Attrition Rates in Mindfulness-Based Interventions for Chronic Pain

Objective: Mindfulness-based interventions (MBIs) show promise in managing chronic pain but often require substantial time commitments, leading to high attrition and concerns about acceptability. This meta-analysis evaluated attrition rates in MBIs for chronic pain and examined moderators contributing to participant withdrawal.

Methods: Following PRISMA guidelines, we searched relevant databases for studies of MBIs for pain. Eligible studies included randomised controlled trials, controlled trials, and quasi-experimental designs that reported attrition data for adults (≥18 y) with chronic pain lasting over 3 months. Data extraction covered attrition metrics, program characteristics, and participant demographics. Statistical analyses included random-effects meta-analyses of proportions, sensitivity analyses, meta-regression, and publication bias assessments.

Results: Forty-four studies (45 intervention conditions) were included. The pooled attrition rate was 30.1% (95% CI: 24.5%- 37.3%) with substantial heterogeneity ( I ²=89.0%). Attrition increased with stricter completion thresholds (minimum sessions required for programme completion status) ( P <0.001, R ²=28.1%): 18.0% (≥3 to 4 sessions), 31.6% (≥5 to 6 sessions), and 49.7% (>6 sessions). Online delivery showed higher attrition (51.0%) than in-person delivery (25.6%, P =0.002, R ²=17.1%). Individually delivered MBIs were also associated with higher attrition than group formats (β=0.216, P =0.039, R ²=5.5%). Publication bias analyses suggested minor influence on the pooled effect, which remained robust after adjustment.

Discussion: Attrition rates for MBIs in chronic pain vary widely. Higher attrition is associated with stricter completion criteria, online delivery, and individual formats. These findings highlight the need to optimise MBI programme structure for management of pain.