Abstract
BackgroundThere is a need for a way to measure success in multi-modal pain therapy that researchers and clinicians can agree upon. According to developments in health services research, operationalizing success should take patient-reported outcomes into account. We will present a success criterion for pain therapy that combines different patient-reported variables and includes validity measures. The usable criterion should be part of a statistically significant and satisfactory model identifying predictors of successful pain therapy.MethodsRoutine data from 375 patients treated with multi-modal pain therapy from 2008 to 2013 were used. The change scores of five constructs were used for the combined success criterion: pain severity, disability due to pain, depressiveness, and physical- and mental-health-related quality of life. According to the literature, an improvement of at least ½ standard deviation was required on at least four of the five constructs to count as successful. A three-step analytical approach including multiple binary logistic regression analysis was chosen to identify the predictors of therapy success with the success criterion as the dependent variable.ResultsA total of 58.1 % of the patients were classified as successful. Convergent and predictive validity data show significant correlations between the criterion and established instruments, while discriminative validity could also be shown. A multiple binary logistic regression analysis confirmed the feasibility; a significant model (Chi2 (8) = 52.585; p < .001) that explained 17.6 % of the variance identified the following predictors of therapy success: highest pain severity in the last 4 weeks, disability due to pain, and number of physician visits in the last 6 months.ConclusionsIt is possible to develop a feasible success criterion that combines several variables and includes patient-reported outcomes (“PROs”) with routine data that can be used in a predictor analysis in multi-modal pain therapy. The criterion was based on basic constructs used in pain therapy and used widespread validated self-rating instruments. Thus, it should be easy to transfer this criterion to other institutions.
Highlights
There is a need for a way to measure success in multi-modal pain therapy that researchers and clinicians can agree upon
The operationalization of successful pain therapy is handled in diverse ways: There are research groups that use pain levels as a measure of success (e.g. [1, 2]), whereas others operationalize success as an increase in social functioning, by using days absent due to sickness as an indicator (e.g. [3, 4]), or by using healthcare contacts (e.g. [1, 5])
The construct “depressiveness” was a special case: Here, we looked for improvement only in patients who had been identified as “depressive” at t1
Summary
There is a need for a way to measure success in multi-modal pain therapy that researchers and clinicians can agree upon. We will present a success criterion for pain therapy that combines different patient-reported variables and includes validity measures. There has been no standard procedure or agreement among clinicians who work internationally in pain therapy about which measures to use [7] even though there are national projects that have suggested, for example, that one agreed-upon questionnaire consisting of different instruments be used—for example the German Pain Questionnaire “Deutscher Schmerzfragebogen” [8]. A systematic literature research by Deckert et al [7] in 2013 identified 71 relevant studies reporting heterogenic outcome measures for multi-modal pain therapy. The efficacy of multi-modal pain therapy has already been shown, even though there is still a lack of studies on differential indication as reported in the review by van Geen and colleagues [6]
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