Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 5

J Rehabil Med 2019; 51: 2–10
REVIEW ARTICLE
PREDICTORS OF DROPOUT IN INTERDISCIPLINARY CHRONIC PAIN
MANAGEMENT PROGRAMMES: A SYSTEMATIC REVIEW
Janke OOSTERHAVEN, PT, MSc 1,2 , Harriet WITTINK, PT, PhD 1 , Jurgen MOLLEMA, MSc 1 , Cas KRUITWAGEN, MSc 1,3 and
Walter DEVILLÉ, MD, PhD 2–4
From the 1 Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, 2 Amsterdam Institute for Social Science
Research, University of Amsterdam, Amsterdam, 3 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht,
and 4 National Knowledge and Advisory Centre on Migrants, Refugees and Health (Pharos), Utrecht, The Netherlands
Objective: Systematic review to identify predictors
for dropout during interdisciplinary pain manage-
ment programmes.
Data sources: PubMed, PsycINFO, CINAHL, Embase,
and SPORTDiscus were searched from inception to
22 June 2017.
Study selection: Screening, data-extraction and qua-
lity assessment was carried out independently by 2
researchers.
Data synthesis: Eight studies with low methodolo-
gical quality were included in this review. Out of 63
potential predictors identified in univariate analy-
ses, significant results were found for 18 predictors
of dropout in multiple logistic regression analyses in
4 domains, as described by Meichenbaum & Turk: (i)
sociodemographic domain (2); (ii) patient domain
(8); (iii) disease domain (6); and (iv) treatment do-
main (2).
Conclusion: This systematic review presents an
overview of predictors 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 development. Future research should
focus on therapist/therapy-related predictors and
the interaction between these predictors. This re-
view suggests future research on this topic, in order
to generate better outcomes in interdisciplinary pain
management programmes.
Key words: dropout; chronic musculoskeletal pain; interdis-
ciplinary pain management programmes; systematic review.
Accepted Oct 2, 2018; Epub ahead of print Dec 4, 2018
J Rehabil Med 2019; 51: 2–10
Correspondence address: Janke Oosterhaven, Research Group Lifest-
yle and Health, University of Applied Sciences Utrecht, Heidelberglaan
7, NL-3584 CS Utrecht, The Netherlands. E-mail: janke.oosterhaven@
hu.nl
D
ropout from chronic musculoskeletal pain ma-
nagement programmes is associated with poor
treatment outcomes (1–3). Despite this, dropout con-
tinues to be a neglected topic even after Turk & Rudy
brought relapse and non-compliance to attention as a
significant problem in chronic pain management (4).
This is remarkable, since the assumption is that, be-
cause of the complexity of chronic pain management
programmes and the focus on self-care behaviour,
dropout is inevitable (4–6).
LAY ABSTRACT
Dropout from interdisciplinary pain management pro-
grammes is reported to be high. This may result in poor
treatment outcomes. Therefore, paying attention to
the prevention of dropout is important. This systematic
review presents an overview of predictors of dropout
(mainly patient characteristics) and makes suggestions
for future research on this topic.
To date, the literature on dropout in interdisciplinary
pain management has largely relied on post-hoc ana-
lyses on differences between dropouts and treatment
completers in cross-sectional research studies. The
importance of dropout is acknowledged considering
the dropout rates found in these studies ranging from
5% to 46% (4, 7, 8). However, few longitudinal studies
have been performed and, as yet, no systematic review
has summarized predictors for dropout. More insight
in these predictors is needed to develop strategies to
prevent premature treatment dropout. Although various
definitions of dropout exist, we used the following
definition: “patients with chronic pain, who were refer-
red to a chronic pain management programme, who
initiated (participated in the baseline assessments),
but discontinued prior to completion of the entire
programme” (9).
Since therapy for patients with chronic pain is partly
similar to that of patients with mental disorders, we
can look at mental health research that has been done
on dropout in psychotherapy/cognitive therapy. This
literature demonstrated dropout incidences around
20% (19.7–21.9%) and valuable insights with regard
to predictors of dropout have been gained (10–13).
These predictors can be categorized in 5 domains of
barriers to retention in therapy, as suggested by Meic-
henbaum & Turk (14): (i) sociodemographic (dropouts
were younger and less educated (10, 13)); (ii) patient
(dropouts were less motivated for treatment, prefer-
red alternative treatments and were diagnosed with
a specific disorder such as depression or substance
use disorder) (10–13); (iii) disease; (iv) treatment (no
pre-determined treatment time limit and outpatient
treatments were associated with dropout); and (v)
healthcare system/system domain (higher dropout rates
were found when the treatment was applied by trainees
instead of licensed therapists (10)).
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
doi: 10.2340/16501977-2502
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977