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Oosterhaven J1,2, Wittink H1, Mollema J3, Kruitwagen C4, Deville W2
1University of Applied Sciences Utrecht, Researchgroup Lifestyle and Health, Utrecht, Netherlands, 2University of Amsterdam, Amsterdam Institute of Social Science Research, Amsterdam, Netherlands, 3University of Applied Sciences Utrecht, Utrecht, Netherlands, 4Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
Background: Interdisciplinary pain management programmes are provided by a multidisciplinary team (psychologists, physical therapists, occupational therapists, social workers) collaborating in assessment and treatment using a shared biopsychosocial model and goals. Although interdisciplinary pain management programmes have been shown to be moderately effective for patients with chronic pain, room for improvement remains. Due to the complexity of chronic pain management programmes and the focus on self-care behaviour, dropout is inevitable. Dropout is associated with poor treatment outcome. Turk and Rudy brought relapse and noncompliance to attention as a significant problem in chronic pain management in the early nineties, despite this dropout continues to be a neglected topic until now.
Purpose: The objective of this systematic review was to identify predictors for dropout during interdisciplinary pain management programmes.
Methods: This systematic review was performed according to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions and a PROSPERO protocol was developed a priori. A comprehensive search strategy was conducted in the following databases: PubMed, PsychINFO, CINAHL, Embase and SPORTDiscus. Screening, data-extraction and quality assessment was done independently by two researchers. Any difference between the two reviewers was resolved through discussion and if needed a third reviewer was consulted to reach consensus. The methodological quality of all included studies was assessed with the QUIPS tool. The heterogeneity of the study populations, study interventions, predictors, statistical analyses and statistical reporting did not support applying a best evidence synthesis.
Results: Eight studies with low methodological quality were included in this review. Out of 63 potential predictors identified in univariate analyses, significant results were found for 18 predictors of dropout in multiple logistic regression analyses in four domains as described by Meichenbaum and Turk:
1) the sociodemographic domain (2);
2) patient domain (8);
3) disease domain (6) and
4) treatment domain (2).
Conclusion(s): This systematic review revealed that the literature with regard to the prediction of dropout is still in the stage of model development. This systematic review will challenge clinicians and researchers to collaborate in developing strategies to overcome dropout in order to generate better outcomes in chronic pain management programmes.
Implications: Dropout is still a neglected topic in daily practice and in research in interdisciplinary pain management. Strategies that have been developed in the mental health literature that may also be applied in interdisciplinary pain management programmes are: to focus on patient's expectations and- preferences and motivation before and during treatment and to monitor the work-alliance between patient and therapist and create the possibility for patients to give feedback to the therapist.
Keywords: Dropout, Interdisciplinary Pain Management Programmes, Systematic Review
Funding acknowledgements: This study is supported by grants of the Dutch government- NWO- 023.004.121 and SIA Raak 2012-14-12P
Purpose: The objective of this systematic review was to identify predictors for dropout during interdisciplinary pain management programmes.
Methods: This systematic review was performed according to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions and a PROSPERO protocol was developed a priori. A comprehensive search strategy was conducted in the following databases: PubMed, PsychINFO, CINAHL, Embase and SPORTDiscus. Screening, data-extraction and quality assessment was done independently by two researchers. Any difference between the two reviewers was resolved through discussion and if needed a third reviewer was consulted to reach consensus. The methodological quality of all included studies was assessed with the QUIPS tool. The heterogeneity of the study populations, study interventions, predictors, statistical analyses and statistical reporting did not support applying a best evidence synthesis.
Results: Eight studies with low methodological quality were included in this review. Out of 63 potential predictors identified in univariate analyses, significant results were found for 18 predictors of dropout in multiple logistic regression analyses in four domains as described by Meichenbaum and Turk:
1) the sociodemographic domain (2);
2) patient domain (8);
3) disease domain (6) and
4) treatment domain (2).
Conclusion(s): This systematic review revealed that the literature with regard to the prediction of dropout is still in the stage of model development. This systematic review will challenge clinicians and researchers to collaborate in developing strategies to overcome dropout in order to generate better outcomes in chronic pain management programmes.
Implications: Dropout is still a neglected topic in daily practice and in research in interdisciplinary pain management. Strategies that have been developed in the mental health literature that may also be applied in interdisciplinary pain management programmes are: to focus on patient's expectations and- preferences and motivation before and during treatment and to monitor the work-alliance between patient and therapist and create the possibility for patients to give feedback to the therapist.
Keywords: Dropout, Interdisciplinary Pain Management Programmes, Systematic Review
Funding acknowledgements: This study is supported by grants of the Dutch government- NWO- 023.004.121 and SIA Raak 2012-14-12P
Topic: Pain & pain management
Ethics approval required: No
Institution: University of Amsterdam
Ethics committee: For this systematic review no ethics approval was required
Reason not required: For this systematic review no ethics approval was required
All authors, affiliations and abstracts have been published as submitted.
