Patient and Health Service Factors Associated with Enrollment in a Multidisciplinary Pain Rehabilitation Program: A Retrospective Cohort Study

Michael A. Bushey^1,2*Lindsay Flegge^1,2Elizabeth K. Harris²Melissa Melendez²Flora McConnell Hammond^2,3,4

• ¹Department of Psychiatry, School of Medicine, Indiana University Bloomington, Suite, Indiana, United States
• ²Neuroscience Center, Indiana University Health, Indianapolis, Indiana, United States
• ³Department of Physical Medicine and Rehabilitation, School of Medicine, Indiana University Bloomington, Indianapolis, Indiana, United States
• ⁴Rehabilitation Hospital of Indiana, Indianapolis, Indiana, United States

Introduction: Despite multidisciplinary pain rehabilitation programs (PRPs) being well-established as an effective treatment for chronic pain, the existence of such programs has been declining across the United States over recent decades.Objective: This study aims to identify factors associated with enrollment in a three-week, intensive outpatient PRP.Methods: This is a retrospective cohort study of all patient visits to a multidisciplinary pain evaluation clinic in 2023. The cohort was divided into those who did and did not subsequently enroll in a PRP program. Health service, demographic, and patient-reported outcome measures were compared between groups; continuous variables by independent samples Student's T-tests and categorical variables by chi-squared tests.Results: Of the 335 patients who had an evaluation in 2023, 48 went on to enroll in PRP (PRP-Yes group), and 287 did not (PRP-No group). Compared to PRP non-enrollers, the PRP-enrollers were more likely to have had a mental health (94% vs. 52%, p <.001) and physical therapy (94% vs. 48%, p<.001) assessment as part of their evaluation, had shorter lag times between their initial referral and medical evaluation (mean (SD) 43.5 (28.9) vs. 57.7 (41.7), p = .024), and had significantly greater anxiety, PTSD symptoms, somatic symptoms, and insomnia. Additionally, referral source, medical provider, and physical therapy provider seen differed significantly between PRP-enrollers and non-enrollers. PRP enrollment was not predicted by demographic variables including race, payer-type, or distance from the clinic.Discussion: Both personal and systemic factors were identified to be associated with enrollment in a threeweek multidisciplinary PRP. These findings highlight variables worth considering for clinical and research programs looking to increase PRP enrollment.