Early termination in interdisciplinary pain rehabilitation: numbers, timing, and reasons. A mixed method study

Abstract

Purpose

To analyse the number of, timing of, and reasons for early termination of interdisciplinary pain rehabilitation (IPR).

Methods

A multicentre study in two Dutch rehabilitation centres with a mixed method design. Quantitative part: retrospective patient file review of all IPR patients. Qualitative part: 20 semi-structured patient interviews with early IPR terminators.

Results

One hundred and thirty-seven of 428 participants (31.3%) had terminated IPR early, of which almost 30% had a positive reason. Of a planned treatment duration of 12 weeks, the median (interquartile range (IQR)) reduction was 5.3 week (3.0; 8.0). Over 80% of the early terminators with negative reasons stopped in the first half of IPR, whereas approximately 55% of the early terminators with positive reasons stopped in the final quarter of IPR. A discrepancy between patient expectations of the aim and content and the actual IPR was mentioned as a negative reason for early termination. Many of the positive early terminators were able to self-manage.

Conclusions

Previously reported figures on early termination were confirmed. Early termination of IPR should not be considered negative per se, because a substantial proportion of early terminations have a positive reason. Negative early terminators tend to stop earlier during IPR, compared to positive terminators.

Implications for rehabilitation

• Substantial rates of patients (31%) terminate interdisciplinary pain rehabilitation (IPR) earlier than planned.

• Early IPR termination should not be considered negative per se, because a substantial proportion of early terminations have a positive reason (i.e. goals achieved early).

• Although patients receive extensive personalised information about aim and content of IPR before starting, early terminators with a negative reason often have different expectations about the aim and content of treatment.

• Clinicians and researchers should be focused on how to explain IPR to the patient and check whether the patient has understood it well and is convinced of its credibility.

Keywords:

• Early termination
• interdisciplinary pain rehabilitation
• chronic pain
• patient reason
• timing

Acknowledgements

Many thanks are due to all rehabilitation physicians and therapist of the Pain Rehabilitation Department of the Center for Rehabilitation of the University Medical Centre Groningen and Revalidatie Friesland for including the participants of the qualitative part of the study.

Disclosure statement

The authors report no declarations of interest.