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Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet; Department of Rehabilitation Medicine, Danderyd Hospital.
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2019 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 35, no 2, p. 148-173Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).

METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with GRADE.

RESULTS: Pain related factors (intensity and chronicity) were not associated with function/disability at long-term follow up, OR=0.84, 95% CI: 0.65-1.07 and OR=0.97, 95% CI: 0.93-1.00 respectively (moderate LoE). A better function at follow up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07, 95% CI: 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77, 95% CI: 0.65-0.92, low levels of cognitive behavioural risk factors, OR 0.85, 95% CI: 0.77-0.93 and high levels of protective cognitive behavioural factors, OR=1.49; 95% CI: 1.17-1.90 (moderate LoE).

DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pre-treatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019. Vol. 35, no 2, p. 148-173
Keywords [en]
chronic musculoskeletal pain, GRADE, interdisciplinary rehabilitation, meta-analysis, prognostic factors, treatment outcome
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-154906DOI: 10.1097/AJP.0000000000000669ISI: 000458401700006PubMedID: 30371517OAI: oai:DiVA.org:umu-154906DiVA, id: diva2:1275038
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-04-16Bibliographically approved

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Stålnacke, Britt-Marie

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