James Cook University ISSN 1445-6354
Introduction: For individuals living in rural/remote areas, there are recognised barriers limiting access to specialist services for persistent pain management. Although there is currently evidence to support the use of telehealth to deliver individual pain management support, there is minimal evidence to support the use of pain management programs delivered within a group model, via telehealth. The aim of this research was to perform a formative evaluation of a persistent pain management program implemented via a multisite telehealth group model, and examine consumer perceptions.
Methods: The “Manage Your Pain” multisite telehealth group program was developed as a modified hub and spoke model. The model allowed participants from multiple rural/remote “spoke” sites to access 4 x 2 hour specialist persistent pain management sessions from a metropolitan Interdisciplinary Persistent Pain Management Centre (“hub” site, 491-1009km from spoke sites), and simultaneously enable real time access/interactions between participants at each of the spoke sites. Twenty-one individuals living with persistent pain participated in 1 of 5 multisite telehealth groups over the 12 month period. All participants completed standard pain scales pre-post pain management program, including:- Chronic Pain Acceptance Questionnaire 20 (CPAQ20); Brief Pain Inventory (BPI); Depression Anxiety Stress Scale (DASS 21); Pain Self Efficacy 2 (PSEQ20), and; the Participant Reported Outcomes Measurement Information System (PROMIS). The Patient Impression of Change Scale (PICS), a telehealth perceptions survey, and a semi-structured telephone interview were completed post programme.
Results: Results revealed significant (p<0.05) improvements in the Activity subscale and Total Score of the CPAQ, with 6 (30%) showing reliable improvement (90% CI), indicating a higher levels of activity engagement and pain acceptance post program. Four (19%) participants made reliable improvement on the BPI interference. Post program, the PICS revealed 65% of participants reported improvements in overall function, 61% indicated improved mood, 57% reported improved physical activity, and 50% had some improvement in pain. Post program <10% of participants reported having technical (audio, visual) issues that had impacted on their sessions, and >90% found telehealth to be comfortable, convenient and would consider using it for their healthcare in the future. Post program most participants felt they had connected with, and were in a shared health experience with other group members through the multisite telehealth model. The interviews revealed three main themes (a) Group Experiences, which involved comments relating to the dynamics of the group and the shared experience, (b) Telehealth Accessibility, which pertained to perceptions of the telehealth model for accessing specialist services, and (c) Limitations and Concerns where participants spoke of possible improvements to the program delivery model.
Conclusions: Results confirmed that participants received benefit from the pain management program and that they had positive perceptions of receiving the service via a telehealth model. The current findings provide positive data to support using telehealth to deliver specialist persistent pain management for individuals who face accessibility issues in rural and remote communities. The model also demonstrated that positive elements of group treatment can be achieved through telehealth group models.