Treatment compliance and results of exposure in vivo for patients with musculoskeletal pain after implementation in a rehabilitation center: a series of single case studies.

Abstract

A subgroup of chronic musculoskeletal pain patients experiences pain-related fear, for which exposure <i>in vivo</i> (EIV) has been developed. While EIV has shown effectiveness in research settings, its implementation in clinical practice remains limited. The purpose of this study was to assess the results and procedural fidelity directly following implementation in a clinical setting. Single Case Research study (<i>n</i> = 10; 5 men, 5 women) using daily scores on patient-specific goals, pain-related disability, and pain-catastrophizing as primary outcome measures. Generalization measures included questionnaires pre-post treatment and patient file data. Procedural fidelity was evaluated using the Method of Assessing Treatment Delivery. A recently trained treatment team delivered the EIV with high procedural fidelity (Cohen's kappa = 0.85). However, no statistically significant changes were observed in the daily measures for any patient. Nevertheless, based on triangulation data reported by the treatment team during the evaluation, most patients reported positive effects. Additionally, several patients reported clinically relevant changes on generalization measures. Based on the analysis of the daily measures no statistically significant change was found. However, the generic outcome measures and triangulation data- analysis showed that most patients did experience positive results. Procedural fidelity for EIV following implementation was good.