Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 6

Additional records identified
through other sources
(n=1)
Title abstracts screened
(n=55) Records excluded
(n=23)
Full-text articles
assessed for eligibility
(n=32) Full-text articles excluded,
with reasons
(n=24 )
Study design (n=22)
Intervention (n=2)
Studies included in
systematic review
(n=8)
Fig. 1. Flow chart of study selection.
METHODS
The Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines (15) and the Cochrane
Handbook for Systematic Reviews of Interventions (16) were
followed in performing the review. A PROSPERO protocol
(registration number: CRD42016039689, https://www.crd.
york.ac.uk/prospero/ (17) was developed a priori together with
a medical information specialist (JM). Amendments made during
the research process were registered in the PROSPERO protocol.
Literature search and study selection
A comprehensive search strategy was conducted from inception
to 22 June 2017 in the following databases: PubMed, PsycINFO,
CINAHL, Embase and SPORTDiscus. To achieve maximum
sensitivity we applied medical subject headings and title/abstract
text searches (Appendix S1 1 ). The PubMed search strategy was
translated to the other databases. Studies obtained through screen­
ing reference lists were added in the top righthand box of the
PRISMA flowchart (Fig. 1). The search strategies were reviewed
and conducted by an experienced medical information specialist.
Screening was done independently by 2 reviewers (JO, HW).
The first step was to screen articles on titles and abstracts. The
second step was assessment of the full-texts of the articles for
inclusion (JO, HW). For each article, any discrepancy between
the 2 reviewers was resolved through discussion. In the first
screening stage (titles plus abstracts), studies were included
when both reviewers agreed they were eligible for inclusion,
or if there was doubt about whether or not to exclude them. In
the second screening stage (full-texts), studies were included
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2502
1
Records identified through database searching:
SPORTDISCUS: 134
EMBASE: 698
PUBMED: 591
PSYCINFO: 323
CINAHL: 208
(n=1,954)
3
Records after duplicates removed
(n=1,400)
The mental health literature demonstrated asso-
ciations between dropout and negative treatment
outcomes. An important reported reason for dro-
pout was the patient’s low motivation. Since re-
search studies select the most motivated patients,
selection bias may affect the generalizability of
these studies and may lead to overestimation of
treatment effects (10–13). It is not clear if these
findings may be transferred to interdisciplinary
pain management programmes. For most patients
with chronic pain these programmes are their
last hope. Systematic research on predictors of
dropout in these programmes may reveal specific
knowledge on how to address these predictors.
This may prevent a lot of frustration, overutiliza-
tion of the healthcare system and more patients
who complete interdisciplinary pain management
programmes, which may result in better treatment
outcomes.
Therefore, the following research question was
addressed in this systematic review: which factors
are predictors of dropout of patients with chronic
musculoskeletal pain during interdisciplinary pain
management programmes?
Included
Predictors of dropout: a systematic review
when both reviewers felt they met all the inclusion criteria. The
following definition of predictor was used in this systematic
review: “a predictive factor is a measurement that is associated
with response or lack of response to a particular therapy” (18).
Due to the complexity of dropout we focused in this systematic
review on studies that applied both univariate analyses and
multiple logistic regression analyses. These studies are also
known as outcome prediction models (19).
Articles were included if: (i) the study population involved
patients over 18 years of age, with chronic non-cancer mus-
culoskeletal pain, i.e. chronic pain that is localized in muscles,
ligaments, bones, fasciae, bursae or joints. Chronic pain was
defined as: “pain that persists longer than 3 months, or pain that
extends beyond the expected period of healing” (20); (ii) the
study intervention consisted of interdisciplinary pain management
programmes. Interdisciplinary was defined as: “clinicians from
different specialities working together and communicating with
each other on a frequent and scheduled basis about patients to
reach a common goal” (21); (iii) the study design was: retrospec-
tive- or prospective cohort study or randomized controlled trials
(RCTs) with the aim to identify multiple predictors for dropout
during treatment and containing both univariate analyses and
multiple logistic regression analyses; (iv) the language of the
article was limited to: English, Dutch, French or German. Articles
were excluded if the study intervention consisted of: (i) dropout
during medication trials or (ii) an online intervention.
Methodological quality assessment
The methodological quality of all included studies was asses-
sed independently by 2 reviewers (JO, HW) with the Quality
in Prognosis Studies (QUIPS) tool. This tool is appropriate to
assess the risk of bias in prognostic studies and considers 6
domains: study participation, study attrition, prognostic factor
measurement, outcome measurement, study confounding, and
statistical analyses (Table I) (22, 23).
J Rehabil Med 51, 2019