Exploring indicators for pain rehabilitation: A Delphi study using a multidisciplinary expert panel

Abstract

Lack of referral guidelines can cause delayed or even non-existent rehabilitation for chronic pain patients. Indicators signalling the need for interventions could counteract this delay for pain rehabilitation and thereby prevent deteriorating patient health. This study aimed to explore the indicators of need for pain rehabilitation using a multidisciplinary expert panel working with pain rehabilitation. A three-round Delphi study was conducted with a multidisciplinary expert panel (n = 23), each representing one pain rehabilitation unit in Sweden. The expert panel produced indicators, which were then ranked using a four-point Likert scale. Twenty multi-faceted indicators for pain rehabilitation were identified. A major part concerned patient problems with activity level, catastrophizing, coping, existential problems, fear avoidance, high pain rating, medication, mental health, motivation, no pain relief, pain spread/increase, psychosocial problems combined with activity problems, psychosocial problems, recovery, and reduced physical function. Furthermore, indicators concerned demographic factors, sick leave, situation in primary health care and work. Finally, tacit knowledge was pointed out as an indicator. The results support previous research but also bring out less quantifiable indicators, such as relying on tacit knowledge while assessing a patient's need for rehabilitation. The indicators for pain rehabilitation were comprehensive, pointing out that needs assessment is complex. Despite reaching consensus on 19 out of 20 indicators, further research is needed to deepen knowledge in this area and to secure a fair assessment of a patient's need for pain rehabilitation.