Moving with Pain A Physiotherapy Led

Pain Management Programme

Pauline Campbell and Elizabeth Connolly-AndersonPhysiotherapy Department, Altnagelvin Area Hospital, WHSCT

Chronic Pain Incidence NI Context Previous Service Provision The Way Forward “Moving with Pain” Programme Outcome Measures Quantitative and Qualitative results The Future

Overview

Uk Average; 1 in 7 (7.8 million people)

Regional Figures: North East/Yorkshire 9.0% North West 16.5% East Midlands 9.3% West Midlands 17.5% East 12.9% London 14.3% South East 13.2% South West 13.4% Wales 9.9% Scotland 18.1% Northern Ireland 19.0%

Chronic Pain Incidence(Breivik et al, 2006)

2005 – Raft of recommendations for how pain services could be improved

2010 – ‘little progression for these recommendations’ (apart from CREST guidelines, 2008)

www.arthritiscare.org.uk/.../PainProposalUKSnapshotFinal.pdf

19.4% of people in NI aged 16-64 have experienced sexual violence or abuse (French & Freel, 2009)

Ilex Briefing (2009), Derry-Londonderry - ‘large proportions of children living in poverty, low employment rates, large numbers of families reliant on benefits, premature mortality and poor educational outcomes

WHSCT MSK “Core” Physiotherapy- 90% Chronic MSK Pain Referrals

NI Context

Biomedical Ax 1:1 Treatment Functional Rehab Class Little use of Outcome measures Perceived high re-referral rates High Dropout rates Reported Barriers to

participation

WHSCT: Previous Physiotherapy Provision

The Way Forward

Biopsychosocial Assessment

PATIENT

Outcome measuresEvidenced

Based Practice

Patient Feedba

ck

MOVING WITH PAIN

Education

Self Manageme

nt Staff

Group

Clinical Guidelines in Chronic Pain Management were reviewed – European Chronic Low Back Pain (2004), NICE Persistent Low Back Pain (2009)

Systematic reviews of the evidence for chronic musculoskeletal pain management were conducted

A multimodal programme was devised Evidence based components:

Education Relaxation Training Goal Setting Exercise

Evidence Review

Outcomes Measures

Outcome measures were chosen in accordance with the IMMPACT recommendations of core outcome measures in chronic pain clinical trials (Dworkin et al, 2005)

BPI, PSEQ, PGIC A qualitative study was conducted to capture

service users’ lived experience with chronic pain Re-referral rates to the physiotherapy were also

examined

Venn Diagram summarises qualitative

analysis of 111 feedback forms

‘Moving With Pain’ Patient Feedback

Quantitative Results

Clinical Outcome Measure

Pre Post Statistical Significance

BPI – ‘worst pain’

7.2 (4.03)

6.77 (4.02) p 0.02

PSEQ - mean 2.5 (1.61)

2.87 (1.62) p <0.001

PGIC N/A 3.61 (1.61) N/ARe-Referral Rate

Pre Post Statistical Significance

0.08 (27.11)

0.01 (13.86)

p <0.001

The ‘Moving With Pain’ programme was unanimously selected by the judges from a very strong field. It is commended for an innovative approach to overcoming the fear of moving with pain in those with musculoskeletal pain.  Their robust outcome measures showed considerable movement over a traditional functional rehabilitation programme and patient satisfaction was high. Referral  to the physiotherapy department was reduced by 87%, a significant reduction in cost and resource.

NI Healthcare Awards 2014

Pain Management Programme of the Year

Judges’ Comments

The Future…

Moving with Pain available Trust Wide

Staff Development - Economies of time, lack of staff skills or other resources risk reducing the effectiveness of the programme to a point where gains are insignificant. http://www.britishpainsociety.org/book_pmp2013_main.pdf

Group for < 18yr olds Patient Involvement-focus Group and 1 year follow-up Application for funding for Tea/coffee and Primary

Care/Community Setting