36.
GuildfordBJJacobsCMDaly-EichenhardtA, et al.Assessing physical functioning on pain management programmes: the unique contribution of directly assessed physical performance measures and their relationship to self-reports. Br J Pain2017; 11(1): 46–57. DOI: 10.1177/2049463716680559
37.
RevickiDHaysRDCellaD, et al.Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol2008; 61(2): 102–109. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0895435607001199
ChenCXKroenkeKStumpTE, et al.Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials, Pain2018; 159(4): 775–782. Available from: https://journals.lww.com/00006396-201804000-00017
40.
NicholasMVlaeyenJWSRiefW, et al.The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain2019; 160(1): 28–37.
41.
PerrotSCohenMBarkeA, et al.The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. Pain2019; 160(1): 77–82. Available from: https://journals.lww.com/00006396-201901000-00010
42.
ScholzJFinnerupNBAttalN, et al.The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain2019; 160(1): 53–59. Available from: https://journals.lww.com/00006396-201901000-00007
43.
AzizQGiamberardinoMABarkeA, et al.The IASP classification of chronic pain for ICD-11: chronic secondary visceral pain. Pain2019; 160(1): 69–76.
44.
BoonstraAMRenemanMFWaaksmaBR, et al.Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain. Disabil Rehabil2015; 37(14): 1242–1250. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25228388
45.
TseliEVixnerLLoMartireR, et al.Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: results from a national quality registry in Sweden. J Rehabil Med2020; 52: jrm00019. DOI: 10.2340/16501977-2648
46.
GilpinHRStahlDRMcCrackenLM. A theoretically guided approach to identifying predictors of treatment outcome in Contextual Cognitive Behavioural Therapy for chronic pain. Eur J Pain2019; 23(2): 354–366. DOI: 10.1002/ejp.1310
47.
JensenMPSmithAEAlschulerKN, et al.The role of pain acceptance on function in individuals with disabilities. Pain2016; 157(1): 247–254. Available from: https://journals.lww.com/00006396-201601000-00025
48.
TaubenBTheodoreB. Measurement-based stepped care approach to interdisciplinary chronic pain management. In: Practical management of pain (5th edition) Chapter 4,2014, pp. 37-46. Available from: https://doi.org/10.1016/B978-0-323-08340-9.00004-9
49.
HillJCWhitehurstDGTLewisM, et al.Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet2011; 378: 1560–1571.
50.
BuzasiEKurakataHGandhiA, et al.Effects of booster sessions on self-management interventions for chronic musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials. Pain2022; 163(2): 214–257. Available from: https://journals.lww.com/10.1097/j.pain.0000000000002302
51.
PriceCMde CCWilliamsA, et al.Implementation of patient‐reported outcomes (PROMs) from specialist pain clinics in England and Wales: experience from a nationwide study. Eur J Pain2019; 23: ejp.1406. DOI: 10.1002/ejp.1406
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