Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change

Abstract

Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure clients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics.Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation.Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10, and PSEQ.Results: 56 out of 83 clients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. 18 showed no reliable change. Only one person deteriorated.Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduces the reliability of these conclusions and led to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made.

A single case experimental design: how do different psychological outcome measures capture the experience of a client undergoing CBT for chronic pain

“…Analysis was conducted using reliable change index (RCI) scores 22 and clinical cut-off scores. Data for RCI and clinical cut-offs have been obtained from: GAD-7, 23 PHQ-9, 7 PSEQ, 24 RCI data for the PCS was obtained from Mehlsen et al, 25 and clinical cut-offs on the PCS were from Sullivan. 15…”

Clinical effectiveness of a pain psychology service within an outpatient secondary care setting

“…Efforts to improve care and cost-efficiency have led to an increasing emphasis on "evidencebased practice", i.e., therapies supported by randomised control trials (RCTs) (Macey et al, 2015). RCTs attest to the treatment efficacy of ACT under controlled conditions in comparison with wait-list, control groups and CBT (e.g.…”

“…The Morley study found pre-post effect sizes (d) ranging from 0.26 to 0.73 (i.e. small to medium magnitudes) This evaluation follows on from one conducted in 2012-2013 (Macey et al, 2015) and was deemed necessary as part of the service's commitment to continuous evaluation, accountability and transparency (Department of Health (DOH, 2010). Demonstrating effectiveness is also necessary for future planning, and evaluations are used to make continual improvements to clinical data recording.…”

“…This also ensured that clients assessed in earlier service evaluations (e.g. Macey et al, 2015) were not duplicated here.…”

“…By using these established cut-offs we are able to make direct comparisons with a previous evaluation (in terms of proportions showing reliable and clinical change) which adopted the same criterion (e.g. Macey et al, 2015). The combination of RCI and CSC criteria also enables patients to be classified into one of five possible outcomes at post-treatment (Connell and Barkham, 2007;Davies and Sheldon, 2011):…”