title: The vocational continuum: how to make sense of vocational outcomes after group cognitive behavioural therapy for chronic pain sufferers.
abstract: BACKGROUND
  Vocational outcomes following group CBT programmes for patients with chronic pain are scarcely reported within the literature, despite their importance as measures of function. This study reports vocational, physical and psychological outcomes following a group CBT programme for patients suffering chronic pain. The study aimed to examine the vocational situation of chronic pain patients who completed a group CBT programme, using a scale known as the vocational continuum. The scale was developed to measure changes in RTW intention and work status, in an effort to reconceptualise vocational outcomes for this population with respect to the RTW process.
  
  
  METHODS
  A group of patients referred to a hospital pain clinic that went on to complete a group CBT programme were retrospectively surveyed about their vocational status at various time points. Physical outcomes measured included the 12-min walk test, 2-min sit to stand test, 2-min stair climb test and timed 20-m walk test. Psychological outcomes measured included pain intensity, self-efficacy, psychological distress (depression, anxiety and stress), catastrophising and disability. Responses to vocational items including work status, hours of work, intention to RTW and barriers to RTW were incorporated into the vocational continuum.
  
  
  RESULTS
  Two hundred and nine (58%) of the 360 patients who completed the group CBT programme between 1998 and 2005 completed the vocational survey. Ninety percent of participants reported that their chronic pain was a barrier to RTW or increasing hours of work pre-CBT. According to the vocational continuum, fifty per cent of the study population advanced toward working full-time (chi(2)(2, N = 163) = 28.87, P < 0.01) and this result was associated with a significant reduction in pain as a reported barrier to RTW or increasing participation in work post-CBT. Significant improvements were seen across all physical and psychological measures for study participants at 1, 6 and 12 month intervals post-CBT.
  
  
  CONCLUSIONS
  The study demonstrates improvements across physical and psychological measures post-CBT, indicating that participants benefited from reduced levels of pain-related distress and disability. Although retrospective, the study also suggests improvements were made across vocational outcomes. By doing so, the study adds to scant literature reporting on vocational outcomes of group CBT programmes for patients with chronic pain and offers a new scale for measuring and interpreting vocational outcomes for this population.
authors.affiliation: Barbara Walker Centre for Pain Management, St. Vincent's Hospital, 35 Victoria Parade, Fitzroy, 3065, VIC, Australia. darrencameronwhite@gmail.com
authors.forename: Darren C
authors.initials: DC
authors.lastname: White
authors.forename: Rowena
authors.initials: R
authors.lastname: Beecham
authors.forename: Kathryn
authors.initials: K
authors.lastname: Kirkwood
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000534:rehabilitation*; D011615:Psychotherapy, Group; D012050:Rehabilitation, Vocational / Q000523:psychology*; D012189:Retrospective Studies