Dosage of pain rehabilitation programs: a qualitative study from patient and professionals' perspectives

Background: There is a large and unexplained practice variation in prescribed dosages of pain rehabilitation programs (PRP), and evidence regarding the optimum dosage is unknown. Methods: To explore perspectives of patients and rehabilitation professionals regarding dosages of PRP an explorative qualitative research design was performed with thematic analysis. Patients and rehabilitation professionals were recruited from three rehabilitaton centers in the Netherlands. A purposive sample of patients who completed a PRP, with a range of personal and clinical characteristics was included. Rehabilitation professionals from all different disciplines, working within multidisciplinary PRP for a minimum of two years, for at least 0.5 fte were included. Individual semi-structured interviews were conducted with 12 patients undergoing PRP, and three focus groups were formed with a total of 17 rehabilitation professionals involved in PRP. Results: All patients were satisfied with received dosage. Factors important in relation to dosage of PRP were categorized into patient related characteristics (case complexity from a biopsychosocial perspective) to treatment related characteristics (logistics and format of the program, interaction between patients and professionals), and external factors (support from others, costs, traveling distance and injury compensation). Professionals concluded that dosage was currently based on historical grounds and clinical expertise. Conclusion: Patients and professionals from different centers considered the same factors related to dosage of PRP, but these considerations (from patients and professionals) led to different dose choices between centers. PRP dosage appeared to be mainly based on historical grounds and clinical expertise. The insights of this study could assist in future research regarding optimum dosage of PRP and rehabilitation programs in general.