Clinical effectiveness of a pain psychology service within an outpatient secondary care setting
| DOI | https://doi.org/10.1108/MHRJ-11-2014-0043 |
| Pages | 166-176 |
| Published date | 14 September 2015 |
| Date | 14 September 2015 |
| Author | Kerry Lynn Sheldon,Simon P. Clarke,Nima Moghaddam |
| Subject Matter | Health & social care,Mental health |
Clinical effectiveness of a pain psychology
service within an outpatient secondary
care setting
Kerry Lynn Sheldon, Simon P. Clarke and Nima Moghaddam
Dr Kerry Lynn Sheldon is
Clinical Psychologist at
Older People’s Mental Health
Services –Psychology,
Rotherham, Doncaster and
South Humber NHS
Foundation Trust,
Scunthorpe, UK.
Dr Simon P. Clarke is Clinical
Psychologist at Physical Health
Clinical Psychology Services,
Nottinghamshire Healthcare
NHS Foundation Trust, Sutton
in Ashfield, UK and Research
Clinical Psychologist at Arthritis
Research UK Pain Centre,
University of Nottingham,
Nottingham, UK.
Dr Nima Moghaddam
is based at Trent DClinPsy
Programme, University of
Lincoln, Lincoln, UK.
Abstract
Purpose –Data gatheredfrom routine clinicalsettings is complementaryto evidence garneredfrom controlled
efficacytrials. The purpose of this paper is to presentindividual-level analysisof changes in a group of patients
dischargedfrom psychological therapy withinan outpatient pain service. The service had recently shifted from
a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy.
Design/methodology/approach –Reliable and clinically significant change methodology was applied
to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to
2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated.
Findings –Outcomes were not adversely affected by the shift in service focus as clients demonstrating
reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically
significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted.
The service met a number of NICE quality standards concerning the “relational”aspects of care.
Research limitations/implications –Clinical effectiveness is evaluated through one outcome measure
therebylimiting conclusions.The longer term effectiveness of the service remainsunclear. Narrow demographic
informationlimits an assessmentof any systematic biasesin findings. Little is known abouttreatment drop-outs.
Practical implications –A number of recommendations concerning data collection and future service
evaluations are made.
Social implications –Returning to paid or unpaid activities has a high public health impact.
Originality/value –This paper contributes towards the evidence base for using psychological therapies with
clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for
general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness
(i.e. practice-based evidence).
Keywords ACT, Pain, Clinically significant change, Practice-based evidence,
Quality assurance/service evaluation, Reliable change
Paper type Research paper
Background
Policy context
Recent audits have highlighted the patchy and often inconsistent services provided for people
with chronic pain (English Pain Summit, 2012). Despite the increase in provision of psychological
therapies demonstrated by such initiatives as Improving Access to Psychological Therapies
(IAPT) (Department of Health (DOH), 2011), psychological services are often unresponsive to the
specific needs of patients with chronic pain (British Pain Society, 2009). It is thus paramount that
psychological services specialising in pain develop ways of evaluating service outcomes in a way
that is consistent with the needs of patients with chronic pain.
Received 6 November 2014
Revised 23 February 2015
21 May 2015
Accepted 15 June 2015
PAGE166
j
MENTALHEALTH REVIEW JOURNAL
j
VOL. 20 NO. 3 2015, pp. 166-176, © Emerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-11-2014-0043
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