NETWORK PAIN REHABILITATION LIMBURG

Rationale: In the Netherlands, the currently used rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not transparent because of the lack of evidence based guidelines for treatments matching the level of complexity of each chronic pain patient. Additionally, it is unclear if treatment options used are effective and efficient. Moreover, the costs for chronic pain rehabilitation are high. It is plausible that the effectiveness of the rehabilitation care for patients with CMP can be improved when the care is organized in a network with a stepped care approach and assessment tools to support the decision-making of the healthcare professional are used. In this Network, every patient receives an individual treatment program based on this/her complexity of pain related disability.

Objective To get an impression about the feasibility of Network Pain Rehabilitation Limburg, first a qualitative pilot study will be performed. This pilot study will focus on the barriers and facilitators of the implementation strategy and network structure, perceived quality of care, and the effect of the Network Pain Rehabilitation Limburg at daily functioning and participation in CMP patients.
Study design: A pilot study with an iterative and incremental design will be conducted. In three phases, nine physiotherapists, six GPs and two RPs with surrounded healthcare specialists, all situated in region Parkstad, will be participating in the Network Pain Rehabilitation Limburg. In phase 1 (start of the project till 1 October 2017) exploration of context will take place in order to develop the design of the Network and to educate the involved healthcare specialists. Next, in phase 2 (1 October 2017 till 1 March 2018) specification of content will be the focus. The design of the Network will be adjusted to daily practice. In phase 3 (1 March 2018 till 1 November 2018) the focus will be on the organization of care and reporting.

Moreover, a pre-post test design will be conducted to investigate the effect of Network Pain Rehabilitation Limburg at the pain problem of approximately 100 patients with CMP.

Study population: Healthcare specialists situated in the region Parkstad (South Limburg) who want to participate in Network Pain Rehabilitation Limburg. In addition to the healthcare specialists, adults aged 18 to 70 years old who visit the participating physiotherapists, GPs, or RP with CMP will be invited to participate in this study.

Main study parameters/endpoints: The barriers and facilitators regarding the implementation strategy, assessment tools, treatment protocols, and Pain Rehabilitation Coach will be determined with the use of focus groups. Therefore, healthcare specialists are asked to participate in 3 focus groups in each phase of the study. Moreover, a sample of patients will be asked to participate in a focus group at the end of the study. This information will be used to evaluate the feasibility of the Network and if required to adjust the Network for further research.

Also the quality of care, at the earlier mentioned aspects, will be determined during these focus groups. In addition to the focus group for patients, all patients will receive questionnaires about their satisfaction with the Pain Rehabilitation Coach. Regarding the quality of the referral and the treatment itself, patients will receive after referral and at the end of the treatment program an additional questionnaire. In addition, patients referred by a participating GP to a participating RP will receive an additional questionnaire regarding the quality of the referral of the RP.

The effect of the Network at the rehabilitation healthcare will be measured as two components: 1) as the effect at the referral pattern of patients with CMP in terms of efficiency and number of incorrect referrals, 2) and the effect on patient’s CMP and health outcomes. Therefore, healthcare specialists will receive a questionnaire regarding the referral pattern at that moment before the implementation of the Network and after the implementation. Patients will receive questions about anxiety and depression, and catastrophizing in order to compare their level of complexity with their referred treatment. The effect at patient’s CMP will be measured with questions regarding daily functioning (activities, disability, work participation, and pain intensity).

We hypothesize that Network Pain Rehabilitation Limburg will be feasible in daily practice based on the found barriers and facillitators and perceived quality of care. Moreover, the effect of the different treatments on the physical functioning of the chronic musculoskeletal pain (CMP) patients will be experienced positive.

Healthcare specialists:

4 education days before 1 October 2017

3 focusgroups (November 2017, February 2018, June 2018)

2 questionnaires regarding referral pattern: June 2017 and February 2018



Patients with CMP:

T0 Questionnaire after referral

T1 Questionnaire: only for patients referred from a General practitioner to a rehabilitation physician. After the referral of the General Practitioner.

T2 Questionnaire: at the end of the treatment. This will depend of the choosen treatment for the patient.

protocolized evidence-based musculoskeletal pain rehabilitation treatment plans, Pain Rehabilitation Coach, assessment tools, integrated in the current care, no comparison group.