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An evaluation of a web-based pain management programme - ‘Pathway Through Pain’: findings from interim analysis

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Pimm, J., Sarhan, F., Maloney, C., Pickering, S., King, S., Woods, N., Coote1, L. Nayoan, J.,

1 Buckinghamshire Chronic Pain and Fatigue Management Service
2 Centre of Excellence for Telehealth and Assisted Living (CETAL) – Buckinghamshire New University

Abstract

Background
There is a growing body of evidence supporting the effectiveness of web-based cognitive behavioural interventions. However, evidence for use of web-based treatments for chronic pain is still developing (Macea et al. 2010).This is a 3-year mixed method project using a non-randomised comparison of an experimental and control group.

Objectives
The objectives were to examine pre-post changes in clinical outcomes and the impact of technology on scores of quality of life, depression, disability and anxiety.

Methods
Patients were referred by healthcare workers within community-based services. Referral suitability was determined through a screening process carried out by a clinician working within the Buckinghamshire Chronic Pain and Fatigue Management Service (CPFMS). Outcome measures included disability (ODI), depression (PHQ-9), anxiety (GAD-7) and quality of life (EQ-VAS). The main reason people were not offered treatment was because they did not return the required screening forms. In this conference we will report the first 190 completers with pre- and post-intervention data available. Recruitment for the evaluation has been completed; final analysis of all completers is expected in April 2016.

Qualitative information was collected from completer and non-completer patients using three sources; focus groups, semi-structured interviews, and written feedback. Two focus groups were conducted for completers (n=11) and one for non-completer groups (n=4). Due to a low response rate from the non-completer group, a further six semi-structured interviews were conducted.

Results
Significant improvements were reported for all of the outcomes measured. Patients completing the web-based pain management programme showed significant improvements in disability (ODI, p = 0.000, effect size = 0.26), mood (PHQ-9, p= 0.000, effect size = 0.44), anxiety (GAD-7, p = 0.000, effect size = 0.39), and quality of life (EQ-VAS, p=0.000, effect size = 0.41). Follow up data (one month post-intervention) is available for 74 of the patients; significant improvements were maintained for anxiety and depression.

Those who completed the online programme reported feeling more motivated and willing to try different avenues to manage pain. They felt they benefited from taking part in the programme and reported improved quality of life. Those who did not complete the programme reported that parts of the programme were not relevant to them at that time. Both groups reported feeling ‘invisible’ and that previous clinicians have not taken them seriously.

Conclusion
This interim analysis of an on-going evaluation showed significant pre-post improvements in all outcome measures with small to medium effect sizes. Patients completing the online programme reported that they learnt new ways to cope and improve their quality of life, and the programme was relevant and touched on areas of importance in their life This improved safety through appropriate patient selection, engagement with the programme, review of progress and follow-up for those completing and failing to complete the programme. Integrating of the web-based programme with existing pain services created increase patient choice and access to pain management.

An evaluation of a web-based pain management programme - ‘Pathway Through Pain’: findings from interim analysis

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Pimm, J., Coote, L. Nayoan, J. & Sarhan, F.

1 Buckinghamshire Chronic Pain and Fatigue Management Service
2 Centre of Excellence for Telehealth and Assisted Living (CETAL) – Buckinghamshire New University

Abstract

Background
There is a growing body of evidence supporting the effectiveness of web-based cognitive behavioural interventions. However, evidence for use of web-based treatments for chronic pain is still developing (Macea et al. 2010). This is an interim evaluation of changes in clinical outcomes following a web-based pain management programme, Pathway Through Pain.

Objectives
The objective was to examine pre-post changes in clinical outcomes for people completing the web-based programme.

Methods
Patients were referred by physiotherapists working within a community-based musculoskeletal service. Referral suitability was determined through a screening process carried out by a clinician working within the Buckinghamshire Chronic Pain and Fatigue Management Service (CPFMS). Outcome measures included disability (ODI), depression (PHQ-9), anxiety (GAD-7) and quality of life (EQ-VAS). 450 out of 807 people referred were offered treatment. The main reason people were not offered treatment was because they did not return the required screening forms. We will report the first 155 completers with pre- and post-intervention data available. Recruitment for the evaluation has been completed; final analysis of all completers is expected in April 2016.

Results
Significant improvements were reported for all of the outcomes measured. People completing the web-based pain management programme showed significant improvements in disability (ODI, p = 0.000, effect size = 0.26), mood (PHQ-9, p= 0.000, effect size = 0.44), anxiety (GAD-7, p = 0.000, effect size = 0.39), and quality of life (EQ-VAS, p=0.000, effect size = 0.41). Follow up data (one month post-intervention) is available for 74 of the patients; significant improvements were maintained for anxiety and depression. Physiotherapists were able to identify suitable patients for a web based pain management programme with 84% of referrals accepted.

Conclusion
This interim analysis of an on-going evaluation showed significant pre-post improvements in all outcome measures with small to medium effect sizes. Screening of referrals by a clinician working within a pain management programme service is advised as a minority of people referred were not suitable for the programme. This improved safety through appropriate patient selection, engagement with the programme, review of progress and follow-up for those completing and failing to complete the programme. Integrating of the web-based programme with existing pain services created increase patient choice and access to pain management.

Division of Health Psychology Annual Conference 2015 16-18 September 2015, London

Patient experiences of the Pathway Through Pain programme: A web-based pain management programme

Background
There is a growing body of evidence supporting the effectiveness of web-based cognitive behavioural interventions for people with chronic back pain. This is a 3-year project using a non-randomised comparison of an experimental and control group. This paper reports on the experiences of taking part in the online programme.

Methods
Qualitative information was collected from completer and non-completer participants using three sources; focus groups, semi-structured interviews, and written feedback. Two focus groups were conducted for completers (n=11) and one for non-completer groups (n=4). Due to a low response rate from the non-completer group, a further six semi-structured interviews were conducted. Peoples reported experiences of the online programme were analysed using thematic analysis; two independent researchers rated participants’ responses into themes.

Findings
The themes identified were:

  • Willingness to try anything to make the pain disappear
  • Coping with the emotional impact of pain
  • Coming to terms with living with pain
  • Motivation to continue with the online programme
  • Relevance of the content/message to the person’s problems

Discussion
Those who completed the online programme reported feeling more motivated and willing to try different avenues to manage pain. They felt they benefited from taking part in the programme and reported improved quality of life. Those who did not complete the programme reported that parts of the programme were not relevant to them at that time. Both groups reported feeling ‘invisible’ and that previous clinicians have not taken them seriously.

Conclusion
People completing the online programme reported that they learnt new ways to cope and improve their quality of life, and the programme was relevant and touched on areas of importance in their life.