Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial

Vera-Christina Mertens,Rob J E M Smeets,Mariëlle E J B Goossens,Albere J Köke,Jeanine A Verbunt

doi:10.1186/1745-6215-14-90

Vera-Christina Mertens, Rob J E M Smeets + Show 3 more

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https://doi.org/10.1186/1745-6215-14-90

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Abstract

BackgroundNon-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment.Methods/designStudy design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment.Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program.Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each.Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment.Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: ‘involvement in a life situation’) 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs of the pre-treatment intervention, productivity losses, and healthcare utilization. Potential moderators and active ingredients of MI are explored. For the process evaluation, parameters such as MI fidelity, feasibility, and experiences are explored.DiscussionThe results of this study will provide evidence on the effectiveness of this MI-based pre-treatment in pain rehabilitation. Furthermore, a cost-effectiveness analysis and exploration of moderating and working mechanisms of MI and an extensive process evaluation takes place.Trial registrationNederlands trial register NTR3065

Highlights

Non-adherence and drop-out are major problems in pain rehabilitation
Exploration actual situation, burden and impairments of the chronic pain in daily life Assessing + enhancing motivation, self-efficacy, and readiness to change for behavior Giving feedback adapted to the state of readiness-to-change Continuation exploration Continuation assessing + enhancing motivation, self-efficacy, and readiness to change for behavior Is given related to the stage of change of the participant according to the motivational interviewing (MI)-principles
Pain education (Usual care (UC)) Goal: provide the participant with information General principles of health education and patient education Content based on the book ‘De pijn de baas’ [42] (Mastering pain) Content is fixed by means of the treatment protocol Provision of general health education about topics related to chronic pain Provision of information regarding core elements of pain rehabilitation Continuation of general health education about topics related to chronic pain

Summary

Introduction

Non-adherence and drop-out are major problems in pain rehabilitation. A MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment. Chronic non-specific musculoskeletal pain is a major health burden. It occurs in approximately 10% of the general population [1] and causes disability [2], medical expenses [3], and a high amount of work absenteeism [4]. In the Netherlands, cognitive behavioral therapy (CBT)-based approaches are part of usual rehabilitation care for patients with non-specific chronic pain [5], and recommended in the Dutch guidelines [6]. According to the International Classification of Functioning, Disability and Health (ICF), participation is therein defined as ‘involvement in a life situation’ whereas the opposite, participation restrictions, are defined as ‘problems an individual may experience in involvement in life situations’ [9]

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