The effectiveness of multi-disciplinary pain management and motivational interviewing for people with chronic pain

Both groups will receive a 12 week multi-disciplinary pain management program aiming to improve quality of life through a goal oriented graded activity/exercise program provided by registered medical, physiotherapy, psychology and dietitian practitioners with a special interest in chronic pain. There will be 12 individual psychology sessions (1 hour each), 16 group psychology sessions (2 x 60 minutes per week over the final 8 weeks), 32 x 45 minute individual physiotherapy sessions, 4 x 60 minute group dietitian sessions ± 4 x 30 minute individual dietitian sessions (if indicated), >4 x 30 minute individual medical sessions over 12 weeks. Group sessions would have no more than 10 participants. The program may be delivered face to face or via telehealth based on participant preference. Each session will focus on goal setting and scheduling activities and exercises that enable achievement of short, medium and long term goals. Common goals and associated activities would include hobbies (eg playing local football), relationships (eg communicating positively with partner over dinner) and work (eg returning to normal duties/hours). Common exercises would include walking and standing dumbbell exercises (eg bicep curl, squats, step ups). Biological, psychological and social barriers to achieving goals would be addressed through education and a cognitive behavioural approach. Adherence would be checked through electronic records of completed sessions as well as goal/rehabilitation sheet analysis tracking daily activity/exercise/goal achievement. Following discharge from the program there would be low frequency (typically monthly for 6 sessions) physiotherapy ± psychology/medical sessions up to 52 weeks to support achievement of long term goals. There would be no difference in the physiotherapy sessions between the control and intervention group apart from 10 of the sessions being conducted using an Motivational interviewing (MI) approach. Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. In the experimental group, the pain management physiotherapy component will be provided in accordance with the spirit of motivational interviewing micro-skills during processes of engagement, focusing, evoking and planning to increase goal oriented graded activity/exercise as well as address specific barriers to recovery. Ten of these sessions will have pre-determined foci, running for 45 minutes, commencing early in the program and continuing until the final session 24 weeks after discharge from the program. The sessions will aim to improve pain and activity limitation by way of greater self-efficacy in pain management participants, with better maintenance of treatment effects in the long-term. Three sessions will then be conducted early in the pain management program (weeks 1, 2 and 4), with the goal of eliciting and strengthening an understanding of MI principles, the participant’s own values based goals, behaviour that address specific barriers to recovery and readiness to undertake a goal oriented graded activity/exercise. In the early to mid stages of the pain management program, the participant will commence a home based graded activity and clinic based supervised exercise program. Four sessions (weeks 5, 7, 9 and 12) will be conducted reviewing progress with this program and using MI communication skills and principles to elicit and strengthen graded progressions in activity/exercise. The sessions will also explore any challenges/barriers with the graded activity/exercise program and consider medium to longer term goals including return to work. Following discharge from the program three sessions (4, 11 and 25 weeks after discharge) will be conducted with the aim of supporting the ongoing goal oriented graded activity/exercise using MI skills and principles. Physiotherapists will be trained before the trial from an experienced psychologist in motivational interviewing including group and one on one role play sessions. During the trial audio recordings of participant treatment will be randomly evaluated for each physiotherapist using the Motivational Interviewing Treatment Integrity (MITI) code for fidelity. Group and individual meetings between the psychologist and the physiotherapists ± top up training will be provided. Detailed clinical notes will be kept for both groups and evaluated by the researchers for congruence with the clinical protocol. Treatment receipt and enactment will be evaluated on a proportion of the sample for both groups. Both groups will receive treatment individualised based on the participant's goals and the barriers to recovery identified by the practitioners.