Patient-Reported Outcome of a Multidisciplinary Pain Management Program, Focusing on Occupational Performance and Satisfaction with Performance

Abstract

Aim:The aim was to describe the effect of a multidisciplinary pain management program, in terms of patientreported occupational performance and satisfaction with performance. Methods:The study is a retrospective, case series study. Data from interviews documented routinely in patient medical records were used. Interviews were made at introduction, on conclusion and six months after a pain management program. Data from all participants (n=85) introduced during one year, were analysed. The Canadian Occupational Performance Measure (COPM) was used as the main outcome measure.Results: Estimated occupational performance as well as satisfaction with performance improved between measures (occupational performance p<0.001; satisfaction with performance p<0.001). The percentage of participants, who improved two or more points on the COPM ten-point scale between baseline and the 6-month follow up, was 27% for occupational performance and 40% for satisfaction with performance. Conclusion:The findings raise questions regarding what the team might learn from different ways of scrutinizing results; the relevant level of MID in this program; and the overall objective in terms of the proportion of clients who reported a 'successful' outcome in occupational performance and satisfaction with performance, based on the identified MID. These questions need to be further analysed and discussed within the professional team.

Everyday occupational problems perceived by participants in a pain rehabilitation programme

“…One of these (10) was similar to the present study with regard to type of participants (mixed pain diagnoses and mostly women) and rehabilitation setting (specialized pain rehabilitation at university hospital). Almost the same percentage of problems in the leisure category (32% as compared to 31% in the present study) was reported in that study (10). These authors, however, observed a higher frequency of problems in productivity (40% as compared to 32%) and a somewhat lower frequency in self-care (28% as compared to 37%).…”

“…Several studies reporting frequencies of occupational problems using the COPM have been published (10,(29)(30). One of these (10) was similar to the present study with regard to type of participants (mixed pain diagnoses and mostly women) and rehabilitation setting (specialized pain rehabilitation at university hospital).…”

“…This semi-structured interview-based measure focuses on meaningful and important occupations as chosen by patients. The COPM was developed for use by occupational therapists, but has also been adopted as a general outcome measure for teambased pain rehabilitation (8)(9)(10)(11)(12). Occupations are in this context used to denote all kinds of everyday chores, including self-care, paid/unpaid work, household management, and leisure (13).…”

“…Samuelsson et al (10) found working to be the most frequently prioritized everyday occupational problem (69% of participants) in a population of patients with musculoskeletal pain, whereas Walsh et al (9) reported walking (56% of participants) to be the most frequently prioritized problem among patients with chronic low-back pain. These diverging findings indicate a need to further assess which types of occupational problems are most relevant among patients with pain entering pain rehabilitation programmes.…”

“…Then, each of these occupations is rated on a performance scale (1 = not able to perform, 10 = able to perform extremely well) and a satisfaction with performance scale (1 = not satisfied at all, 10 = extremely satisfied). The COPM has been found to be reliable (21) and valid, when tested for concurrent criterion and construct validity (22,23), suitable for improving the process of goal-setting and to be a responsive outcome measure for occupational therapy in general (11) and for pain and team-based treatment programmes specifically (10,24,25). The Swedish version (26), also shown to be responsive to change over time (11), was used in the present study.…”