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What do clinicians consider when assessing chronic low back pain? A content analysis of multidisciplinary pain centre team assessments of functioning, disability, and health

Bagraith, Karl S.a,b,c,d,*; Strong, Jennyb,d; Meredith, Pamela J.d,e; McPhail, Steven M.f,g

doi: 10.1097/j.pain.0000000000001285
Clinical Note
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Global Year 2018

Beyond expert suggestions as to the appropriate subject matter for chronic pain assessments, little is known about the actual content of multidisciplinary pain centre (MPC) clinical assessments. The International Classification of Functioning, Disability and Health Low Back Pain Core Set (ICF LBP-CS) provides a universal language to support the consistent description of LBP-related assessments across disciplines within multidisciplinary teams (MDTs). This study sought to map the content of MPC clinical assessments to the ICF to: (1) identify and compare the content of clinical MDT assessments using a cross-disciplinary framework and (2) examine the content validity of the LBP-CS. A qualitative examination of MPC team clinical assessments of chronic low back pain was undertaken. Multidisciplinary team (pain medicine, psychiatry, nursing, physiotherapy, occupational therapy, and psychology) assessments were audio-recorded and transcribed. Concepts were extracted from transcripts using a meaning condensation procedure and then linked to the ICF. Across 7 MDT assessments, comprised 42 discipline-specific assessments and 241,209 transcribed words, 8596 concepts were extracted. Contextual factors (ie, the person and environment), except for physiotherapy, accounted for almost half of each discipline's assessments (range: 49%-58%). Concepts spanned 113 second-level ICF categories, including 73/78 LBP-CS categories. Overall, the findings revealed novel insights into the content of MPC clinical assessments that can be used to improve health care delivery. International Classification of Functioning, Disability and Health–based assessment profiles demonstrated unique contributions from each discipline to chronic low back pain assessment. Finally, users of the LBP-CS can be confident that the tool exhibits sound content validity from the perceptive of MDT assessments of functioning, disability, and health.

A qualitative examination of multidisciplinary pain centre clinical assessments revealed novel insights into the content of team assessments of chronic low back pain that can be used to improve health care delivery.

aInterdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia

bOccupational Therapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

cProfessor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

dOccupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia

eOccupational Therapy, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia

fCentre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia

gInstitute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia

Corresponding author. Address: Interdisciplinary Persistent Pain Centre, 2 Investigator Dr, Robina, Gold Coast, Queensland 4226, Australia. Tel.: +61756686825; fax: +61756809539. E-mail address: Karl.Bagraith@gmail.com (K.S. Bagraith).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received January 26, 2018

Received in revised form May 10, 2018

Accepted May 13, 2018

© 2018 International Association for the Study of Pain
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