Interdisciplinary Treatment Program Research Articles

Outcomes of Pediatric Patients with Excessive Postural Tachycardia After Attending an Intensive Interdisciplinary Pain Program: A Pilot Study

Background/Objectives: Adolescents with autonomic disorders who attend Intensive Interdisciplinary Pain Treatment (IIPT) programs report improvements in functioning. However, it is unclear whether they experience corresponding improvements in physiological measures. As such, the aim of this pilot study was to examine changes in physiological measures in youth attending an IIPT program who demonstrated excessive postural tachycardia on an active stand test. The secondary goal was to examine associations between physiological measurements and self-reported measures of chronic orthostatic intolerance (cOI) and functioning. Methods: At admission and discharge, eighteen adolescents and young adults (AYAs) attending IIPT (M age = 17.39 years; SD = 2.15 years) completed an active stand test, measures of breathing rate and muscle tension, as well as self-reported measures of cOI symptoms and functioning. Results: AYAs showed significant reduction in active stand test heart rate increase (p < 0.001; d = 1.07) and maximum heart rate (p = 0.002, d = 0.76) from admission to discharge. Improvements were also observed in resting respiration rate (p = 0.001, d = 89) and resting trapezoid tension (p = 0.03, d = 0.49). Although patients showed significant improvements on self-report measures of functioning (p < 0.001, d = 1.78), changes on subjective report of cOI symptoms did not reach significance. Exploratory analyses that only included patients with a POTS diagnosis were consistent with the overall results. Conclusions: Youth who demonstrated excessive postural tachycardia on active stand test at admission to an IIPT showed significant improvements from admission to discharge in their active stand maximum heart rate and heart rate increase, as well as respiration rate, muscle tension, and reports of their functioning. Future research is necessary to examine the mechanisms of change that contribute to symptom improvement.

Physical function estimates change in pain following IIPT among children with chronic pain.

Chronic pain can negatively impact a child's quality of life. Pediatric Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to improve overall functioning despite pain through various rehabilitative strategies. It is, however, unclear whether improved function corresponds to self-reported decrease in pain levels. Hence, the purpose of this study is to examine the relationship between changes in physical function and perceived pain among children with chronic pain who have undergone inpatient IIPT. A secondary analysis of pre-existing databases of IIPT from two different inpatient acute rehabilitation programs was carried out. Children and adolescents (N = 309; age = 16.2 ± 2.6; 79% females) with chronic pain who attended on average 4-week inpatient IIPT from Nov 2011 to Jan 2023 were included. Participants completed pain intensity (Numerical Pain Rating Scale) and self-reported function measures (Lower Extremity Functional Scale [LEFS], Upper Extremity Functional Index [UEFI], Canadian Occupational Performance Measure [COPM]-Performance, and COPM-Satisfaction) at admission and discharge. Change in self-reported physical function was significantly associated with change in pain from admission to discharge. After covariate adjustment, self-reported physical function (per the LEFS, UEFI, COPM-Performance, and COPM-Satisfaction) explained 19.8%, 7.8%, 12.0%, and 8.6% of the variance in change in pain, respectively. These measures of self-reported physical function further distinguished between minimal (<30%) and moderate (≥30%) pain reduction. Self-reported functional gains during IIPT are associated with greater change in perceived pain. Moreover, measures of self-reported physical function can help identify children at risk of minimal pain reduction post-IIPT.

Physical function and perceived pain following inpatient intensive interdisciplinary pain treatment for children and adolescents.

Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses. To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain. Cross-sectional, secondary analysis. Inpatient acute rehabilitation. Children and adolescents with chronic pain (n = 258; females/males = 204/54; age = 16.5 ± 2.6) admitted to a 4-week inpatient IIPT program from November 2011 to January 2023. Participants attended individual and group sessions involving physical therapy, occupational therapy, aquatic therapy, cognitive behavioral therapy, school-related tasks, and meditation. The sessions focused on improving strength, endurance, and function, while helping participants modify physical sensations, catastrophic thinking, and maladaptive behaviors. Collected at admission and discharge: pain intensity (Numerical Pain Rating Scale; scale: 0-10), lower extremity function (Lower Extremity Functional Scale [LEFS]; scale: 0-80), upper extremity function (Upper Extremity Functional Index [UEFI]; scale: 0-80), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition short form [BOT-2 SF]; scale: 0-70), and occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]; scale: 0-10 for both). Overall, participants reported significant improvements (p < .05) in median LEFS (median change [MC] = +30.5; 25th, 75th percentile range [PR] = 19, 42), UEFI (MC = +21; PR = 12.8, 31), BOT-2 SF (MC = +9; PR = 5, 15), COPM performance (MC = +4; PR = 2.8, 5.4), and COPM satisfaction (MC = +5.6; PR = 3.8, 7.2). Moreover, participants reported significant reduction (p < .05) in median pain intensity (MC = -3; PR = 1, 5). For a majority of participants, MC surpassed previously reported minimally clinical important difference thresholds. Findings highlight the relevance of inpatient IIPT programs in enhancing physical function and reducing perceived pain in children and adolescents with chronic pain.

Prediction models for treatment success after an interdisciplinary multimodal pain treatment program

Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69–0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.

Group dynamics and therapy outcome of multimodal pain therapies: A prospective observational trial.

For the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost- and time-intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes. We conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5-week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program. In contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. This trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs. The study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.

Eating concerns in youth with functional abdominal pain disorders.

Adolescents with functional abdominal pain (FAP) often experience pain and other gastrointestinal symptoms in the context of eating, which may place them at risk for eating disorders. This study compared disordered eating and its sequalae in adolescents with FAP to those with chronic headache. Participants in this retrospective chart review study were 270 adolescents and young adults (mean age 15.9; standard deviation [SD] = 1.63; 60% female) attending an intensive, interdisciplinary pain treatment program, including 135 youth with FAP and an age- and gender-matched control group with a primary pain diagnosis of chronic headache. Information was extracted related to eating- and weight-related symptoms. Independent t-tests and χ2 analyses found that compared with adolescents with chronic headache, patients with FAP showed significantly more eating pathology as reflected by scores on the Eating Attitudes Test-26 (EAT-26) (p < 0.001), endorsement of pain-related restrictive eating (p < 0.01), eating disorder history (p < 0.001), and avoidant restrictive food intake disorder (ARFID) diagnoses (p < 0.001). Compared to those with chronic headache, significantly more patients with FAP had lost 10 pounds or more (p < 0.01) and a higher proportion were underweight (p < 0.001). Among all participants, a history of exclusion diets used to manage symptoms significantly increased the risk for ARFID (p < 0.001). The results of this study highlight the increased risk of eating-related concerns among youth with FAP, as well as the judicious use of exclusion diets to manage symptoms in these patients.

A - 32 The Patient Global Impression of Change—a Powerful Complimentary Tool for Assessing Improvement in Concussion Patients

Abstract Objective The purpose of this study was to determine the extent to which patient’s perspective of symptom improvement, as indexed by the Patient Global Impression of Change (PGIC) survey, is associated with symptom improvement on common measures of neurobehavioral and mental health symptoms following concussion. Methods Data were from 474 US active duty service members in interdisciplinary treatment programs for TBI. PGIC rating (range = 1–7) was evaluated for compatibility in assessing improvement in or clinically-elevated neurobehavioral (using Neurobehavioral Symptom Inventory, NSI) and mental health (using Post-traumatic Stress Disorder Checklist, DSM-5, PCL-5 and Patient Health Questionnaire, PHQ-8) symptoms. Results Higher PGIC scores were related to a higher prevalence of a clinically-relevant decrease in NSI, PCL-5 or PHQ-8 scores. Participants with a PGIC rating of 3+ (vs. &amp;lt; 3) were about 2.2 (CI = 1.4–3.5), 1.6 (CI = 1.1–1.3), and 2.7 (CI = 1.4–5.1) times more likely to report a clinically-relevant decrease in NSI, PCL-5 and PHQ-8 symptoms, respectively. Conclusion PGIC may help providers incorporate patients’ perspectives on symptom improvement achieved during rehabilitation. An approach combining PGIC with surveys such as NSI, PCL-5 and PHQ-8 may provide a more comprehensive understanding of symptom improvement and realistic view of expectations for what would be deemed recovery to pre-injury symptom levels.

