How Effective is a Physiotherapy Led Persistent Pain Programme Following an Initial Pain Education Session?

Purpose

CwmTaf Healthboard previously offered an exercise programme for the treatment of chronic low-back pain. After reviewing this service, it was felt this did not represent population needs or the current pain science/literature, and that the treatment principles could be applied to patients with more generic persistent pain presentations.

Persistent pain patients often have low self-efficacy and are repeatedly poor attenders to therapy-led interventions.

To address this, a pain education session was introduced prior to commencing a pain programme entitled The Functional Conditioning Programme (FCP).

The questions posed were how effective would this education session be at preventing dropout rates and how clinically effective would the FCP be?

 

96.7%
of patients improved on at least one outcome measure and 2 patients (3.3%) were worse on all data sets.
57%
of patients reported a lower STaRT back score when retested. Despite this not being a valid outcome score it could be suggestive that patients had less fear-avoidance and catastrophyisation.

Approach

This was a service evaluation and improvement project.

Triaged patients, identified as having pain for greater than 6 weeks and had previously been unsuccessful with standard physiotherapy were invited to a group-based pain education session.

Physiotherapists used a PowerPoint presentation explaining current pain science, evidence-based management and specific details of the FCP.

Patients were given a telephone number to contact if they wished to attend a 1:1 physiotherapy session and subsequently the FCP.

Patient's attending the 1:1 session completed the following outcome measures; 1. EQ5D, including health percentage score, 2. Oswestry Disability Index (ODI) (later changed to the Patient Self-Efficacy Score - PSEQ, as patients were not fully compliant with the ODI) 3. STaRT back score.

Patients were invited to attend the full FCP sessions (4 x 2-hour sessions) running at 3 separate leisure centres. Patients were then invited back to recomplete their outcome measures 6 weeks post-FCP.

Outcomes

Over a period of 301 days 243 patients were invited to the pain education sessions and 173 'Did Not Attend' (71% drop out rate).

Of those who did attend 59 pre-intervention data sets were collected. Of these 42 patients completed pre and post outcomes (28% drop out).

96.7% of patients improved on at least one outcome measure and 2 patients (3.3%) were worse on all data sets.

40.5% EQ5D scores improved, with an average improvement of 0.262 over an average of 81 days.

52.5% of patients stated their overall health percentage had improved (average increase of 17.3%).

ODI 52.3% improved their scores (average reduction 4.4 points).

PSEQ 28.5% of patients with completed data sets improved with an average increase of 11.08 marks.

57% of patients reported a lower STaRT back score when retested. Despite this not being a valid outcome score it could be suggestive that patients had less fear-avoidance and catastrophyisation.
 

It appears that inviting patients to a pain education talk leads to a high dropout rate. It could be argued that this reduces nonattendance to 1:1 physio and thus increases productivity with hypothesised positive financial implications.

When comparing the pre and post outcome measures it is evident that the service is clinically effective as a large proportion of patients improved their outcome measures.

Future work includes introducing physical outcome measures (e.g sit-to-stand in 30 seconds) to analyse objective changes.

Implications

Implications of the project include finding ways of attempting to positively facilitate patient choice.

Funding acknowledgements

None.

Additional notes

This work was presented at Physiotherapy UK 2019