Outcomes at a glance

1. Outcomes at a glance • This Outcome report is based on data from clients who completed a Pain Management Programme at the RealHealth Treatment Centre in Coventry between May 2010 and November 2012 . • Pain related disability was reduced on average by 28% from start to completion of the Pain Management Programme, and these improvements were maintained at a four week follow up. • Of the clients who showed emotional problems at the start of the programme, 87% showed a clinical improvement in symptoms on programme completion. • Programme users showed an average reduction in fear of movement and activity avoidance of 22%, which had not returned to baseline levels 4 weeks after programme completion. • Confidence in performing activities whilst in pain increased by 64% from start to completion of the programme, and these benefits were maintained at a four week follow up. • Clients showed an average reduction in catastrophic thinking of 28% at programme completion and 34% at follow up compared to initial pre-programme assessments. • On average, functional ability improved by 23% from programme start to programme completion, and improvements of 20% were maintained 4 weeks following programme completion. • Representative sample based on 16 clients

2. Reducing Pain-Related Disability The Roland & Morris Disability Questionnaire (RMDQ) is a widely used health status measure for low back pain, providing self-ratings of the level of physical disability experienced by the patient as a consequence of the pain. Scores on the RMDQ range from 0-24, with higher scores indicating a greater level of pain related disability. Our data shows that for the clients in the Pain Management Programme there was a significant average reduction of 28% in pain related disability scores between admission and discharge from the programme. These improvements were maintained at follow up 4 weeks after programme completion. Improving Self-Efficacy The Pain Self-Efficacy Questionnaire (PSEQ) is a 10-item questionnaire developed for people with ongoing pain to assess a patient’s confidence in performing activities while in pain. Higher PSEQ scores indicate stronger self-efficacy beliefs and are associated with return to work and maintenance of functional gains. Scores on the PSEQ were increased by 64% from start to completion of the programme, indicating significant improvements in self-efficacy beliefs. These benefits were maintained at a 4 week follow up, with PSEQ scores still showing a 57% increase from the programme start.

3. Reducing fear of movement The TAMPA Scale for Kinesiophobia (TSK) is a 17 item questionnaire that provides subjective self-report ratings of the extent of fear of movement or activity as a result of chronic pain. Possible scores on The TSK range from 17 to 68, with higher scores indicating an increasing fear of movement, injury or re-injury. Programme users showed a significant reduction in TSK scores of 22% from programme start to programme completion, with a mean reduction of 20% maintained 4 weeks following programme completion. Reducing catastrophic thinking The Pain-Related Self-Statements Scale (PRSS) is a 18 item cognitive measure of the extent of catastrophic thinking and depressive symptoms. Scores on the PRSS range from 0 to 5, with higher scores indicating more frequent catastrophising when experiencing pain. Our data shows a reduction in PRSS scores of 28% from the start of the programme to completion, and further reductions at follow up resulted in an overall reduction in PRSS scores of 34%. This indicates that the programme significantly decreased the extent of clients’ catastrophic thinking and led to continued improvements over the 4 weeks following programme completion.

4. Reducing emotional problems The Hospital Anxiety and Depression Scale is a 14 item scale used to determine the levels of emotional problems experienced by a patient. The scale contains two subscales, anxiety (7 items) and depression (7 items). Scores of 11 or higher on either of the subscales indicate probable presence of mood disorder and a score of 8 to 10 is suggestive of the presence of emotional problems in the respective area (Snaith, 2003). HADS scores for the depression subscale indicated that 50% of our programme users had a probable mood disorder, and 38% had suggestive emotional problems on admission to the programme. On completion of the programme, however, 50% showed no emotional problems and these benefits were maintained with 46% still showing no emotional problems at a 4 week follow up. Improvements were also seen on the HADS anxiety subscale, with the percentage of programme users identified as having a probable mood disorder dropping from 60% to 26% at programme completion. 53% showed no emotional problems on the anxiety subscale at programme completion and this was maintained at a 4 week follow up.

5. Improving functional ability Functional ability measures were taken to assess any improvements in strength, flexibility, co-ordination and self-confidence in activity over the course of the programme. Specific functional ability measures included timed walk, sit to stand, get up and go, and step ups. These measures were taken at the start of the programme, on completion of the three-week programme, and at a follow up four weeks after programme completion. The data shows a significant improvement in overall functional ability of 23% from pre-programme assessment to programme completion. These improvements were maintained over the four weeks following programme completion, with an average improvement of 20% seen at 4 week follow up assessments.