Moving with Pain
A Physiotherapy Led
Pain Management Programme
Pauline Campbell and Elizabeth Connolly-Anderson
Physiotherapy Department, Altnagelvin Area Hospital, WHSCT
Overview
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Chronic Pain Incidence
NI Context
Previous Service Provision
The Way Forward
“Moving with Pain” Programme
Outcome Measures
Quantitative and Qualitative results
The Future
Chronic Pain Incidence
(Breivik et al, 2006)
 Uk Average; 1 in 7 (7.8 million people)
 Regional Figures:
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North East/Yorkshire
North West
East Midlands
West Midlands
East
London
South East
South West
Wales
Scotland
Northern Ireland
9.0%
16.5%
9.3%
17.5%
12.9%
14.3%
13.2%
13.4%
9.9%
18.1%
19.0%
NI Context
 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
WHSCT:
Previous Physiotherapy Provision
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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
The Way Forward
Patient
Feedback
Self
Management
Evidenced Based
Practice
Group
Staff
Education
PATIENT
Outcome
measures
Biopsychosocial
Assessment
Evidence Review
 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:
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Education
Relaxation Training
Goal Setting
Exercise
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
‘Moving With Pain’ Patient Feedback
 Venn Diagram
summarises
qualitative analysis
of 111 feedback
forms
Quantitative Results
Clinical Outcome
Measure
Pre
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/A
Re-Referral
Rate
Post
Statistical
Significance
Pre
Post
Statistical
Significance
0.08 (27.11)
0.01 (13.86) p <0.001
NI Healthcare Awards 2014
Pain Management
Programme of the Year
Judges’ Comments
 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.
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