The Effectiveness of Biopsychosocial Interventions at the Dallas Spinal Rehabilitation Center: Applying the NIDRR Logic Model
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BACKGROUND: The National Institute on Disability and Rehabilitation Research has developed a program evaluation framework, the NIDRR logic model describing and assessing the relationship between planning, implementing, and evaluating outcomes in rehabilitation service environments, such as the Dallas Spinal Rehabilitation Center. Standard primary care facilities have treated chronic pain with narcotic medications; however, controversies surrounding the lack of long-term efficacy, risk of addiction, and the physical and psychological side effects of these medications continue to be heavily debated. There is strong evidence to support a biopsychosocial treatment approach for chronic pain which reduces narcotic dependence and restores daily functioning. The purpose of this study is to assess the effectiveness of the comprehensive interdisciplinary pain rehabilitation (IPR) program at the DSRC based on the NIDRR logic model. SUBJECTS: A total of 226 patients (131 males [58%] and 95 females [42%]) with chronic pain were admitted to the IPR program at the DSRC between January 2010 and December 2012. Among the 226 patients, 150 patients required medication tapering at admission. The average age of patients was 47 years old (SD= 9.74). The DSRC assigned patients to one of two groups after assessing the severity of their chronic pain curbing their ADL limitations, their social functioning, and their individualized treatment goals; 60 patients were in the chronic pain program, and 166 patients were in the functional restoration program. Patients attended between 80 hours to 160 hours of treatment that included medication management, physical therapy, cognitive-behavioral therapy with psychoeducation and biofeedback, and vocational counseling. METHOD: The current study is a descriptive design. All patients completed self-report measures assessing their current level of pain, functioning, depression, anxiety, and fear-avoidance beliefs at pre- and post-treatment. A dependent paired-samples t-test was used to assess the significance of treatment effect. RESULTS: Overall, significant improvements were seen among patients in the areas of independent functioning, depression, anxiety, fear-avoidance beliefs, medication tapering, and return to work status. Physical demand level, assessing independent functioning, improved significantly, t(225)=27.79, p=.000, among all patients. Results indicated significant improvements in depression scores, t(225)=13.38, p= .000, and anxiety scores, t(225)= 12.94, p= .000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(225)= 13.68, p= .000, as did those beliefs pertaining to work, t(223)= 15.33, p= .000. Additionally, 93% of patients successfully returned to work after completion of the program, and 96% of patients who required tapering at admission successfully tapered or discontinued their medication use. Improvements were also found within each treatment group. Physical demand level in the chronic pain program improved significantly, t(59)=12.19, p.000. Results indicated significant improvements in depression scores, t(59)= 5.79, p= .000, as well as anxiety scores, t(59)= 5.83, p=.000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(59)= 7.16, p= .000, as did those beliefs pertaining to work, t(59)=8.77, p= .000. Forty-four (73%) patients in the chronic pain program successfully returned to work. Of the 45 patients that required medication tapering at admission, 101 (96%) tapered or discontinued their medications. DISCUSSION: The NIDRR logic model has provided an excellent framework to assess treatment effectiveness in rehabilitation centers. Findings suggest that a biopsychosocial approach for chronic pain (e.g., the IPR program) is effective and efficient in diminishing overall distress and corroborating more biopsychosocial long-term effects than a short term quick fix of narcotic medications.