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Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change

Katherine Macey, Simon Clarke, Nima Golijani-Moghaddam, Roshan das Nair


Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure clients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics.

Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation.

Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10, and PSEQ.

Results: 56 out of 83 clients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. 18 showed no reliable change. Only one person deteriorated.

Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduces the reliability of these conclusions and led to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made.

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Department of Health (DOH). (2010). Equity and excellence: Liberating the NHS. London: Department of Health.

Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education 65 (12) 1378-1382.

Wiech, K. & Tracey, I. (2009). The influence of negative emotions on pain: behavioral effects and neural mechanisms. NeuroImage 47 (3) 987-994.

Keefe, F.J., Rumble, M.E., Scipio, C.D., Giordano, L.A. & Perri, L.M. (2004). Psychological aspects of persistent pain: current state of the science. Journal of Pain 5 (4) 195-211.

Turk, D.C. & Okifuji, A. (2002). Psychological Factors in Chronic Pain: Evolution and Revolution. Journal of Consulting and Clinical Psychology 70 (3) 678-690.

Morley, S., Eccleston, C. & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults , excluding headache. Pain 80, 1-13.

Veehof, M.M., Oskam, M.-J., Schreurs, K.M.G. & Bohlmeijer, E.T. (2011). Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain 152 (3) 533-542.

Jensen, M.P. & Turk, D.C. (2014). Contributions of psychology to the understanding and treatment of people with chronic pain: Why it matters to ALL psychologists. American Psychologist 69 (2) 105-118.

Lohnberg, J.A. (2007). A Review of Outcome Studies on Cognitive-Behavioral Therapy for Reducing Fear-Avoidance Beliefs Among Individuals With Chronic Pain. Journal of Clinical Psychology in Medical Settings 14 (2) 113-122.

Turner, J.A, Holtzman, S. & Mancl, L. (2007). Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain 127 (3) 276-286.

Turner, J.A, Mancl, L. & Aaron, L.A. (2006). Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain 121 (3) 181-194.

NICE. (2009). Early management of persistent non-specific low back pain. London: NICE.

Schulte, D. & Bochum, R. (2002). What to Do When Manuals Fail ? The Dual Model of Psychotherapy. Clinical Psychology: Science and Practice 9 (3) 312-328.

British Psychological Society (BPS). (2011). Good Practice Guidelines on the use of psychological formulation. Leicester: British Psychological Society.

Barkham, M. & Mellor-Clark, J. (2003). Bridging evidence-based practice and practice-based evidence: developing a rigorous and relevant knowledge for the psychological therapies. Clinical Psychology & Psychotherapy 10 (6) 319-327.

Andrews, W., Twigg, E., Minami, T. & Johnson, G. (2011). Piloting a practice research network: a 12-month evaluation of the Human Givens approach in primary care at a general medical practice. Psychology and Psychotherapy 84 (4) 389-405.

Cooper, M., Turpin, G., Bucks, R. & Kent, G. (2005). Good Practice Guidelines for the Conduct of Psychological Research within the NHS. Leicester: British Psychological Society.

Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Audin, K., Connell, J. & McGrath, G. (2000). CORE: Clinical Outcomes in Routine Evaluation. Journal of Mental Health 9 (3) 247-255.

Mellor-Clark, J. (2007). CORE: A Decade of Development. Rugby: CORE IMS.

Connell, J. & Barkham, M. (2007). CORE-10 User Manual, Version 1.1. Rugby, UK: CORE Systems Trust & CORE Information Management Systems Ltd.

Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67 (6) 361-370.

Bjelland, I., Dahl, A.A, Haug, T.T. & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research 52 (2) 69-77.

Snaith, R.P. (2003). The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes 4, 6-9.

Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results. Journal of Psychosomatic Research 42 (1) 17-41.

Nicholas, M.K. (2007). The pain self-efficacy questionnaire: Taking pain into account. European Journal of Pain 11 (2) 153-163.

Jacobson, N.S. & Truax, P. (1991). Clinical Significance : A Statistical Approach to Defining Meaningful Change in Psychotherapy Research. Journal of Consulting and Clincal Psychology 59 (1) 12-19.

Morley, S., Williams, A. & Hussain, S. (2008). Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: Evaluation of a CBT informed pain-management programme. Pain 137, 670-680.

Bewick, B., Trusler, K., Mullin, T., Grant, S. & Mothersole, G. (2006). Routine outcome measurement completion rates of the CORE-OM in primary care psychological therapies and counselling. Counselling and Psychotherapy Research 6 (1) 33-40.

Halstead, J., Youn, S.J. & Armijo, I. (2013). Scientific and clinical considerations in progress monitoring: When is a brief measure too brief? Canadian Psychology / Psychologie Canadienne 54 (1) 83-85.

Ottenbacher, K.J. & Cusick, A. (1990). Goal Attainment Scaling as a method of Clinical Service Evaluation. American Journal of Occupational Therapy 44 (6) 519-525.

Cosco, T.D., Doyle, F., Ward, M. & McGee, H. (2012). Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review. Journal of Psychosomatic Research 72 (3) 180-184.

Coyne, J.C. & van Sonderen, E. (2012). The Hospital Anxiety and Depression Scale (HADS) is dead, but like Elvis, there will still be citings. Journal of Psychosomatic Research 73 (1) 77-78.

DCP. (2013). Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a paradigm shift - Position Statement. Leicester: British Psychological Society.

Norton, S., Cosco, T., Doyle, F., Done, J. & Sacker, A. (2013). The Hospital Anxiety and Depression Scale: a meta confirmatory factor analysis. Journal of Psychosomatic Research 74 (1) 74-81.

Gibbons, C.J., Mills, R.J., Thornton, E.W., Ealing, J., Mitchell, J.D., Shaw, P.J., Talbot, K., Tennant, A. & Young, C.A. (2011). Rasch analysis of the hospital anxiety and depression scale (HADS) for use in motor neurone disease. Health and Quality of Life Outcomes 9 (1) 82.

Duncan, B.L., Miller, S.D., Sparks, J.A., Claud, D.A., Beach, P., Reynolds, L.R. & Johnson, L.D. (2003). The Session Rating Scale : Preliminary Psychometric Properties of a “ Working” Alliance Measure. Journal of Brief Therapy 3 (1) 3-12.

Miller, S.D., Duncan, B.L., Sparks, J.A. & Claud, D.A. (2003). The Outcome Rating Scale : A Preliminary Study of the Reliability, Validity and Feasibility of a Brief Visual Analog Measure. Journal of Brief Therapy 2 (2) 91-100.

Dworkin, R.H., Turk, D.C., Farrar, J.T., Haythornthwaite, J.A., Jensen, M.P., Katz, N.P. et al. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 113 (1-2) 9-19.



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