19 | SCI And Chronic Pain Management

Evaluating Progress

Evaluation

Ida's pain experience and functioning status were assessed again at the end of Ida's Rehab-Cycle® to see which of the goals set at the beginning of the Rehab-Cycle® were achieved and to inform further healthcare decisions.

The results of this re-assessment (or re-evaluation) indicated that Ida made significant progress in all of the goals she and the rehabilitation team set. Although not all of the specific goals defined for each of the intervention targets were achieved, she showed improvements in most of them.

"...Ida made significant progress in all of the goals she and the rehabilitation team set..."

Goal achievement and the results of the final assessment of this particular Rehab-Cycle® were documented using the ICF Evaluation Display. The ICF Evaluation Display is an extended version of Ida's ICF Categorical Profile that visually shows (as a bar graph) the ICF qualifier rating given to each of her intervention targets during the final assessment along with the ratings from the initial assessment. It is a sort of “before and after” picture. Note that the comparison of the initial and final ratings only show that there was a change and whether the goals were achieved, but not whether the change or goal achievement was directly due to specific interventions. See table 4.

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Table 4: ICF Evaluation Display; ICF Qualifier: rate of the extent of problems (0=no problem to 4=complete problem) in the components of body functions (b), body structures (s), activities and participation (d) and the extent of positive (+) or negative impact of environmental (e) and personal factors (pf); Goal relation: 1 and 2 refer to Cycle Goals 1 and 2; SP refers to the Service-Program Goal; G refers to the Global Goal. Goal value refers to the ICF qualifiers to achieve after an intervention. Goal achievement: + means achieved, - means not achieved.

In terms of the primary reason for initiating this Rehab-Cycle® – effective pain management  – the final assessment revealed mixed results. Ida's goal of pain reduction from severe to mild pain was not achieved. Nevertheless Ida's pain in her head, neck, lower limbs, and joints did improve from severe to moderate pain. This improvement was reflected in the lower score of perceived pain on the Visual Analogue Scale. Ida's score changed from 8 to 3 on a scale from 0 (no pain) to 10 (pain as bad as it could be).{cs19-fn22} Furthermore, the physician seemed to have optimised Ida's pain medication.

Highly relevant for facilitating pain management, the intervention targets under cycle goal 1 ‘improvement in handling stress and other psychological demands’, i.e. b130 Energy and drive, b134 Sleep functions, b152 Emotional functions, e310 Immediate family, e410 Individual attitudes of immediate family, e5800 Health services, and pf Coping strategies, were achieved. However, the goal defined for the intervention target with the same name as the cycle goal itself, i.e. d240 Handling stress and other psychological demands, was not achieved.

Ida is much less nervous, overall more positive and self-assured, and can sleep through the whole night.

Ida’s psychologist at the end of the Rehab-Cycle®

In retrospect, selected goals set for pain management and cycle goal 1 may have been too ambitious, thus leading to the low goal achievement mentioned above.

In spite of not achieving selected goals related to pain management and handling stress, Ida perceived a clear reduction in pain and an improvement in her ability to relax. She attributed this progress to art therapy, painting, and playing the singing bowls.

For the first time since my accident, I feel like I can deal with my pain...I think I’ll be able to enjoy life and friends again.

Ida at the end of the Rehab-Cycle®

With regard to the achievement of the goals set for improving mobility, i.e. cycle goal 2, and for Ida's global goal of increased participation in social life, the majority of the goals were achieved. For example, at the final assessment Ida was able to transfer independently and stably without the use of a rubbing plate, only requiring help when transferring vertically. Furthermore, Ida was able to manoeuvre her manual wheelchair on flat surfaces and slightly ascending slopes. Ida's family was especially supportive in facilitating her participation in social activities.

At the end of the Rehab-Cycle® Ida was discharged home. To further strengthen Ida's pain management strategies and promote her social integration into the community, the rehabilitation team recommended that she seeks admission to a day programme at a clinic near her home.

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