Longitudinal qualitative perspectives of adolescents in an intensive interdisciplinary pain program

ObjectivesChronic pain in children and adolescents is often associated with functional, physical, and psychosocial challenges. Intensive interdisciplinary pain treatment (IIPT) programs are effective at helping these youth regain functioning, but little is known about their perspectives prior to and during IIPT participation. This study sought to better understand how children and adolescents experience the process from evaluation to completion of the IIPT program.MethodsIndividual interviews (n = 7) were conducted at three time-points; (1) prior to initial evaluation in a pain clinic, (2) after pain clinic evaluation while considering IIPT, and (3) after completion of an IIPT program.ResultsParticipants ranged in age from 13–17 years. Across these time points, participants demonstrated changes in thoughts and perspectives. While Time 1 was associated with ambivalence, skepticism, and some hope, Time 2 was characterized by processing information about the program and resolution of some of their ambivalence. At Time 3, participants described their experience as “challenging” and “intense” and reported recognition that they had benefited from the program. Participants also wished to pass along lessons learned to future potential patients.DiscussionThis study provides information to help clinicians better approach adolescents with chronic pain who may be considering IIPT.

Screening for eating disorders in adolescents with chronic pain: the Eating Attitudes Test–16–Chronic Pain

BackgroundFew measures have been validated to screen for eating disorders (ED) in youth with chronic pain. We conducted confirmatory (CFA) of two established factor structures of the Eating Attitudes Test-26 (EAT-26) in a sample of youth with chronic pain attending an intensive interdisciplinary pain treatment (IIPT) program and examined the validity of the best-fitting model in predicting ED diagnoses in this sample.MethodsParticipants were 880 adolescents (M age = 16.1, SD = 2.1) consecutively admitted into an IIPT program who completed the EAT-26 upon admission. CFA was conducted and in the case of inadequate fit, EFA was planned to identify alternative models. Factors of the best-fitting model were included in a logistic regression analysis to predict ED diagnoses.ResultsThe TLIs (0.70; 0.90), RMSEAs (0.09; 0.07) and CFIs (0.73; 0.92) suggested poor fit of one model and adequate of the second model. Goodness of fit indices from EFA (TLI:0.85, RMSEA:0.06) did not outperform the fit of the second CFA. As such, the second model was retained with the exception of one factor. The items loaded onto a 16-item, five factor model: Fear of Getting Fat, Social Pressure to Gain Weight, Eating-Related Control, Eating-Related Guilt and Food Preoccupation. Based on chart review, 19.1% of the participants were diagnosed with an eating disorder. Logistic regression analyses indicated the new 16-item measure and Fear of Getting Fat, significantly predicted an ED diagnosis that did not include avoidant restrictive food intake disorder (ARFID) and Social Pressure to Gain Weight significantly predicted a diagnosis of ARFID.ConclusionsAn alternative 16-item, 5-factor structure of the EAT-26 should be considered in screening for EDs with youth with chronic pain.

Characteristics and outcomes of youth with functional seizures attending intensive interdisciplinary pain treatment

Functional seizures (FS) can be debilitating and negatively impact quality of life. Yet intervention research for FS is limited, especially for youth. This study examined clinical characteristics and outcomes of youth with FS (13–23 years) presenting to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States. Sixty youth (mean age = 16.5 years; 83.3 % female) met inclusion criteria. At intake, comorbid chronic pain, somatic symptoms, autonomic dysfunction, eating and weight disturbances, and mental health concerns were common. Despite this high symptom burden, youth with FS reported significant improvements in functioning measured with the Functional Disability Inventory, t(53) = 9.80, p <.001, d = 1.32; depression measured with the Center for Epidemiological Studies – Depression Scale for Children, t(53) = 6.76, p <.001, d = 0.91; anxiety measured with the Spence Children’s Anxiety Scale, t(53) = 3.97, p < .001, d = 0.53; and catastrophizing measured with the Pain Catastrophizing Scale for Children, t(53) = 6.44, p <.001, d = 0.86, following completion of the program, suggesting that IIPT may be an effective treatment option for highly disabled and emotionally distressed youth with FS. Future research is needed to continue to refine best practices for youth with FS to reduce suffering and improve outcomes.

