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Lamper C, Huijnen IPJ, Kroese MEAL, Köke AJ, Brouwer G, Ruwaard D, Verbunt JAMCF. Exploring the feasibility of a network of organizations for pain rehabilitation: What are the lessons learned? PLoS One 2022; 17:e0273030. [PMID: 36107861 PMCID: PMC9477302 DOI: 10.1371/journal.pone.0273030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background and aims Integration of care is lacking for chronic musculoskeletal pain patients. Network Pain Rehabilitation Limburg, a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients’ levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability. Methods This study was conducted with a three-phase iterative and incremental design from October 2017 to October 2018. The network comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase. Results According to health care professionals, guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One mentioned barrier is the stigmatization of chronic pain by the general population. In regular care, approaches are often more biomedical than biopsychosocial, causing patients to resist participating. The current organization of health care acts as a barrier, complicating implementation between and within practices. Health care professionals were enthusiastic about the iterative, bottom-up development. A critical mass of participating organizations is needed for proper implementation. Conclusion Network Pain Rehabilitation Limburg is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine Network Pain Rehabilitation Limburg. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model. Trail registration Registration number: NTR6654 or https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6654.
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Affiliation(s)
- Cynthia Lamper
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- * E-mail: (CL); (IPJH)
| | - Ivan P. J. Huijnen
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
- * E-mail: (CL); (IPJH)
| | - Mariëlle E. A. L. Kroese
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Albère J. Köke
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Gijs Brouwer
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jeanine A. M. C. F. Verbunt
- Faculty of Health, Medicine and Life Sciences, Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
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den Hollander M, Smeets RJEM, van Meulenbroek T, van Laake-Geelen CCM, Baadjou VA, Timmers I. Exposure in Vivo as a Treatment Approach to Target Pain-Related Fear: Theory and New Insights From Research and Clinical Practice. Phys Ther 2022; 102:6515749. [PMID: 35084025 DOI: 10.1093/ptj/pzab270] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/21/2021] [Accepted: 11/07/2021] [Indexed: 01/07/2023]
Abstract
UNLABELLED Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives. IMPACT For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.
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Affiliation(s)
- Marlies den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,CIR Revalidatie, location Eindhoven, the Netherlands
| | - Thijs van Meulenbroek
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Charlotte C M van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Vera A Baadjou
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Inge Timmers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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Lamper C, Huijnen IPJ, Goossens MEJB, Winkens B, Ruwaard D, Verbunt JAMCF, Kroese ME. The (cost-)effectiveness and cost-utility of a novel integrative care initiative for patients with chronic musculoskeletal pain: the pragmatic trial protocol of Network Pain Rehabilitation Limburg. Health Qual Life Outcomes 2020; 18:320. [PMID: 33004059 PMCID: PMC7528600 DOI: 10.1186/s12955-020-01569-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not optimally organized. The Network Pain Rehabilitation Limburg 2.0 (NPRL2.0) provides integrated care with a biopsychosocial approach and strives to improve the Quadruple Aim outcomes: pain-related disability of patients with CMP; experiences of care of patients with CMP; meaning in the work of healthcare professionals; and healthcare costs. Firstly, in this study, the effectiveness (with regard to the functioning and participation of patients) of primary care for patients with CMP will be assessed, comparing care organized following the NPRL2.0 procedure with usual care. Secondly, the cost-effectiveness and cost-utility with regard to health-related quality of life and healthcare costs will be assessed. And thirdly, the effect of duration of participation in a local network in primary care will be studied. METHODS In this pragmatic study, it is expected that two local networks with 105 patients will participate in the prospective cohort study and six local networks with 184 patients in the stepped-wedge based design. Healthcare professionals in the local networks will recruit patients. INCLUSION CRITERIA age ≥ 18 years; having CMP; willing to improve functioning despite pain; and adequate Dutch literacy. EXCLUSION CRITERIA pregnancy; and having a treatable medical or psychiatric disease. Patients will complete questionnaires at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4). Questionnaires at T1 and T4 will include the Pain Disability Index and Short Form Health Survey. Questionnaires at T1, T2, T3, and T4 will include the EQ-5D-5L, and iMTA Medical Consumption and Productivity Cost Questionnaires. Outcomes will be compared using linear mixed-model analysis and costs will be compared using bootstrapping methods. DISCUSSION NPRL2.0 is a multidimensional, complex intervention, executed in daily practice, and therefore needing a pragmatic study design. The current study will assess NPRL2.0 with respect to the Quadruple Aim outcomes: patient health and costs. This will provide more information on the (cost-) effectiveness of the organization of care in a network structure regarding patients with CMP. The other two Quadruple Aim outcomes will be examined alongside this study. Trial registration Netherlands Trial Register: NL7643. https://www.trialregister.nl/trial/7643 .
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Affiliation(s)
- Cynthia Lamper
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Ivan P J Huijnen
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Mariëlle E J B Goossens
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jeanine A M C F Verbunt
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
| | - Mariëlle E Kroese
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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