Abstract
BackgroundFor studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol.ObjectivesTo evaluate whether an interdisciplinary graded exposure program, for adolescents with chronic musculoskeletal pain reporting pain-related fear, was performed according to protocol, and whether it is feasible to implement the program in rehabilitation care.MethodsA process evaluation where quantitative and qualitative data on participant characteristics (adolescents, parents and therapists), attendance and participants’ opinion on the program were collected, by means of registration forms, questionnaires and group interviews. To evaluate treatment fidelity, audio and video recordings of program sessions were analyzed.ResultsThirty adolescents were offered the program, of which 23 started the program. Adolescents attended on average 90% of the sessions. At least one parent per adolescent participated in the program. Analysis of 20 randomly selected recordings of treatment sessions revealed that treatment fidelity was high, since 81% of essential treatment elements were offered to the adolescents. The program was considered client-centered by adolescents and family-centered by parents. Treatment teams wished to continue offering the program in their center.ConclusionThe interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program. Implementation of the program in rehabilitation care is considered feasible.Trial registrationClinicaltrials.gov ID: NCT02181725 (7 February 2014).
Highlights
For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol
The interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program
Dependent on the level of disability, the complexity of the pain problem, the level of pain-related fear, psychosocial problems, and the presence of joint hypermobility syndrome, the consultant decided, supported by the results of the screening performed by the interdisciplinary team, whether the adolescent was eligible to participate in the study [22]
Summary
For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol. There is a risk that complaints continue to exist in adulthood [3,4,5] Because of this wide impact, chronic pain in Dekker et al BMC Health Services Research (2020) 20:213 children and adolescent is considered a complex health problem that requires interdisciplinary treatment in case of a high level of pain-related disability [6,7,8]. When pain is perceived as a threat (e.g. as a sign of injury) this can provoke anticipatory fear responses, catastrophizing thoughts and associated protective and avoidant-behavior Prolongation of these behaviors may have the paradoxical effect that fear, associated pain sensitivity and disability sustain [15]. Exposure in vivo interventions showed promising results in reducing functional disability in various chronic pain conditions in adults [18,19,20]
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