Non-Pharmacologic Intensive Interdisciplinary Pain Treatment in Pediatrics: Impact on Symptoms, Daily Functioning, and the Family Unit.

Objectives: To assess non-pharmacologic treatment outcomes pertaining to health-related quality of life (HRQoL) in youth with chronic idiopathic pain and their families. Methods: We conducted a retrospective cohort study of 115 youth with chronic idiopathic pain enrolled in a non-pharmacologic, hospital-based intensive interdisciplinary pain treatment (IIPT) program. HRQoL measures for the patient (Pediatric Quality of Life Inventory [PedsQL] short form) and family unit (PedsQL Family Impact) were collected on admission and discharge as part of routine clinical care. Changes in PedsQL scores were calculated using the Wilcoxon signed-rank test. Multivariable linear regression was used to explore factors associated with patient-level HRQoL. Results: Both individuals and the family unit reported that their HRQoL improved in all domains by program completion. Improvements in pain and allodynia were present for program participants at the time of completion as well as at the 3-month follow-up, suggesting durability of these effects. Conclusions: A non-pharmacologic IIPT program is a compelling treatment for pediatric and adolescent chronic idiopathic pain, for both patients and the family unit. Patients participating in this program had positive treatment outcomes with significantly improved subjective and objective measures of physical, emotional, social, and cognitive function.

Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain—a pilot nonrandomized treatment study

PurposePersonal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase.MethodsParticipants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program.ResultsOf 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated.ConclusionsWearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.

Gender Diversity Among Youth Attending an Intensive Interdisciplinary Pain Treatment Program.

Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.

Multimodal and Interdisciplinary Interventions for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023.

Localized provoked vulvodynia (LPV) is a chronic condition characterized by pain in the vulvar vestibule, which can be provoked by pressure or touch and which is not tied to a clear underlying cause. Research into the etiology of and most appropriate treatment strategy for LPV is still limited. Using Arksey and O'Malley's model for scoping reviews, we evaluated the research question: what is the current evidence regarding the efficacy/effectiveness of multimodal or interdisciplinary interventions for the treatment of LPV? We collated and analyzed articles from 2010 to 2023 to capture the current research landscape. Our review identified 27 studies, which either compared treatments between classes (eg pharmacologic versus psychologic modalities) or described interdisciplinary treatment programs. We identify several trends in the literature. First, outcome measures are inconsistent between studies, often unvalidated, and may not adequately mirror patient concerns. Second, the absence of appropriate comparator groups in many studies restricts providers' ability to appraise which treatments may be most efficacious. Third, selection bias and demographic homogeneity limit generalizability. Finally, we highlight the need for head-to-head trials of vestibulectomy with other treatments considered first line for vulvodynia management. There is insufficient evidence to suggest the superiority of one treatment modality for LPV relative to others or to recommend a particular interdisciplinary management strategy. Future research should use a head-to-head design where sham control is impossible, incorporate patient-centered outcome measures, and investigate impacts of treatment among diverse samples of LPV patients.

Psychosocial Functioning of Parents of Youth Receiving Intensive Interdisciplinary Pain Treatment.

