Clinical effectiveness of a pain psychology service within an outpatient secondary care setting

Sheldon, Kerry, Clarke, Simon and Moghaddam, Nima (2015) Clinical effectiveness of a pain psychology service within an outpatient secondary care setting. Mental Health Review Journal, 20 (3). pp. 166-176. ISSN 1361-9322

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Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. This paper presents individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy (ACT).

Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-14. Outcomes were compared to 2012-13. A patient satisfaction questionnaire was administered and functional outcomes were collated.

Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliably improvement increased from 2012-13; 81% reliably improved, 44% made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care.

Research limitations/implications
Clinically effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs.

Practical implications
A number of recommendations concerning data collection and future service evaluations are made.

This paper contributes towards the evidence-base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e., practice-based evidence).

Keywords:pain, Acceptance and Commitment Therapy, service evaluation, practice-based evidence, bmjdoi, bmjgoldcheck, NotOAChecked
Subjects:C Biological Sciences > C841 Health Psychology
C Biological Sciences > C840 Clinical Psychology
Divisions:College of Social Science > School of Psychology
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ID Code:18195
Deposited On:04 Aug 2015 10:24

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