Effectiveness of a multidisciplinary rehabilitation program in real-world patients with chronic back pain: A pilot cohort data analysis

Dokyoung S You, Maisa S Ziadni, Corinne E Cooley, David C Talavera, Sean C Mackey, Heather Poupore-King, Dokyoung S You, Maisa S Ziadni, Corinne E Cooley, David C Talavera, Sean C Mackey, Heather Poupore-King

Abstract

Background: Randomized clinical trials (RCT) suggest a multidisciplinary approach to pain rehabilitation is superior to other active treatments in improving pain intensity, function, disability, and pain interference for patients with chronic pain, with small effect size (ds= 0.20-0.36) but its effectiveness remains unknown in real-world practice.

Objective: The current study examined the effectiveness of a multidisciplinary program to a cognitive and behavioral therapy (pain-CBT) in real-world patients with chronic back pain.

Methods: Twenty-eight patients (M𝑎𝑔𝑒= 57.6, 82.1% Female) completed a multidisciplinary program that included pain psychology and physical therapy. Eighteen patients (M𝑎𝑔𝑒= 58.9, 77.8% Female) completed a CBT-alone program. Using a learning healthcare system, the Pain Catastrophizing Scale, 0-10 Numerical Pain Rating Scale, and Patient-Reported Outcomes Measurement Information System® measures were administered before and after the programs.

Results: We found significant improvement in mobility and pain behavior only after a multidisciplinary program (p's < 0.031; d= 0.69 and 0.55). We also found significant improvement in pain interference, fatigue, depression, anxiety, social role satisfaction, and pain catastrophizing after pain-CBT or multidisciplinary programs (p's < 0.037; ds = 0.29-0.73). Pain ratings were not significantly changed by either program (p's > 0.207).

Conclusions: The effect of a multidisciplinary rehabilitation program observed in RCT would be generalizable to real-world practice.

Keywords: Chronic back pain; a learning health system; acceptance and commitment therapy; cognitive and behavioral therapy; multidisciplinary program; physical therapy.

Conflict of interest statement

None to report.

Figures

Figure 1.
Figure 1.
Comparison of survey administration and the treatment course for Pain-CBT and BIA programs. Post-Tx: post-treatment.
Figure 2.
Figure 2.
Comparisons of pre- and post-treatment outcomes. A)–G) are PROMIS T scores of Mobility, Pain Interference, Pain Behavior, Fatigue, Depression, Anxiety, and Social Role Satisfaction, respectively, with higher T scores indicating worse health status in each domain. H) is PCS total score. Errors = SEM.

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