Using surveys to assess patient-centered factors that may affect responses to chronic pain treatment
Do patients and clinicians find HEAL, PROMIS, and the American Chronic Pain Association (ACPA) Pain Log to be useful in treatment? METHODS: In this prospective observational study, persons with chronic pain starting a CAM (eg, acupuncture, chiropractic; n = 109) or a conventional medicine treatment...
| Main Authors: | , , |
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| Corporate Author: | |
| Format: | eBook |
| Language: | English |
| Published: |
[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
[2019], 2019
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Do patients and clinicians find HEAL, PROMIS, and the American Chronic Pain Association (ACPA) Pain Log to be useful in treatment? METHODS: In this prospective observational study, persons with chronic pain starting a CAM (eg, acupuncture, chiropractic; n = 109) or a conventional medicine treatment (eg, physical therapy, medication management; n = 100) completed HEAL and PROMIS measures online at baseline and at 2 and 4 months later. They rated clinical global improvement (CGI) at follow-ups. Correlations and multiple regression were the main analytic strategies. We compared CAM and conventional patients as well as those with lower and higher HEAL TEX to evaluate HTE. A subset of patients (n = 44) and clinicians (n = 13) completed interviews on the clarity and clinical utility of HEAL, PROMIS, and ACPA Pain Log. BACKGROUND: Nonspecific, contextual factors are seldom measured in research trials or clinics, yet they can influence outcomes. This project evaluated the Healing Encounters and Attitudes Lists (HEAL) and PROMIS measures during pain treatment. HEAL includes Patient-Provider Connection, Healthcare Environment perceptions, Treatment Expectancy (TEX), Positive Outlook (POS), Spirituality (SPT), and Attitudes Toward Complementary/Alternative Medicine (CAM). We addressed heterogeneity of treatment effects (HTE), the methods gap, by comparing outcomes in patient subgroups: persons receiving CAM vs conventional treatments and, separately, patient subgroups who had higher and lower scores on HEAL TEX. OBJECTIVE: Specific research questions:1. Do nonspecific factors, assessed by HEAL, predict pain treatment outcomes?2. Do the PROMIS and HEAL measures contribute to an understanding of which subgroups of patients may benefit from pain treatments?3. RESULTS: Baseline HEAL TEX, POS, and CAM were correlated with follow-up PROMIS Pain Intensity, and baseline HEAL TEX, POS, CAM, and SPT were correlated with PROMIS Pain Interference. All baseline HEAL scores except those for SPT were correlated with CGI at 2 and 4 months (Spearman rho, all P < .05). In final regression models, baseline HEAL TEX and baseline Pain Intensity accounted for 42% of the variance in 4-month Pain Intensity, with HEAL TEX contributing 2% additional variance over baseline Pain Intensity. Baseline HEAL CAM, SPT, and POS accounted for 2.1%, 1.7%, and 1.5%, respectively, of 4-month follow-up Pain Interference variance beyond that accounted for by baseline Pain Interference. Regarding subgroup comparisons based on receiving CAM vs conventional treatments, the conventional treatment group had higher PROMIS Average Pain, Pain Interference, and Pain Intensity; lower Physical Functioning; and poorer Overall Health compared with the CAM treatment group at all time points. The lower TEX group had higher pain and poorer health and functioning than the higher TEX group at all time points. In interviews, patients and clinicians reported HEAL and PROMIS to be relevant to their treatment, and patients made suggestions for the ACPA Pain Log. CONCLUSIONS: Several HEAL measures were correlated with later PROMIS Pain treatment outcomes. Higher HEAL TEX and choosing CAM over conventional medicine were patient factors that positively influenced outcomes. Patients and clinicians found HEAL and PROMIS measures as well as the ACPA Pain Log to be potentially useful tools for enhancing communication in clinical settings. LIMITATIONS: This study included only patients with chronic pain; however, HEAL and many PROMIS measures apply to a broader range of patients and treatments |
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| Physical Description: | 1 PDF file (77 pages) illustrations |