Background & Aims

This study aims to determine whether age, sex and outcome measures are predictive of improvement in pain interference following pain rehabilitation.

Background
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. There is insufficient evidence about whether psychological, biological or social factors are predictive of outcome following pain rehabilitation. This study aims to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation. The secondary aim was to undertake a responder analysis.

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. Inclusion Criteria were adults aged 18 or above, patients that have attended the pain rehabilitation service and completed an intensive pain rehabilitation programme (40 -45 hours of rehabilitation). Patients gave their written consent to their anonymised, aggregated data being stored on a database for 5 years and being used for service evaluation and publication purposes. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in Brief Pain Inventory (BPI). Each model was adjusted for baseline BPI, sex, depression and fear avoidance. An MID was calculated for the BPI and used in a responder analysis.

Results

Standard regression analyses of 209 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. In the regression analyses of the BLP, included variables were sex, age, BPI-interference, pain intensity NRS, PHQ-9, TSK, CPAQ, sit to stand in 1 minute and 5 minute walk test. In the regression analyses of the GBA data, included variables were sex, age, BPI-interference, pain intensity NRS, PHQ. 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<0.05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement (p = <0.0005).

Conclusions

Conclusions
We have demonstrated that higher self-reported pain interference and better performance in physical performance tests at baseline were significant predictors of better outcome and were indicators of greater treatment response, following two separate rehabilitation programmes. Better performance in physical performance tests was significantly associated with rehabilitation outcome. Participants with higher pain interference scores and lower levels of function were less likely to achieve an MID in the BPI–pain interference scale. This novel finding, focussing on markers of physical function, may prove useful in the clinical setting to guide decision making with regard signposting to appropriate rehabilitation programmes. Future research is needed to validate these findings, as well as to extend the analysis to evaluate which factors predict response to one type of pain rehabilitation intervention over another.

References

1.
Heelas L, Soni A, Barker K. Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme? British Journal of Pain. 2023;17(6):532-545. doi:10.1177/20494637231190190
Craner JR, Sperry JA, Koball AM, et al. Unique contributions of acceptance and catastrophizing on chronic pain adaptation. Int J Behav Med 2017; 24(4): 542–551.
Boonstra AM, Reneman MF, Waaksma BR, et al. Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain. Disabil Rehabil 2015; 37(14): 1242–1250.

Presenting Author

Leila Heelas

Poster Authors

Leila Heelas

MSc

Oxford University Hospitals NHS FT

Lead Author

Anushka Soni BA Hons Medicine D Phil

Oxford University / OUH NHS FT

Lead Author

Karen Barker BSc

MSc

Oxford University Hospitals NHS Foundation Trust

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies