Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 12

Predictors of dropout: a systematic review
9
literature with regard to the topic of dropout is still in
the stage of model development, this is defined as type
1A studies, according to the TRIPOD statement (37).
Since no internal or external validation was considered
in the studies included in this systematic review, the
results should be interpreted with care. session evaluation of progress and define no fixed
length of the programme (10–13, 39). This systematic
review will challenge clinicians and researchers to pay
more attention to dropout and collaborate in developing
strategies to overcome dropout in order to generate bet-
ter outcomes in chronic pain management programmes.
Strengths Conclusion
Since Turk & Rudy addressed the topic of dropout in
the early1990s, little high-quality research has become
available, as shown by this systematic review. The ma-
jority of research on dropout in interdisciplinary pain
management programmes for chronic musculoskeletal
pain has relied on the investigation of differences bet-
ween dropouts and programme completers at baseline
or univariate analyses of one variable associated with
dropout. To our knowledge this is the first systematic
review on dropout in chronic musculoskeletal pain
patients in the rehabilitation setting. A strength of this
review is that it provides an overview of predictors of
dropout in chronic musculoskeletal pain: 63 potential
predictors of dropout in univariate analyses and 48 out
of 63 potential predictors were investigated in multiple
logistic regression analyses. This systematic review presents an overview of pre-
dictors of dropout. The literature with regard to the
prediction of dropout has focused mainly on patient
characteristics and is still in the stage of model deve-
lopment. Future research might also focus on therapist/
therapy-related predictors and the interaction between
these predictors. This review suggests future research
on this topic, in order to generate better outcomes in
interdisciplinary pain management programmes.
Implications and future directions
Dropout is still a neglected topic in daily practice and
in research in interdisciplinary pain management.
Learning from the abundant amount of research that
has been done in the mental health literature recom-
mendations for future directions can be specified. One
direction could be to perform exit interviews with
dropouts to investigate reasons for dropout. Based on
these reasons for dropout, strategies may be developed
to prevent dropout in future (39). Another direction
is to address factors that are predictive for dropout in
clinical assessment and to make a distinction whether
predictors are modifiable or non-modifiable. For
example, younger age is a predictor for dropout in
chronic pain management programmes. This predictor
is non-modifiable and may be addressed by modifying
the treatment schedule.
Other strategies that have been developed in the
mental health literature that may also be applied in
interdisciplinary pain management programmes are: to
focus on the assessment of patient’s expectations and
preferences and motivation before treatment onset and
during the treatment programme, to provide education
to address patient’s expectations, preferences and mo-
tivation, to monitor the work-alliance between patient
and therapist and create the possibility for patients to
give feedback to the therapist. Since dropout patients
are all different, ideally, prediction of dropout would
use prospective cohort designs including session by
ACKNOWLEDGEMENTS
The authors thank Josca Snoei and Liedeke van Schoot at the
University of Applied Sciences Utrecht for their help with the
initial construction of this systematic review. The authors also
thank Rob Scholten of the Dutch Cochrane Centre for his advice
on the best evidence synthesis of this review.
Funding sources: This study is supported by grants of the Dutch
government- NWO- 023.004.121 and SIA Raak 2012-14-12P.
Systematic review registration number: CRD42016039689.
The authors have no conflicts of interest to declare.
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