Journal of Rehabilitation Medicine 51-10 | Page 42

J. Oosterhaven et al.
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motivated for behavioural change; (iii) patients
unable to read or speak Dutch; and (iv) patients
involved in a health-related legal procedure of
conflicting interest.
Intervention
The outpatient IPMP in Heliomare is based on
cognitive behavioural therapy with patient pain
neuroscience education, based on a biopsychoso-
cial explanation of chronic pain. The programme
lasts 16–20 weeks and comprises a diagnostic
phase of 4 weeks, and a treatment phase of 12–16
weeks. Individual illness representations, treat-
Fig. 1. A dynamic extended model of treatment and illness representations (E-CSM of
ment beliefs, emotional representations and co-
Self-Regulation). Reprinted with permission of “Treatment appraisals and beliefs predict
adherence to complementary therapies: a prospective study using a dynamic extended
ping procedures of the patients are addressed in
self-regulation model” by F. Bishop, L. Yardley, G. Lewith, 2008. Br J Health Psychol. 13
the interdisciplinary assessments, resulting in an
(4): 701–718. ©2008 The British Psychological Society (6).
individually-tailored intervention programme.
The treatment phase focuses on personal rehabi-
litation goals, enabling patients to use adequate
treatment beliefs, a “mismatch” in communication can
coping strategies to improve self-management behaviour with
be the result (11–13). These unaddressed beliefs and
chronic pain. The individually-tailored intervention programmes
treatment expectations may result in non-adherence
takes the form of 2–3 meetings per week for 1 h with profes-
sionals from different disciplines, such as physiotherapy, social
and dropout by individual patients, both associated
work, occupational therapy or psychology (16).
with poor treatment outcomes. Patient dropout may
cause feelings of demoralization in providers and may
lead to overutilization of the healthcare system and
high financial costs at the societal level (14).
To improve the overall effectiveness of IPMPs, more
insight is needed from studies which are designed a
priori to predict dropout, such as prospective cohort
studies (5). The central aims of this study were to
explore predictors of dropout of patients with chronic
musculoskeletal pain in an IPMP, and to develop and
validate a multivariable prediction model based on the
E-CSM of Self-Regulation.
Procedure
Study assessments were integrated into the clinical baseline
assessments (T0) and post-rehabilitation assessments (T1). A
total of 208 consecutive patients were invited before the start
of the clinical baseline assessment by an assistant psychologist
(WW) to participate in this study, of which 195 (94%) agreed.
Thirteen patients refused to participate in the study for the fol-
lowing reasons: concentration problems, poor vision, and refusal
to participate in clinical assessments. Another 7 patients were
excluded as they did not have a diagnosis of chronic muscu-
loskeletal pain. All 188 included patients completed baseline
assessments as part of the intake of the IPMP and received
standard rehabilitation care for 16–20 weeks (Fig. 2).
For all patients the dropout status was determined from patient
registries in the institution by 2 independent researchers (JO, JD).
Each patient was classified as either a programme completer (0) or
dropout (1). Dropout was defined as: “patients with chronic pain,
who were referred to a chronic pain management programme,
who initiated (participated in the baseline assessments), but
discontinued prior to completion of the entire programme” (17).
METHODS
Design
This study used a prospective cohort design. The study was
registered with the Medical Ethics Committee of the Academic
Medical Centre of Amsterdam, which declared that it does not
fall under the scope of the “Medical Research
Involving Human Subjects Act”. All patients
provided written informed consent.
Subjects and recruitment
Patients with chronic pain were recruited and
followed up (July 2013 to May 2015) in an in-
terdisciplinary outpatient rehabilitation centre,
Heliomare Wijk aan Zee, in the Netherlands.
Chronic pain was defined as pain that persists
for longer than 3 months, or pain that extends
beyond the expected period of healing (15). The
inclusion criterion was: having chronic muscu-
loskeletal non-cancer pain eligible for an IPMP.
The exclusion criteria were: (i) patients with
chronic musculoskeletal pain with serious in-
terfering psychiatric problems; (ii) patients not
www.medicaljournals.se/jrm
Patients referred for chronic pain rehabilitation asked to participate
208
Patients signed informed consent
195
T0 Baseline assessment pre- rehabilitation
188
Rehabilitation
Dropouts
35
Fig. 2. Patient flowchart.
Completers
153
Patients Declined to participate
13
Patients excluded by exclusion criteria
7