Exploration of the Effectiveness of a Three-week Multidisciplinary Chronic Pain Programme at Queen Elizabeth Health, New Zealand
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Multidisciplinary chronic pain programmes are well known to help those with chronic pain. However, there is still much to understand about what components work and for whom. This doctoral thesis involved two studies. Study one explored whether programme treatment was more effective delivered in a group-based approach compared to a more individual approach and study two explored whether patients’ baseline characteristics at admission could predict three-month outcome. Methods: The first study was a retrospective cohort study. A total of 231 patients were surveyed; 112 patients were on a programme where more individually based components were delivered, and 119 patients in the group-based components programme. HADS anxiety and depression, and the QE Health Scale were compared at baseline and at discharge from the 3-week programme. The second study was a prospective cohort study where 165 patients completed the three-week programme, of whom 100 patients returned the three month follow up survey. Demographic data were collected at baseline, while clinical outcome measures (BPI intensity and interference, DASS-21 depression, anxiety and stress, PCS rumination, helplessness and magnification and PSEQ pain self-efficiency questionnaire) data were collected three times: at baseline, programme discharge, and 3-month follow up. Regression analysis was utilised to determine if baseline demographic or clinical characteristics were associated with outcomes at 3-months. Results: Study one found that there were no significant differences in any outcome measures between the group and individual delivery. Those patients who had RA and OA in the group delivery had statistically significant improvement in the QE Health score and HADS depression then those receiving individual delivery. The second study found that all the clinical outcome measures that were high at baseline were also high at follow up. PCS rumination and BPI intensity and interference were more predictive of multiple poorer outcomes at 3 months than any other outcomes. As far as demographics were concerned, being Māori was associated with poorer outcomes at three months in relation to BPI Interference and PCS magnification. Those with fibromyalgia had a significant increase in PSEQ but decrease in DASS-21 depression at 3 months. Part time workers had a reduction in PCS helplessness and rumination. Conclusion: These results provide an opportunity for targeted intervention to groups of people in the future, adding to the body of knowledge regarding the effectiveness of a variety of multidisciplinary pain management programmes.