Parents of youth with chronic pain report psychosocial difficulties, yet treatment often focuses on improving their child's functioning and pain. This study evaluated changes in parents' social and emotional functioning and explored predictors of change, as they completed a parent-focused intervention while their child was enrolled in an intensive interdisciplinary pain treatment (IIPT) program. Parents (n = 69) completed questionnaires at baseline and weekly (average duration of 4 weeks) during their child's participation in IIPT. Parents engaged in 3 groups per week providing education, therapeutic art, and psychotherapy (3 hr/week total). At baseline, 38% of parents reported scores in the clinically elevated range for at least 1 psychosocial variable. Linear mixed modeling for the full sample indicated reduced parent anxiety (t = -2.72, p<.01) and depression (t = -3.59, p<.001), but not increased emotional support (t = 1.86, p>.05) or reduced social isolation (t = -1.20, p>.05). For parents with at least moderately elevated psychosocial concerns, statistically significant improvements were observed for all 4 outcomes (all p's<.01). Psychological flexibility, cognitive reappraisal, and emotional suppression were found to be related to changes in parent outcomes (anxiety, depression, isolation, and support). Findings support the benefit of parent-focused interventions in addition to child-focused interventions. Many parents of youth participating in IIPT had elevated scores for at least 1 psychosocial concern at baseline. Brief, parent-focused intervention including psychoeducation, therapeutic art, and psychotherapy targeting mindfulness, acceptance, and values had a significant impact on these parents, particularly those with greater struggles at baseline.

Reduction in Feeding Problems and Impact on Family Following a 12-Week Interdisciplinary Group Feeding Intervention for Children With Feeding Problems and Their Caregivers

Caregivers and their children with clinical levels of feeding problems participated in Picnic Group, an outpatient interdisciplinary family group treatment program for children with feeding disorders and their caregivers at a large regional pediatric hospital. The manualized treatment is based on an interdisciplinary systematic approach that draws from sensory integration, communication, and cognitive behavioral strategies (e.g., classical conditioning, systematic desensitization, communication of automatic thoughts) to increase pleasurable interactions with food over a 12-week period and includes caregiver and child intervention components. Escape extinction techniques such as nonremoval of the spoon were not used in treatment. Caregivers completed measures focused on their children’s feeding behaviors and family strain at baseline and at the end of the 12-week intervention. Wilcoxon signed-rank tests compared measures between baseline and the end of treatment. Results indicated that at the 12th week, caregivers generally reported one less feeding problem, fewer specific types of eating and mealtime problematic behaviors, and decreased impact of feeding problems on the family. Children were able to work up a hierarchy of food interactions with more foods per group session than at the first session. Caregivers of children with a developmental diagnosis showed the most decrease in caregiver strain. Outpatient interdisciplinary group treatment can decrease feeding problems and caregiver strain in families with children with feeding disorders.

Treatment outcomes for children with chronic food refusal in a community behavioral health center

AbstractAbnormal patterns of feeding behavior are seen in children with and without developmental disabilities; if not treated early, these patterns may lead to a diagnosis of avoidant/restrictive food intake disorder (ARFID). A multitude of treatments for ARFID varying in theoretical orientation, intensity, and modality exist in the literature. Given the potential for complexity in the clinical presentation of ARFID, intensive interdisciplinary treatment programs are often the preferred intervention choice. However, due to the limited availability of these highly controlled settings, underserved populations are often limited to any outpatient feeding therapy that is available locally. This study focused on examining the outcomes of a behavioral outpatient feeding program in a community behavioral health center. Results show that there were statistically significant treatment outcomes when comparing observable feeding behaviors and caregiver satisfaction measures from admission to discharge. Moreover, these gains were maintained at follow‐up supporting the treatment efficacy of such programs.

The Telehealth Tradeoff: A Multimethod Study of the Benefits and Challenges Associated With Maintaining Treatment Outcomes Using a Hybrid Model of Pediatric Intensive Interdisciplinary Pain Treatment.

The COVID-19 pandemic required intensive interdisciplinary pain treatment (IIPT) programs to shift to virtual models of care. This study used a multimethod approach to examine outcomes of a pediatric hybrid IIPT program (50% in-person treatment and 50% synchronous video-based telehealth) and assessed staff experiences while treating within this model. Patients (M=14.73, SD=2.04; 79% female) reported pain intensity, functional disability, and psychological factors (anxiety, depressive symptoms, fear of pain, pain catastrophizing, social functioning) at admission, discharge, and short-term follow-up. Differences in treatment outcomes at discharge and short-term follow-up between patients who participated in the hybrid IIPT model (n=42) during the pandemic and those who participated in the traditional in-person model before the pandemic (n=42) were examined. Quantitative assessments of staff burnout and perceived effort and qualitative assessments exploring staff perspectives about the challenges and advantages of the hybrid IIPT model were gathered. Youth in both groups made significant improvements across the majority of treatment outcomes; however, the hybrid group reported higher levels of pain at discharge and anxiety at follow-up. The majority of IIPT staff reported moderate to high levels of overall burnout, and almost half reported high levels of emotional exhaustion. Staff highlighted various challenges and benefits associated with treating within the hybrid model. When considering telehealth as a treatment tool for youth with complex chronic pain, it is crucial to leverage its benefits while addressing its challenges for patients and providers.

