Browsing by Subject "Pain rehabilitation"

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    Patient and health service factors associated with enrollment in a multidisciplinary pain rehabilitation program: a retrospective cohort study
    (Frontiers Media, 2025-04-10) Bushey, Michael A.; Flegge, Lindsay G.; Melendez, Melissa; Harris, Elizabeth K.; Hammond, Flora M.; Psychiatry, School of Medicine
    Introduction: Despite multidisciplinary pain rehabilitation programs (PRPs) being well-established as an effective treatment for chronic pain, the existence of such programs has been declining across the United States over recent decades. Objective: This study aims to identify factors associated with enrollment in a three-week, intensive outpatient PRP. Methods: This is a retrospective cohort study of all patient visits to a multidisciplinary pain evaluation clinic in 2023. The cohort was divided into those who did and did not subsequently enroll in a PRP program. Health service, demographic, and patient-reported outcome measures were compared between groups; continuous variables by independent samples Student's T-tests and categorical variables by chi-squared tests. Results: Of the 335 patients who had an evaluation in 2023, 48 went on to enroll in PRP (PRP-Yes group), and 287 did not (PRP-No group). Compared to PRP non-enrollers, the PRP-enrollers were more likely to have had a mental health (94% vs. 52%, p < .001) and physical therapy (94% vs. 48%, p < .001) assessment as part of their evaluation, had shorter lag times between their initial referral and medical evaluation [mean (SD) 43.5 (28.9) vs. 57.7 (41.7), p = .024], and had significantly greater anxiety, PTSD symptoms, somatic symptoms, and insomnia. Additionally, referral source, medical provider, and physical therapy provider seen differed significantly between PRP-enrollers and non-enrollers. PRP enrollment was not predicted by demographic variables including race, payer-type, or distance from the clinic. Discussion: Both personal and systemic factors were identified to be associated with enrollment in a three-week multidisciplinary PRP. These findings highlight variables worth considering for clinical and research programs looking to increase PRP enrollment.
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    Symptomatic joint hypermobility is not a barrier to attendance, graduation, or satisfaction for adults participating in a multidisciplinary pain rehabilitation program
    (Frontiers Media, 2025-03-20) Flegge, Lindsay G.; Estrella, Emma; Harris, Elizabeth K.; Hirsh, Adam T.; Bushey, Michael A.; Psychiatry, School of Medicine
    Introduction: Symptomatic joint hypermobility, as found in conditions like hypermobile Ehlers-Danlos syndrome (hEDS), presents unique challenges in pain management due to associated symptoms such as chronic pain, joint instability, and dysautonomia. Despite the high prevalence of hypermobility and associated healthcare costs, there is a lack of research on effective treatments for these patients, particularly in the context of multidisciplinary pain rehabilitation programs. Objective: This study aims to compare the baseline characteristics, attendance, graduation rates, and patient satisfaction of hypermobile and non-hypermobile adult outpatients participating in a multidisciplinary pain rehabilitation program (PRP). Methods: This retrospective cohort study analyzed clinical data from 335 patients at the Indiana University Health Pain Navigation Service between January 1, 2023, and December 31, 2023. Baseline characteristics were assessed using patient-reported outcome measures, and attendance and graduation rates were tracked. Hypermobile and non-hypermobile groups were compared with independent samples t-tests and chi-squared tests. A multiple linear regression model was used to assess the impact of hypermobility diagnosis on PRP attendance, with pertinent demographic and baseline clinical scores entered as covariates. Results: Hypermobile patients differed significantly from non-hypermobile patients in demographics, including age, gender, race, education, and employment status. Despite these differences, hypermobile patients did not differ from non-hypermobile patients in PRP attendance or graduation rates. Baseline pain, depression, and pain catastrophizing scores were lower in the hypermobile group. Exit surveys indicated similar levels of overall satisfaction with the program, though hypermobile patients were less likely to report that their needs were fully met than were non-hypermobile patients. Discussion: Despite the potential for joint hypermobility to pose a barrier to participation in multidisciplinary pain rehabilitation programs, we found no evidence that patients with a hypermobile diagnosis had less participation in an intensive outpatient pain rehabilitation program. After accounting for group differences in key demographic and clinical variables, there were no significant differences in PRP attendance between hypermobile and non-hypermobile patients. Our results are encouraging regarding the potential for multidisciplinary pain rehabilitation programs to serve the needs of these patients.