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Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: Evaluation of a CBT informed pain management programme

Morley, S., Williams, A. and Hussain, S. (2008) Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: Evaluation of a CBT informed pain management programme. Pain, 137 (3). pp. 670-680. ISSN 0304-3959

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Abstract

Randomized controlled trials and meta-analyses provide evidence for the efficacy of cognitive-behaviourally informed treatment (CBT) programmes for chronic pain. The current study aims to provide practice-based evidence for the effectiveness of CBT in routine clinical settings. Over a 10-year period 1013 pain patients were accepted into a 4 week in-patient pain management programme. Data from more than 800 patients was available at pre-treatment and at one month post-treatment and for around 600 patients at pre-treatment and at 9 months follow-up. Measures reported in this analysis were pain experience and interference, psychological distress (depression and anxiety), self-efficacy, catastrophizing, and walking. Change from pre-treatment to post-treatment and follow-up was assessed with conventional statistical tests, the computation of effect sizes and by the reliable change index (RCI) and clinically significant change (CSC) methodology. These analyses provide evidence of statistical improvement at post-treatment and follow-up and the RCI/CSC methodology suggested that between 1 in 3 and 1 in 7 (depending on the outcome measure) achieved clinically significant gains. There was also evidence that a small percentage of patients (1–2%) reliably deteriorated during the period of treatment. The limitations in the inferences that can be drawn from this study and of the methodology are discussed. A case is made for the application of benchmarking methods using data from RCTs in order to more fully evaluate practice and to generate better quality practice based evidence.

Item Type: Article
Copyright, Publisher and Additional Information: © 2008 Elsevier B.V. This is an author produced version of a paper published in Pain. Uploaded in accordance with the publisher's self archiving policy.
Academic Units: The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Health Sciences (Leeds)
Depositing User: Sherpa Assistant
Date Deposited: 27 Nov 2008 12:18
Last Modified: 08 Feb 2013 17:05
Published Version: http://dx.doi.org/10.1016/j.pain.2008.02.025
Status: Published
Publisher: Elsevier B.V.
Refereed: Yes
Identification Number: 10.1016/j.pain.2008.02.025
URI: http://eprints.whiterose.ac.uk/id/eprint/4946

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