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J Rehabil Med 2019; 51: 761–769 ORIGINAL REPORT PAIN CATASTROPHIZING PREDICTS DROPOUT OF PATIENTS FROM AN INTERDISCIPLINARY CHRONIC PAIN MANAGEMENT PROGRAMME: A PROSPECTIVE COHORT STUDY Janke OOSTERHAVEN, PT, MSc 1,2 , Harriet WITTINK, PT, PhD 1 , Jos DEKKER, MD, MSc 3 , Cas KRUITWAGEN, MSc 1,4 and Walter DEVILLÉ, MD, PhD 2,4,5 From the 1 Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, 2 Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 3 Heliomare, Rehabilitation Centre, Wijk aan Zee, 4 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, and 5 National Knowledge and Advisory Centre on Migrants, Refugees and Health (Pharos), Utrecht, The Netherlands Objective: To explore predictors of dropout of pa- tients with chronic musculoskeletal pain from an interdisciplinary chronic pain management pro- gramme, and to develop and validate a multivariable prediction model, based on the Extended Common- Sense Model of Self-Regulation (E-CSM). Methods: In this prospective cohort study consecu- tive patients with chronic pain were recruited and followed up (July 2013 to May 2015). Possible as- sociations between predictors and dropout were explored by univariate logistic regression analyses. Subsequently, multiple logistic regression analyses were executed to determine the model that best pre- dicted dropout. Results: Of 188 patients who initiated treatment, 35 (19%) were classified as dropouts. The mean age of the dropout group was 47.9 years (standard devi- tion 9.9). Based on the univariate logistic regression analyses 7 predictors of the 18 potential predictors for dropout were eligible for entry into the multiple logistic regression analyses. Finally, only pain cata- strophizing was identified as a significant predictor. Conclusion: Patients with chronic pain who cata- strophize were more prone to dropout from this chronic pain management programme. However, ­ due to the exploratory nature of this study no firm conclusions can be drawn about the predictive value of the E-CSM of Self-Regulation for dropout. Key words: dropout; chronic musculoskeletal pain; interdis- ciplinary pain management programmes; prospective cohort study; Extended Common-Sense Model of Self-Regulation; pain catastrophizing. Accepted Sep 13, 2019; Epub ahead of print Sep 23, 2019 J Rehabil Med 2019; 51: 761–769 Correspondence address: Janke Oosterhaven, Research Group Lifest- yle and Health, University of Applied Sciences Utrecht, Utrecht, The Netherlands. E-mail: [email protected] A lthough interdisciplinary pain management pro- grammes (IPMPs) have been shown to be mode- rately effective for patients with chronic pain (1, 2), there is still room for improvement, because dropout has been reported to range from 10% to 51% (3, 4) and is considered high. A recent systematic review confir- LAY ABSTRACT Interdisciplinary pain management programmes have high dropout rates. Patient dropout from these pro- grammes is associated with poor treatment outcomes and high financial costs for society. To improve the over- all effectiveness of these programmes more insight is needed into predictors of dropout. This study explored whether patient beliefs (emotional and cognitive) about illness and treatment are related to dropout. The re- sults revealed that patients with chronic pain who cata- strophize were more prone to dropout. med that dropout is still a neglected topic in research in this domain, and that more high-quality research is needed based on a conceptual framework (5). A conceptual framework to study dropout is the Extended Common-Sense Model of Self-Regulation (E-CSM of Self-Regulation) (6, 7) (Fig. 1). The E- CSM of Self-Regulation, like cognitive behavioural therapy, a central element in IPMPs, is based on social cognitive theory. Patients learn to identify, monitor and change maladaptive cognitions and feelings related to pain and behaviour. According to the E-CSM of Self-Regulation, patients with chronic pain develop simultaneous cognitive and emotional representations (beliefs/perceptions) about their illness and treatment, as a response to continuous interruptive painful stimuli. These representations guide the patient towards coping strategies, a “common sense” solution to the painful stimuli. Representations are dynamic and may change over time, influenced by perceived symptom changes and appraisal of the therapy (6, 8). Research has shown that maladaptive cognitions (ideas of suffering from a severe illness with a long du- ration, experiencing low personal control) or feelings of extreme worry (anxiety, depression and catastrophi- zing) and low self-efficacy are related to poor treatment outcomes (8, 9). Stronger beliefs in the necessity, and fewer concerns regarding the effects, of treatment lead to higher adherence rates. When treatment does not correspond to patients’ expectations, patients can become frustrated and dropout may follow (10, 11). Published work shows that when healthcare provi- ders fail to explore patients’ illness representations and This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2609