Logo: to the web site of Uppsala University

Interdisciplinary multimodal pain rehabilitation (IMMPR) is recommended for chronic pain, but there is lack of knowledge of who improves and how change unfolds. This study applies single case experimental design (SCED) in clinical inpatient setting, with the aims to evaluate outcomes of IMMRP and processes of change related to Acceptance and Commitment Therapy (ACT). The aim was also to evaluate the feasibility of the method. Methods: This study used repeated daily assessments of key variables for treatment outcome and process measures during baseline, treatment and follow-up. Four participants provided data on pain interference, pain severity, depression and psychological flexibility. In addition, standardized questionnaires for these variables, well-being and overall functioning were administered four times. Results: The results for the daily measures indicated no obvious improvements; on the contrary, there was a worsening for two participants on certain variables. The results on the standard measures varied, indicating no change or clinically significant and reliable changes representing both worsening and improvement. Adherence to daily measures differed among participants. Discussion: The use of SCED provided a perspective on how change unfolded even thoguh it was not in the expected direction of improbement. Notably, the sample represents a population with more severe problems, perhaps with need for individually tailored treatments. Conclusion: Data overall showed no clear pattern of improvement related to treatment. The methods of SCED can be used in an inpatient setting, but with refinements to ameliorate the feasibility, for example receiving feedback during the data collection. In the future it is recommended to include ideographic and behavioral measures, and to continue to develop a process-based approach.