• This Outcome report is based on data from clients who completed a Pain
Management Programme at the RealHealth Treatment Centre in Coventry
between May 2010 and November 2012 .
• Pain related disability was reduced on average by 28% from start to completion
of the Pain Management Programme, and these improvements were
maintained at a four week follow up.
• Of the clients who showed emotional problems at the start of the programme,
87% showed a clinical improvement in symptoms on programme completion.
• Programme users showed an average reduction in fear of movement and
activity avoidance of 22%, which had not returned to baseline levels 4 weeks
after programme completion.
• Confidence in performing activities whilst in pain increased by 64% from start
to completion of the programme, and these benefits were maintained at a four
week follow up.
• Clients showed an average reduction in catastrophic thinking of 28% at
programme completion and 34% at follow up compared to initial preprogramme assessments.
• On average, functional ability improved by 23% from programme start to
programme completion, and improvements of 20% were maintained 4 weeks
following programme completion.
•
Representative sample based on 16 clients
Reducing Pain-Related Disability
18
16
Mean Disability Score
14
12
10
8
6
4
2
0
Start
Completion
Follow Up
Roland & Morris Disability Questionnaire
The Roland & Morris Disability
Questionnaire (RMDQ) is a widely
used health status measure for low
back pain, providing self-ratings of
the level of physical disability
experienced by the patient as a
consequence of the pain. Scores on
the RMDQ range from 0-24, with
higher scores indicating a greater
level of pain related disability. Our
data shows that for the clients in
the Pain Management Programme
there was a significant average
reduction of 28% in pain related
disability scores between admission
and discharge from the
programme. These improvements
were maintained at follow up 4
weeks after programme
completion.
Improving Self-Efficacy
40
Mean Self Efficacy scores
35
30
25
20
15
10
5
0
Start
Completion
Follow Up
The Pain Self-Efficacy Questionnaire (PSEQ)
The Pain Self-Efficacy
Questionnaire (PSEQ) is a 10-item
questionnaire developed for people
with ongoing pain to assess a
patient’s confidence in performing
activities while in pain. Higher
PSEQ scores indicate stronger selfefficacy beliefs and are associated
with return to work and
maintenance of functional gains.
Scores on the PSEQ were increased
by 64% from start to completion of
the programme, indicating
significant improvements in selfefficacy beliefs. These benefits were
maintained at a 4 week follow up,
with PSEQ scores still showing a
57% increase from the programme
start.
Reducing fear of movement
45
Mean Fear Avoidance score
40
35
30
25
20
15
10
5
0
Start
Completion
Follow Up
The TAMPA Scale
The TAMPA Scale for
Kinesiophobia (TSK) is a 17 item
questionnaire that provides
subjective self-report ratings of the
extent of fear of movement or
activity as a result of chronic pain.
Possible scores on The TSK range
from 17 to 68, with higher scores
indicating an increasing fear of
movement, injury or re-injury.
Programme users showed a
significant reduction in TSK scores
of 22% from programme start to
programme completion, with a
mean reduction of 20% maintained
4 weeks following programme
completion.
Reducing catastrophic thinking
Mean extent of catastrophic thinking
3.5
3
2.5
2
1.5
1
0.5
0
Start
Completion
Follow Up
The Pain-Related Self-Statements Scale (PRSS)
The Pain-Related Self-Statements
Scale (PRSS) is a 18 item cognitive
measure of the extent of
catastrophic thinking and
depressive symptoms. Scores on the
PRSS range from 0 to 5, with higher
scores indicating more frequent
catastrophising when experiencing
pain. Our data shows a reduction in
PRSS scores of 28% from the start
of the programme to completion,
and further reductions at follow up
resulted in an overall reduction in
PRSS scores of 34%. This indicates
that the programme significantly
decreased the extent of clients’
catastrophic thinking and led to
continued improvements over the 4
weeks following programme
completion.
Reducing emotional problems
The Hospital Anxiety and Depression Scale is a 14 item scale used to determine the levels of
emotional problems experienced by a patient. The scale contains two subscales, anxiety (7
items) and depression (7 items). Scores of 11 or higher on either of the subscales indicate
probable presence of mood disorder and a score of 8 to 10 is suggestive of the presence of
emotional problems in the respective area (Snaith, 2003).
Percentage of programme users
60
50
40
30
Start
20
Completion
Follow up
10
0
Probable mood
disorder
Suggested
emotional
problems
No emotional
problems
HADS Depression Subscale
Percentage of programme users
70
60
50
40
30
Start
20
Completion
Follow up
10
0
Probable mood
disorder
Suggested
emotional
problems
No emotional
problems
HADS Anxiety Subscale
HADS scores for the
depression subscale
indicated that 50% of
our programme users
had a probable mood
disorder, and 38% had
suggestive emotional
problems on admission
to the programme. On
completion of the
programme, however,
50% showed no
emotional problems
and these benefits were
maintained with 46%
still showing no
emotional problems at a
4 week follow up.
Improvements were
also seen on the HADS
anxiety subscale, with
the percentage of
programme users
identified as having a
probable mood disorder
dropping from 60% to
26% at programme
completion. 53%
showed no emotional
problems on the anxiety
subscale at programme
completion and this
was maintained at a 4
week follow up.
Improving functional ability
Functional ability measures were taken to assess any improvements in
strength, flexibility, co-ordination and self-confidence in activity over the
course of the programme. Specific functional ability measures included
timed walk, sit to stand, get up and go, and step ups. These measures were
taken at the start of the programme, on completion of the three-week
programme, and at a follow up four weeks after programme completion.
Average improvement from baseline (%)
25
20
15
10
5
0
Programme completion
Follow up
Functional Measures
The data shows a significant improvement in overall functional ability of
23% from pre-programme assessment to programme completion. These
improvements were maintained over the four weeks following programme
completion, with an average improvement of 20% seen at 4 week follow up
assessments.