Predictors of attrition in an interdisciplinary pain management program.

PURPOSE/OBJECTIVE: This study sought to investigate the extent to which demographic and clinical characteristics predict which patients drop out of an interdisciplinary pain management program (IPP). RESEARCH METHOD/DESIGN: Participants (N = 178 outpatients, 18-75 years of age) received treatment for various chronic pain conditions in an IPP (including biopsychosocial assessment, cognitive-behavioral, and physical therapies). Separate logistic regression analyses identified the demographic and clinical variables most predictive of attrition across five domains: (a) demographics, (b) number of medical and non/psychiatric diagnoses, (c) opioid use (yes versus no)/risk of misuse, (d) pain-related cognition and behavior, and (e) physical, social, and mental well-being. Significant predictors from the five domains were integrated in a final multivariable logistic regression model. RESULTS: Among patients exposed to a 4-week IPP, 34% dropped out. In the final model, significant predictors of higher odds of attrition included younger age or being unemployed. Also, patients on opioids at preintervention had higher odds of completing the IPP than patients not on opioids at preintervention. Follow-up analyses revealed 24 of 37 completers (65%) on opioids at preintervention reduced or eliminated use over the course of the IPP. CONCLUSIONS/IMPLICATIONS: Because findings are limited by sample and design characteristics, they require replication yet offer novel hypotheses for identifying patients at risk of attrition. Specifically, patients with preintervention opioid use (contrasted with opioid dependence) may particularly benefit from an IPP. Patients at highest risk for early dropout can be targeted for specific engagement interventions to promote completion and effectiveness of IPP. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Validity and reliability of dry needle placement in the deep lumbar multifidus muscle using ultrasound imaging: an in-vivo study.

OBJECTIVES: To use ultrasound (US) imaging to determine the validity and reliability of needle placement of two dry needling (DN) protocols for the lumbar multifidus (LM) in individuals with a high body mass index (BMI). METHODS: Twenty-one participants with a BMI higher than 25 kg/m2 completed the study. A US scanner was used to determine the location of needle placement after a 100 mm long needle was inserted in the LM at L4 and L5 following two DN protocols for the deep LM muscle. US images were saved and viewed 6 months later to determine the intra-tester reliability. RESULTS: The probability of reaching the deep LM muscle was high (85-95%) at L4 and L5. Although the needle reached a bony landmark 85-100% of the time, it only reached the vertebra lamina as intended 70-75% of the time. The intra-tester reliability of needle placements based on analysis of real-time and recorded US images was poor-to-moderate. CONCLUSIONS: Although the bony drop may not indicate that the needle has reached the vertebra lamina as the protocol intended, reaching a bony drop is still meaningful as it coincided with reaching the LM in the majority of participants.