Drop-out from chronic pain treatment programmes: Is randomization justified in biopsychosocial approaches?
Aminata Bicego, Justine Monseur, Floriane Rousseaux and 6 others
PMID 33829274WHAT IT FOUND
In 575 chronic pain patients, low education, waiting more than 4 months, and being randomized were linked to not starting.
Patients who asked for self-hypnosis/self-care and were not randomized were more likely to continue.
Key findings
01Of 575 patients, 281 dropped out and 294 completed the programme.
02Patients who never started were more likely to have a low educational level, to wait more than 4 months, or to be randomized.
03Patients who asked for self-hypnosis/self-care and were not randomized had 72.1% continuers, compared with 19.7% in the randomized group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study did not test whether any treatment worked. It looked at who dropped out, not at pain outcomes. The non-randomized group consisted of patients who asked for self-hypnosis/self-care. That makes it impossible to separate the effect of being randomized from the effect of choosing that treatment. The study was retrospective, so it could not measure all possible predictors, and it did not measure self-efficacy. The 4 treatment groups combined several elements, such as group discussion, self-care tasks, hypnosis, or music. The paper cannot show which part affected drop-out. Therapist expertise was linked to continuation in simple comparisons, but the model did not show therapist expertise was an independent predictor. Many baseline psychological variables showed no significant difference, so the paper does not identify a clear clinical profile beyond education, waiting time, and randomization.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the 72.1% continuation rate in non-randomized patients as evidence that self-hypnosis/self-care is better. That group was composed of patients who specifically asked for it, and the study did not compare treatment outcomes.