title: Evaluation of group and individual change in a multidisciplinary pain management program.
abstract: OBJECTIVE
  Systematic reviews have consistently shown that multidisciplinary interventions are more effective than waitlist and other unimodal active treatments for a range of chronic pain conditions. However, these group-based statistics fail to inform us whether these programs result in clinically meaningful improvement at the individual level. The current study examines group changes and individual responsiveness to a CBT-informed multidisciplinary chronic pain management program.
  
  
  METHODS
  The analyses are based on data obtained from 263 outpatients. In addition to examining group-based treatment effects, we evaluated individual responsiveness to the program using 3 different criteria for assessing clinically important change.
  
  
  RESULTS
  Statistically significant improvement was found for all measures at posttreatment, with effect sizes ranging from small to medium. Gains were largely maintained at follow-up. The results of the clinically important change analysis revealed that not everyone improved uniformly, and the magnitude of change varied across the 3 different methods. This variability in the extent of improvement prompted further analyses in an attempt to identify individual differences that could predict responsiveness to treatment. No differences were found between responders and nonresponders to treatment.
  
  
  CONCLUSIONS
  The results of our study are consistent with previous research, and highlight the potential for multidisciplinary programs to improve the well-being of individuals with chronic pain. Clinically important change analyses underscore the variability that exists in chronic pain patients and allows for a more fine grained evaluation of individual responsiveness to treatment. Considering the strengths and limitations of each methodological approach for assessing clinically important change, guidelines are offered for future research and program development.
authors.affiliation: Chronic Pain Centre, St Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Ingrid C
authors.initials: IC
authors.lastname: Fedoroff
authors.forename: Ekin
authors.initials: E
authors.lastname: Blackwell
authors.forename: Brittany
authors.initials: B
authors.lastname: Speed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003131:Combined Modality Therapy / Q000379:methods*; D016208:Databases, Factual / Q000706:statistics & numerical data; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010146:Pain / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D059408:Pain Management; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D055815:Young Adult