umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Long-term effects of multimodal rehabilitation in primary care for patients with chronic pain
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
Smärt och rehabiliteringscentrum, Institutionen för medicin och hälsa, enheten för fysioterapi, Linköping Universitet.
Smärt och rehabiliteringscentrum, Institutionen för medicin och hälsa, Linköpings Universitet.
Smärt- och rehabiliteringscentrum, Institutionen för medicin och hälsa, Institutionen för beteendevetenskap och lärande, Linköpings Universitet.
Show others and affiliations
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-151463OAI: oai:DiVA.org:umu-151463DiVA, id: diva2:1245026
Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2018-09-05
In thesis
1. Multimodal rehabilitation of patients with chronic musculoskeletal pain, focusing on primary care
Open this publication in new window or tab >>Multimodal rehabilitation of patients with chronic musculoskeletal pain, focusing on primary care
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic pain is a complex condition that has consequences both for individual people and for society. The individual often experiences impact on function, activity and participation. Society is affected by high healthcare and sick leave costs and a loss of workforce. Multimodal rehabilitation programmes (MMRP) have mainly been provided through specialist care but it is now also available through primary care. The overall aim of this thesis was to evaluate the effects of MMRP in patients with chronic musculoskeletal pain and to explore patients’ and healthcare professionals’ experiences of MMRP.

Study I: Aim: To evaluate the effects of an interdisciplinary team assessment and MMRP for patients with chronic pain in a specialist care setting. Design: Longitudinal cohort study. Method: Pain intensity, pain dimensions, anxiety and depression were measured at assessment and at the start and end of MMRP.  A total of 93 women were evaluated. Result: Pain and pain-related measures were significantly improved both after the interdisciplinary assessment and after MMRP.

Study II: Aim: To explore healthcare professionals’ experiences of MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Fourteen healthcare professionals (11 women, 3 men) were interviewed about their work with MMRP. Result: Healthcare professionals considered that MMRP was useful but also challenging. It was difficult to select appropriate patients, and health care professionals felt they were torn between following healthcare legislation and the goals of MMRP. They had to deal with ethical dilemmas as well as decide what constitutes good results.

Study III: Aim: To explore patients’ experiences of participating in MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Twelve former patients (7 women and 5 men) were interviewed about their experiences of MMRP in primary care. Result: Patients in primary care experienced a complex, ongoing process of accepting chronic pain. Obtaining redress, learning about chronic pain, and experiencing fellowship with others with the same condition contributed to the acceptance process.

Study IV: Aim: To evaluate the effects of MMRP in primary care at one-year follow-up for all patients together and for men and women separately and to identify predictive factors for being employable at follow-up. Design: Prospective longitudinal cohort study. Method: Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sick leave extent and sickness compensation were evaluated prior to and one year after MMRP in 234 patients, 34 men and 200 women. Result: All patients improved significantly in most measures at one-year follow-up, and the effect was larger in women. Sick leave decreased while no significant difference was found for total sickness compensation. Patients’ self-reported rating of current work ability before MMRP was significantly associated with being employable at follow-up.

General conclusions and implications: 

MMRP seems to be effective for patients with chronic musculoskeletal pain, both in specialist care and in primary care. MMRP was more effective for women than for men, and the reasons for this need to be investigated further. An interdisciplinary team assessment could also be beneficial for decreasing pain and pain-related measures. Patients in primary care experience a complex, ongoing process of accepting chronic pain. Healthcare professionals have to deal with conflicting emotions with regard to different commitments from healthcare legislation and the goals of MMRP.                         

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2018. p. 58
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1970
Keywords
Multimodal Rehabilitation, Chronic Pain, Primary Care, Specialist Care
National Category
Other Health Sciences
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-151466 (URN)978-91-7601-913-9 (ISBN)
Public defence
2018-09-28, Hörsal Betula, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-06 Created: 2018-09-04 Last updated: 2018-09-17Bibliographically approved

Open Access in DiVA

No full text in DiVA

Search in DiVA

By author/editor
Pietilä Holmner, Elisabeth
By organisation
Department of Community Medicine and Rehabilitation
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 56 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf