Academic journal article Journal of Rehabilitation Research & Development

Are Patient Ratings of Chronic Pain Services Related to Treatment Outcome?

Academic journal article Journal of Rehabilitation Research & Development

Are Patient Ratings of Chronic Pain Services Related to Treatment Outcome?

Article excerpt

Abstract--Consumer ratings of satisfaction with treatment are rarely used as measures of treatment outcome. This study examined the relationships between service ratings and psychometric outcomes of patients receiving pain-management services in a tertiary teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and effectiveness of services received and changes in their pain condition and quality of life (QOL). They also completed pre- and posttreatment measures of pain severity, pain interference, depression, and disability. Pain severity, pain interference, and depression significantly decreased following treatment. The patients' ratings of services were significantly associated with outcome measures. Pre- to posttreatment changes in pain severity and pain interference were associated with treatment satisfaction and effectiveness, improvement in pain condition, and QOL. Pre- to posttreatment change in disability was significantly related to ratings of treatment effectiveness, improvement in pain condition, and quality of life. The findings suggest that pain intensity, pain interference, and disability are important outcome dimensions of pain-management programs.

Key words: chronic pain, chronic pain treatment, depression, disability, multidisciplinary pain treatment, outcome assessment, pain interference, patient satisfaction, ratings of pain services, rehabilitation, treatment outcome, treatment satisfaction.

INTRODUCTION

In this age of accountability, patient feedback, usually on satisfaction with services received, has become a staple for many hospitals and health service providers. An advantage of patient satisfaction ratings is that they offer a low-cost, convenient assessment of the patient's perception of benefit from services. Numerous studies have found that a good patient-provider relationship may lead to a number of positive outcomes [1].

Despite the popularity and convenience of patient satisfaction ratings, very little research has studied how they relate to changes in specific treatment outcome domains; what little research has been performed suggests that the association between patient satisfaction and functional treatment outcomes varies. For example, one study found that treatment satisfaction was poorly related to objective functional scores among patients who received limited wrist fusion [2]. Although most patients in this study indicated that they were satisfied with the results of their surgery, their objective posttreatment wrist-functioning scores were mostly in the fair-to-poor range. Similarly, satisfaction with care was not related to functional status and anxiety among patients who were admitted to a rehabilitation unit after hip or knee surgery [3]. A study on older hospitalized medical patients found that patient health status at discharge, rather than degree of improvement or decline, was related to treatment satisfaction [4]. Thus, patients with similar health status at discharge reported similar levels of satisfaction, regardless of whether their status had improved, declined, or stabilized since their admission.

A survey of adolescents who underwent surgery for idiopathic scoliosis found that 73 percent were satisfied with the cosmetic results. Preoperative psychological difficulties and unrealistic expectations regarding the cosmetic results were associated with patient dissatisfaction or neutrality [5]. Research on patients with chronic pain indicated that expectation of pain relief following total hip and knee arthroplasty was related to subsequent functional ability [6]. This finding suggests that patient expectation may influence treatment outcome; however, patient satisfaction with and effectiveness of pain services were not assessed in this study. In another study of patients who underwent automated percutaneous lumbar discectomy, satisfaction was not related to pain relief but age was; specifically, younger patients reported better outcomes [7]. …

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