BACKGROUND: Pre-outpatient interventions in chronic pain have the potential to improve patient self-management earlier in primary or secondary care, which may minimize pain chronicity and negative health outcomes. The literature for this is sparse, and there are no existing systematic reviews on this topic.
METHODS: The purpose of this systematic review is to examine the evidence for pre-outpatient group interventions in chronic pain.
RESULTS: We identified four studies that looked at this: two randomized control trials, one prospective observational study, and one descriptive study. We identified high-quality evidence that a pre-outpatient group intervention reduces waiting times, moderate-quality evidence that it results in reduced costs per patient, very low-quality evidence that it reduces health care utilization, and very low-quality evidence that it improves service throughput. There were moderate-to-low levels of participant engagement with the initiative, which varied across the included studies. For patient outcome measures, we found no evidence that a pre-outpatient group intervention improves pain intensity, very low-quality evidence that it improves pain-related interference, low-quality evidence that it increases use of pain management strategies and produces high satisfaction levels, low-quality evidence that it improves pain self-efficacy, and no evidence that it improves psychological distress.
CONCLUSIONS: Group interventions before individual appointments have the potential to provide important improvements in service delivery, including improvements in waiting times and cost per patient. Benefits for patient outcome measures are less clear. Clinical heterogeneity and high levels of bias existed in the included studies. Further research is required so that meaningful conclusions can be made about these interventions.
This systematic review looked at published studies addressing the outcomes from pre-outpatient education and assessment in chronic pain patients. Only four published studies were identified with more evidence for benefits for the health care system than there were for individual patient outcomes. Most telling was the low participation rate identified in these studies which suggest that it is difficult to engage patients in such programs which raises questions about whether such interventions will ever show a positive cost benefit ratio.