Background: Current best practice recommends group-based pain management programmes (PMPs) for long-term improvements in persistent pain-related disability.
Purpose: This non-inferiority trial aims to evaluate the clinical and cost-effectiveness of a group-based, online-delivered PMP (iSelf-help) compared to in-person PMP in reducing pain-related disability.
Methods: The iSelf-help non-inferiority randomised controlled trial is a pragmatic, assessor-blinded, two-arm RCT. Adults (age ≥18 years) with persistent non-cancer pain referred to a tertiary pain service deemed eligible for a PMP were recruited and block randomised to intervention (iSelf-help) and control groups (in-person PMP). The iSelf-help group participated in two 60-minute video-conferencing sessions weekly for 12 weeks (first session led by a peer-support facilitator with lived experience of pain; second session led by clinicians) with access to resources via smartphone application and a password-protected website. Control participants received 12-week group-based, in-person PMP.
Results: We recruited 113 participants (56 iSelf-help and 57 in person) with a mean age of 38.2 (13.7) years. The participants were 75% (n=85) female, 8% (n=9 gender diverse), 16% (n=18) Māori. Based on an Intention to treat analysis on the primary outcome (Modified Roland Morris Disability Questionnaire) at six months (N=73), iSelf-help was non-inferior to the in-person group with a point estimate of -0.4 (∞, 1.5). It was also non-inferior for the secondary outcomes of Anxiety, Depression, Stress, Activity interference, Quality of life and Self-efficacy. Programme delivery cost per patient was lower for iSelf-help participants. No serious adverse events were reported.
Conclusions: This is the first on-line delivered group-based PMP with comparable clinical effectiveness in improving pain-related disability in people with persistent pain.
Implications: iSelf-help provides an economic and safe alternative group-based pain management option with increased geographical reach. Theoretically, it could enable choice between their preference for in-person or online health service delivery, providing a more person-centred approach to pain management.

Background: All inpatient services as Christchurch Hospital traditionally faxed paper referrals when referring to Allied Health services, including to Physiotherapy. Due to Health New Zealand initiatives such as “axe the fax”, there was an opportunity to shift towards paper-lite methods, optimise data collection and utilise existing systems.
Purpose: As a response to change, there was a need to coordinate a standardised method of referring to Allied Health services, taking into account service-specific needs, without compromising or changing other forms of referral processes.
Methods: The new system re-design integrated the use of electronic clinical notes for referrals and reflected a “closed-loop” system. Visibility of referrals to services were emphasised and a method of indicating the anticipated response time for assessment was subsequently developed.
Results: Data captured from the new system informs a PowerBI dashboard that provides operational insight to managers on the acute demands in the inpatient setting. Data over a 12 month period includes the time and inpatient location of referrals made, and the referral acknowledgement by the clinician. This includes the types of referrals made, the anticipated response time and priority of referral.
Conclusion(s): This re-design system has enabled data capture and visibility – providing context of the current pressures and demands on the Physiotherapy and Allied Health services on the frontline. Patient care has been enhanced as referring services are more informed in clinical notes and decision makers have data to guide change.
Implications: The clinical implications lead to redefining what a referral is and decision making has been transferred back to clinicians to indicate how soon an assessment or intervention is needed, according to nationally agreed Care Capacity and Demand Management (CCDM) priority guidelines. This scope of work supports the current national initiatives Safe Staffing Healthy Workplace (SSHW) which is informed by the CCDM programme reporting processes.