1. Moving with Pain A Physiotherapy Led Pain Management Programme
Pauline Campbell and Elizabeth Connolly-Anderson
Physiotherapy Department, Altnagelvin Area Hospital, WHSCT

2. Overview Chronic Pain Incidence NI Context Previous Service Provision
The Way Forward
“Moving with Pain” Programme
Outcome Measures
Quantitative and Qualitative results
The Future

3. Chronic Pain Incidence (Breivik et al, 2006)
Uk Average; 1 in 7 (7.8 million people)
Regional Figures:
North East/Yorkshire 9.0%
North West %
East Midlands 9.3%
West Midlands 17.5%
East %
London %
South East %
South West %
Wales 9.9%
Scotland %
Northern Ireland 19.0%

4. NI Context
2005 – Raft of recommendations for how pain services could be improved
2010 – ‘little progression for these recommendations’ (apart from CREST guidelines, 2008)
19.4% of people in NI aged have experienced sexual violence or abuse (French & Freel, 2009)
Ilex Briefing (2009), Derry-Londonderry - ‘large proportions of children living in poverty, low employment rates, large numbers of families reliant on benefits, premature mortality and poor educational outcomes
WHSCT MSK “Core” Physiotherapy- 90% Chronic MSK Pain Referrals

5. WHSCT: Previous Physiotherapy Provision
Biomedical Ax
1:1 Treatment
Functional Rehab Class
Little use of Outcome measures
Perceived high re-referral rates
High Dropout rates
Reported Barriers to participation

6. The Way Forward MOVING WITH PAIN PATIENT Patient Feedback Self
Management
Outcome
measures
Group
Staff
Evidenced Based Practice
Biopsychosocial
Assessment
Education
PATIENT

7. Evidence Review
Clinical Guidelines in Chronic Pain Management were reviewed – European Chronic Low Back Pain (2004), NICE Persistent Low Back Pain (2009)
Systematic reviews of the evidence for chronic musculoskeletal pain management were conducted
A multimodal programme was devised
Evidence based components:
Education
Relaxation Training
Goal Setting
Exercise

8. Outcomes Measures
Outcome measures were chosen in accordance with the IMMPACT recommendations of core outcome measures in chronic pain clinical trials (Dworkin et al, 2005)
BPI, PSEQ, PGIC
A qualitative study was conducted to capture service users’ lived experience with chronic pain
Re-referral rates to the physiotherapy were also examined

9. ‘Moving With Pain’ Patient Feedback
Venn Diagram summarises qualitative analysis of 111 feedback forms

10. Quantitative Results Clinical Outcome Measure Pre Post
Statistical Significance
BPI – ‘worst pain’
7.2 (4.03)
6.77 (4.02)
p 0.02
PSEQ - mean
2.5 (1.61)
2.87 (1.62)
p <0.001
PGIC
N/A
3.61 (1.61)
Re-Referral
Rate
Pre
Post
Statistical Significance
0.08 (27.11)
0.01 (13.86)
p <0.001

11. Pain Management Programme of the Year
NI Healthcare Awards 2014
Pain Management Programme of the Year
Judges’ Comments
The ‘Moving With Pain’ programme was unanimously selected by the judges from a very strong field. It is commended for an innovative approach to overcoming the fear of moving with pain in those with musculoskeletal pain.  Their robust outcome measures showed considerable movement over a traditional functional rehabilitation programme and patient satisfaction was high. Referral  to the physiotherapy department was reduced by 87%, a significant reduction in cost and resource.

12. The Future… Moving with Pain available Trust Wide
Staff Development - Economies of time, lack of staff skills or other resources risk reducing the effectiveness of the programme to a point where gains are insignificant.
Group for < 18yr olds
Patient Involvement-focus Group and 1 year follow-up
Application for funding for Tea/coffee and Primary Care/Community Setting