Associations of baseline characteristics, patient-reported outcomes, and satisfaction with pain therapy with the patient's global impression of change: a prospective cohort study

TL;DR

This study explores how various patient-reported outcomes and satisfaction with pain therapy influence a patient's overall impression of change after surgery.

Contribution

The study identifies pain intensity as the most significant factor affecting global impression of change, while highlighting the role of self-efficacy and adverse events.

Findings

Pain intensity contributed 55% to the patient's global impression of change (PGIC).

Anxiety, preoperative pain, and low treatment satisfaction were associated with less improvement after surgery.

Receiving information about treatment was linked to greater improvement in PGIC.

Abstract

Patient-reported outcome measures (PROMs) are key elements of assessing the efficacy of perioperative pain management. Here, we aimed to capture the association of 10 individually reported aspects of patient's specific impression of change since surgery (PSIC) related to four outcome domains of a previously defined core outcome set, relative to the patient's global impression of change (PGIC). We further evaluated the influence of type of surgery, sex, preoperative baseline characteristics, and satisfaction with pain management on PGIC.

This exploratory analysis used the PROMPT NIT-1 study data (2661 patients, 18 sites, four surgery types: total knee arthroplasty, sternotomy, breast cancer surgery, or endometriosis surgery). Male and female adults were included. All PROMs were assessed on postoperative day 3. We used ordinal regression models with PGIC as a dependent variable and PSICs as independent variables.

The overall model achieved a pseudo-R2 of 0.55 (relative domain contributions: pain intensity 55%, self-efficacy 19%, adverse events 15%, and pain-related interference of physical functioning 10%). Pain-related worrying and depression had no association with the PGIC, whereas anxiety, preoperative pain, opioid intake, low satisfaction with and wish for more treatment, low treatment agency, and overall dissatisfaction were associated with less improvement after surgery. Receiving information about treatment was associated with greater improvement on the PGIC.

Although all four domains contributed to PGIC after surgery, pain intensity was the most important. These findings highlight the importance of both managing postoperative pain and optimising patient experience by addressing self-efficacy, adverse events, and pain-related interference of physical functioning.

NCT 03834922

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