Using the "TOPS," an outcomes instrument for multidisciplinary outpatient pain treatment

Objective. To assess the reliability of an augmented SF-36 instrument, the Treatment Outcomes in Pain Survey ("TOPS"), in patients treated in two pain management programs, and present norms for initial values and treatment-re lated improvements. Design. Prospective case series at two sites with longitudinal follow-up. Setting. Multidisciplinary, comprehensive outpatient pain treatment centers in university hospitals in Salt Lake City and Boston. Patients. Nine hundred and forty seven adult outpatients with a range of so cioeconomic, demographic, and ethnic characteristics, all referred for eval uation and treatment of chronic pain. Interventions. Usual practice multidisciplinary pain treatment. Outcomes Measures. TOPS prior to pain treatment and 5-week nominal follow-u p. Means and standard deviations of baseline and follow-up results. Psychom etric results for reliability (Cronbach alpha), validity (item discriminant validity, validity coefficients), and related statistical precision measur es for group and individual designs. Results. Several measures were precise enough to permit following individua l patients in standard clinic treatment, of which the Total Pain Experience dimension was the most powerful. Similar psychometrics were observed in th e Boston and Salt Lake City sites. The Pain Symptom, Objective Family/Socia l Disability, Objective Work Disability, and tipper Body Functional Limitat ions scales were validated. Discussion. The TOPS was designed to satisfy several models of clinical pai n treatment. It successfully monitored treatment based on those models. Not all patients improve with treatment, but most do. The TOPS can be administ ered in a variety of ways, but we found paper and pencil administration wit h computer scanning of results quick and efficient for making the data avai lable to clinicians as part of treatment. Conclusions. The accuracy of the TOPS is sufficient to monitor the response of individual patients during multidisciplinary treatment of chronic pain. The TOPS provides needed documentation (e.g., to third-party pavers) of th e aggregate value of multidisciplinary outpatient treatment of chronic pain as well as its benefit for individual patients.