Activity and life-role targeting rehabilitation for persistent pain: feasibility of an intervention in primary healthcare

Abstract

Background: The activity and life-role targeting rehabilitation programme (ALAR) promotes patient’s active involvement in pain rehabilitation.

Purpose: to explore the feasibility of ALAR applied in a primary healthcare context.

Materials and methods: An intervention was conducted at primary healthcare centres. Patients experiencing persistent pain were randomly assigned to ALAR + MMR or Multimodal pain rehabilitation (MMR). Data were collected by patient questionnaires before and after intervention (9 weeks and 1 year), medical record examination and therapist telephone interviews.

Results: Seventy percent of ALAR + MMR participants completed the programme (n = 24). Complete data were obtained for half of the participants (ALAR + MMR n = 15, MMR n = 17). More ALAR + MMR than MMR participants perceived that they had been participating in planning their rehabilitation. The addition of ALAR to MMR induced higher costs short term, but had favourable health-economic effects in the long term.

Conclusions: The methods for delivering ALAR in primary healthcare by specially trained physio and occupational therapists were feasible. Therapists’ acceptability and perceived usability of the ALAR programme was high. More ALAR + MMR than MMR participants withdrew without completing treatment. Measures to increase patients’ acceptability of the ALAR programme are warranted. Flexibility in number of treatment sessions and addressing patients’ self-efficacy for undertaking rehabilitation is suggested, thus emphasising a more individualised rehabilitation plan.

Keywords:

• Activities of daily living
• behavioural medicine
• disability
• physiotherapy
• self-efficacy
• self-management

Acknowledgements

The authors thank Anders Norlund, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden for his valuable contribution for the accuracy of the statistical health-economic analyses and drafting of the text in the health-economic parts of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Center for Clinical Research Dalarna (CKFUU-259691/2012); REHSAM (99368-2009/RS14) and the Regional Research Council in Uppsala-ãrebro (RFR-232751/2011).