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

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol.

OBJECTIVES: To evaluate whether an interdisciplinary graded exposure program, for adolescents with chronic musculoskeletal pain reporting pain-related fear, was performed according to protocol, and whether it is feasible to implement the program in rehabilitation care.

METHODS: A process evaluation where quantitative and qualitative data on participant characteristics (adolescents, parents and therapists), attendance and participants' opinion on the program were collected, by means of registration forms, questionnaires and group interviews. To evaluate treatment fidelity, audio and video recordings of program sessions were analyzed.

RESULTS: Thirty adolescents were offered the program, of which 23 started the program. Adolescents attended on average 90% of the sessions. At least one parent per adolescent participated in the program. Analysis of 20 randomly selected recordings of treatment sessions revealed that treatment fidelity was high, since 81% of essential treatment elements were offered to the adolescents. The program was considered client-centered by adolescents and family-centered by parents. Treatment teams wished to continue offering the program in their center.

CONCLUSION: The interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program. Implementation of the program in rehabilitation care is considered feasible.

TRIAL REGISTRATION: ID: NCT02181725 (7 February 2014).

Original languageEnglish
Article number213
Number of pages12
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 14 Mar 2020


  • Graded exposure in vivo
  • Adolescent
  • Chronic pain
  • Treatment fidelity
  • Feasibility
  • CARE

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