Sickness Absence and Disability Pension Among Patients With Chronic Pain in Interdisciplinary Treatment or Unspecified Interventions

Interdisciplinary treatment is a widely implemented strategy for the rehabilitation of patients with chronic pain. A primary treatment objective is to decrease the load on the social insurance system; however, it is questionable whether interdisciplinary treatment reduces sickness absence and disability pension (SA/DP). This register-based observational study compared SA and DP between patients in interdisciplinary treatment and unspecified interventions. With data from 7,752 Swedish specialist health care patients in their prime working age, we analyzed total net SA/DP days over 3 years from the first visit to a pain rehabilitation center. A zero-one-inflated beta model, adjusted for theoretically substantiated confounders, was used to estimate the mean differences in total days and the proportions of patients with both zero and maximum days. Compared with unspecified interventions, interdisciplinary treatment resulted in a mean (95% confidence interval) absolute increase of 50 (37, 62) total days, a 13.0% (11.3%, 14.6%) decrease in patients with zero days, and a 1.5% (.2%, 2.8%) decrease in patients with the maximum days. These findings support that interdisciplinary treatment increases SA/DP compared to less intensive interventions but reduces the risk of maximum days, implying that it is advantageous for patients with the highest absence. This highlights the need for improved patient selection procedures and the adaptation of interdisciplinary treatment programs to more adequately target SA/DP reduction. PerspectivesThis study provides an accessible overview of SA/DP among working-age patients with chronic pain in Swedish specialist health care. It also shows that interdisciplinary treatment does not decrease SA/DP more than alternative treatments in most patients but is advantageous for the patients with the longest absence.

Machine learning clinical decision support for interdisciplinary multimodal chronic musculoskeletal pain treatment.

Chronic musculoskeletal pain is a prevalent condition impacting around 20% of people globally; resulting in patients living with pain, fatigue, restricted social and employment capacity, and reduced quality of life. Interdisciplinary multimodal pain treatment programs have been shown to provide positive outcomes by supporting patients modify their behavior and improve pain management through focusing attention on specific patient valued goals rather than fighting pain. Given the complex nature of chronic pain there is no single clinical measure to assess outcomes from multimodal pain programs. Using Centre for Integral Rehabilitation data from 2019-2021 (n = 2,364), we developed a multidimensional machine learning framework of 13 outcome measures across 5 clinically relevant domains including activity/disability, pain, fatigue, coping and quality of life. Machine learning models for each endpoint were separately trained using the most important 30 of 55 demographic and baseline variables based on minimum redundancy maximum relevance feature selection. Five-fold cross validation identified best performing algorithms which were rerun on deidentified source data to verify prognostic accuracy. Individual algorithm performance ranged from 0.49 to 0.65 AUC reflecting characteristic outcome variation across patients, and unbalanced training data with high positive proportions of up to 86% for some measures. As expected, no single outcome provided a reliable indicator, however the complete set of algorithms established a stratified prognostic patient profile. Patient level validation achieved consistent prognostic assessment of outcomes for 75.3% of the study group (n = 1,953). Clinician review of a sample of predicted negative patients (n = 81) independently confirmed algorithm accuracy and suggests the prognostic profile is potentially valuable for patient selection and goal setting. These results indicate that although no single algorithm was individually conclusive, the complete stratified profile consistently identified patient outcomes. Our predictive profile provides promising positive contribution for clinicians and patients to assist with personalized assessment and goal setting, program engagement and improved patient outcomes.