Date Presented 04/04/19
The purpose of this study was to quantify the impact of a comprehensive multidisciplinary biopsychosocial approach on chronic pain management and OT’s role therein. Fifty-eight chronic pain patients completed the function-focused chronic pain program. Results demonstrated statistically significant improvements (p < 0.05) in perceived functional participation, balance, strength, and decreased use of daily morphine equivalents.
Primary Author and Speaker: Megan Colletti
Additional Authors and Speakers: David Levine
Contributing Authors: Gregory Heath, James Choo, Ted Jones, Thaddeus Mackiewicz
PURPOSE: The purpose of this study was to quantify the impact of a comprehensive multidisciplinary biopsychosocial approach on chronic pain management and occupational therapy’s (OT) role therein.
RATIONALE: Occupational therapists are key proponents of a self-management and biopsychosocial approach to chronic pain management. However, evidence supporting the multidisciplinary biopsychosocial approach with OT named as a discipline is lacking1. The hypothesis of this study, is that the use of a comprehensive multidisciplinary biopsychosocial approach, including a focus on occupational therapy, for patients with chronic pain would demonstrate an improvement in their function, and a decrease in morphine equivalents (MEDD).
DESIGN: Quantitative retrospective study of patients seen between 2015-2018 at Pain Consultants of East Tennessee (PCET), with a primary diagnosis of chronic pain, and who had completed the OT focused rehabilitation program. The primary provider of rehabilitative care was a licensed OT. Exclusion criteria included patients who did not complete the OT program or did not have discharge metrics.
METHOD: This study was approved by the IRB of the University of Tennessee at Chattanooga. Data was collected through the use of electronic patient charts. Information from the psychologist’s initial evaluation was obtained and any psychology interventions recorded. Information from the referring physicians was utilized to collect data for initial MEDD and discharge MEDD. Information on medical procedures performed by the physicians was obtained following date of discharge from OT. Patient’s received skilled occupational therapy services for 60-minute sessions in an outpatient setting. OT interventions included falls prevention training, chronic pain education, neutral spine education for ADL/IADL, functional transfer training, neutral spine positioning for sleep/comfort, ergonomics for works tasks, and self-management training. Outcome measures included the Patient Specific Functional Scale (PSFS), MEDD (mg/day), 30 second chair test (30C), and functional reach test (FRT). Statistical analysis was performed using IBM SPSS Statistics Version 24 (Armonk, NY). A repeated measures ANOVA was used to compare outcome measures from initial OT evaluation to discharge.
RESULTS: Outcomes from 58 participants, with a mean age of 59.1 (range 25-91), 45 female and 13 male were included. The mean number of OT visits was 26 (range 6-36). From initial visit to discharge MEDD decreased from 74.1 mg/day to 64.9 (p < 0.01), the 30C mean improved from 3.0 to 5.5 (p < 0.01), FRT improved from 7.6 – 9.9 (p< 0.01), and the PSFS improved from 2.9 – 6.6 (p < .03).
DISCUSSION: These results demonstrate that a comprehensive multidisciplinary approach focused on functions provides improvement in perceived functional participation, balance, strength and decreases use of MEDD. Patients had a statistically significant improvement in function and in turn a decrease in prescribed MEDD. The CDC recognizes the need for multidisciplinary care provided through a biopsychosocial approach focused on functional return for patients with chronic pain2. However, much of the OT literature on chronic pain addresses OT intervention or need for OT intervention only1,3. Conversely, much of the literature in medical journals does not include OT when discussing the multidisciplinary biopsychosocial approach to chronic pain management4. This article provides strong initial evidence for the support of occupational therapy within the multidisciplinary team for chronic pain management that is easily translated to medical journals, who have in the past not recognized OT within the multidisciplinary team.
References
1. Ashley Uyeshiro Simon, Chantelle E. R. Collins; Lifestyle Redesign® for Chronic Pain Management: A Retrospective Clinical Efficacy Study. Am J Occup Ther 2017;71(4):7104190040p1-7104190040p7. doi:10.5014/ajot.2017.025502
2. Centers for Disease Control and Prevention. (2016, April 27). Nonopioid treatments for chronic pain. Retrieved from http://www.cdc.gov/drugoverdose/pdf/alternative_treatments-a.pdf
3. Katie Robinson, Norelee Kennedy, Dominic Harmon; Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain. Am J Occup Ther 2011;65(1):106-113. doi:10.5014/ajot.2011.09160.
4. Gatchel, R. J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. Journal of Pain, 7, 779–793. https://doi.org/10.1016/j.jpain.2006.08.005
