Outpatient compliance with the various aspects of a multidisciplinary chronic pain management program

• Main Author: Vanecek, Robert Joseph
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2000
• Subjects: Chronic illnesses; Clinical psychology; Outpatient care facilities; Pain management; Psychotherapy; Public health
• ISBN: 9780599676114; 0599676116

To date no study has separately examined patient compliance with the various types of treatment offered in a chronic pain clinic. The current study attempts to discriminate persons who are compliant with recommendations for invasive procedures, office visits for medication management, psychotherapy, and physical therapy, from those who are not. Patient self-rated willingness to consider each form of intervention and compliance rates are compared across treatment modalities. Participants were 100 persons referred to the TTUHSC Pain Clinic. All participants live within 70 miles of the hospital, received recommendations for each treatment modality, and were treated as outpatients. Predictor variables include subjective ratings of disability (ADL) and pain intensity (VAS), the Profile of Mood States (POMS), a Likert-scale rating of willingness to engage in each treatment type, gender, age, education, distance of patient's home from the clinic, chronicity of condition, current and premorbid income, insurance type, and race. Repeated measures MANOVA indicated that patients were less willing to consider psychotherapy than all other forms of treatment. McNemar tests indicated that patients were more compliant with initial office visits than for all other types of treatment. More patients underwent invasive procedures than arrived for initial session of psychotherapy or physical therapy. Discriminant function analyses (DFAs) indicated that initial compliance with psychotherapy was predicted by education, willingness, age, and Caucasian race. ADL score and African-American race predicted initial involvement with physical therapy. Self-rated willingness predicted compliance with invasive procedures. Willingness, premorbid income, and age predicted compliance with office visits. DFAs were conducted to separate persons who continued beyond an initial session in each treatment modality from those who did not. No variable predicted continued compliance with psychotherapy. Age, ADL score, premorbid income, and POMS anger score predicted continued compliance with physical therapy. Education predicted continued invasive procedures beyond the first. Medicaid insurance type predicted continued participation with office visits. The results suggest that patients do not fully endorse the idea of multidisciplinary care and that compliance must be studied independently for each form of intervention offered.