Early termination in interdisciplinary pain rehabilitation: numbers, timing, and reasons. A mixed method study
Bibliographic record
Abstract
PURPOSE: To analyse the number of, timing of, and reasons for early termination of interdisciplinary pain rehabilitation (IPR). METHODS: A multicentre study in two Dutch rehabilitation centres with a mixed method design. Quantitative part: retrospective patient file review of all IPR patients. Qualitative part: 20 semi-structured patient interviews with early IPR terminators. RESULTS: One hundred and thirty-seven of 428 participants (31.3%) had terminated IPR early, of which almost 30% had a positive reason. Of a planned treatment duration of 12 weeks, the median (interquartile range (IQR)) reduction was 5.3 week (3.0; 8.0). Over 80% of the early terminators with negative reasons stopped in the first half of IPR, whereas approximately 55% of the early terminators with positive reasons stopped in the final quarter of IPR. A discrepancy between patient expectations of the aim and content and the actual IPR was mentioned as a negative reason for early termination. Many of the positive early terminators were able to self-manage. CONCLUSIONS: Previously reported figures on early termination were confirmed. Early termination of IPR should not be considered negative per se, because a substantial proportion of early terminations have a positive reason. Negative early terminators tend to stop earlier during IPR, compared to positive terminators.Implications for rehabilitationSubstantial rates of patients (31%) terminate interdisciplinary pain rehabilitation (IPR) earlier than planned.Early IPR termination should not be considered negative per se, because a substantial proportion of early terminations have a positive reason (i.e. goals achieved early).Although patients receive extensive personalised information about aim and content of IPR before starting, early terminators with a negative reason often have different expectations about the aim and content of treatment.Clinicians and researchers should be focused on how to explain IPR to the patient and check whether the patient has understood it well and is convinced of its credibility.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.038 | 0.073 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".