Pain-related fear in adolescents with chronic musculoskeletal pain: process evaluation of an interdisciplinary graded exposure program

Dekker, C.; van Haastregt, J. C. M.; Verbunt, J. A. M. C. F.; de Jong, J. R.; van Meulenbroek, T.; Pernot, H. F. M.; van Velzen, A. D.; Bastiaenen, C. H. G.; Goossens, M. E. J. B.

doi:10.1186/s12913-020-5053-6

Table 2 Percentage of occurrences observed of the Essential^a elements of the of the exposure program

No.	Specific element	Category	Percentage^b
PREPARATION PHASE – n = 8 sessions evaluated
P2	There is good teamwork between the therapists and adolescent	E	100
P3	The adolescent’s concern/fear with regard to activities is being discussed	EU	100
P6	The adolescent assesses the level of perceived threat value of daily activities (PHODA)	EU	94
P8	The aim of the treatment session is explained to the adolescent	E	88
P9	The therapists respond understandingly to the problems expressed by the adolescent	E	100
P10	Photographs of daily activities are being used	EU	88
P14	A hierarchy is being developed based on the threat value of daily activities (PHODA)	EU	88
P17	It is discussed how parents react to the disability and pain of their child.	E	13
	*Mean proportion of essential preparation phase elements (%)*		84
EDUCATION PHASE – n = 5 sessions evaluated
E1	It is emphasized that in chronic pain no clear relationship exists between pain and injury	E	100
E3	The adolescent’s concern/fear with regard to activities is being discussed	EU	100
E4	There is good teamwork between the therapists and adolescent	E	100
E5	The aim of the treatment session is explained to the adolescent	E	80
E9	A biomechanical approach to pain is being discouraged	E	70
E11	It is emphasized that pain reduction is not a therapy goal	E	70
E12	The adolescent is being actively involved in the explanation of the therapy	E	100
E13	It is explained that the treatment is aimed at verifying examining cognitions	EU	70
E14	A bio-psycho-social approach to pain is being explained	E	100
E15	It is emphasized that all activities are possible	E	30
E17	The drawbacks of inactivity are being explained	E	70
E21	The circular model pain-pain cognitions- avoidance – pain is being explained	EU	90
E22	The therapists respond understandingly to the problems expressed by the adolescent	E	90
E23	It is explained that the aim of the therapy is an increase in activity level	E	40
E25	The motivation of the parents for the treatment of their child is being checked	E	10
	*Mean proportion of essential education phase elements (%)*		79
TREATMENT PAHSE – n = 7 sessions evaluated
T1	Homework is being assigned	E	64
T3	The adolescent’s concern/fear with regard to activities is being discussed	EU	100
T4	The aim of the treatment session is explained to the adolescent	E	86
T5	A catastrophizing cognition is being identified	EU	100
T6	There is good teamwork between the therapists and adolescent	E	100
T8	A behavioral experiment is being performed	EU	100
T9	The therapists respond understandingly to the problems expressed by the adolescent	E	93
T11	Activities from the hierarchy or based on threat value are being performed	EU	93
T14	Clear agreements are made about the way in which activities should be carried out (e.g. how often, how high the jumps should be, how to bend down)	EU	50
T15	Homework is being evaluated	E	44
T21	It is discussed how parents react to the activities that the adolescent has started to perform.	E	29
	*Mean proportion of essential treatment phase elements (%)*		79

^aEssential treatment elements are both Essential-and-Unique (EU) and Essential-but-not-unique (E) treatment elements (Method of Assessing Treatment Delivery, described by Leeuw and colleagues [34])
^bThe reported percentage reflects the rating of both raters, therefore for each session evaluated, two ratings were used to calculate the percentage

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