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Do multidimensional pain inventory scale score changes indicate risk of receiving sick leave benefits 1 year after a pain rehabilitation programme?
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark ; Department of Public Health, University of Southern Denmark, Odense, Denmark.
2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 17-18, 1548-1556 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To study whether scale score changes in the Multidimensional Pain Inventory (MPI) can predict which persons disabled by pain will receive sick leave benefits 1 year after completing a pain rehabilitation programme.

Method: An observational study of MPI data derived from 1468 patients, 388 men and 1080 women, who had participated in multidisciplinary cognitive-behavioural oriented pain rehabilitation programmes in Sweden, collected from the Swedish Quality Register for Pain Rehabilitation, before, at the end and 1 year after the programme.

Results: Most MPI scale scores showed improvements after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, we found that a decrease in MPI scales scores for Pain severity and Interference immediately after the pain rehabilitation programme decreased the risk of being on full-time sick leave 1 year later [OR 0.85, (95% CI 0.73–0.99) and OR 0.73, (95% CI 0.61–0.87), respectively]. The Interference scale, which may be considered to include ICF components of both activities and participation, might represent the core of suffering among persons disabled with pain.

Conclusions: A rehabilitation intervention directed to combating the consequences of pain in activities and participation rather than against pain per se might lead to improved working capacity.

Place, publisher, year, edition, pages
London: Taylor & Francis , 2011. Vol. 33, no 17-18, 1548-1556 p.
Keyword [en]
Chronic pain, sick leave benefits, pain rehabilitation, Multidimensional Pain Inventory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-42857DOI: 10.3109/09638288.2010.533815ISI: 000294173200007OAI: oai:DiVA.org:umu-42857DiVA: diva2:410563
Available from: 2011-04-14 Created: 2011-04-14 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Pain rehabilitation in Sweden: a quality registry study
Open this publication in new window or tab >>Pain rehabilitation in Sweden: a quality registry study
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic pain, defined as non-malignant pain emanating from the musculoskeletal system, may limit everyday activities, social functioning and the quality of social and working life for individuals, creating disability as well as incurring high economic and public costs for society. Controlled studies show that cognitive-behavioural interdisciplinary rehabilitation has a positive effect on functioning in patients who have been disabled by chronic non-malignant pain conditions. Positive outcomes described include lower pain intensity, less preoccupation with pain, greater independence and lower consumption of healthcare. On the other hand, the return to work rate varies.

To facilitate comparisons on the national level and to enable audit spirals for single programmes as part of the ongoing quality assurance in healthcare the Swedish Quality Registry for Pain Rehabilitation (SQRP) has aggregated data since 1998 on all patients referred to the majority of Swedish rehabilitation units.

The aim of this dissertation was to improve the knowledge base of pain rehabilitation in Sweden using the validated self-reported instruments of pain and its consequences included in the SQRP.

Methods: The SQRP data were collected before, at the end and 1 year after the intervention for all individuals included, and concerns self-reported demographic variables, pain intensity, activities, thought patterns, impact of pain on daily life and life satisfaction. Individual sick leave data were collected from the Swedish Social Insurance after 1 year. Data collected from 19833 patients (6002 men and 13831 women) of which 7289 participate in work ability improving programmes, were used.

Results: The results of four studies included in this thesis showed that the SQRP provided a basis for scientific works since it use the validated self-report instruments of pain and its consequences and contain a large amount of patient’s data. However, a lack of follow-up data from some units influenced the opportunity of to analyse long-term outcomes. Nevertheless, the SQRP was a useful tool to audit and evaluate as well as to propose optimising of pain rehabilitation. It seemed that contextual factors such as patients’ own beliefs and expectations, education, gender, actual sick leave and employment situation had more importance for the effect of rehabilitation programme than pain characteristics, depression or activity limitation.

The Multidimensional Pain Inventory (MPI) scale scores and MPI coping profiles might be used for assessing the outcomes of treatment interventions. A reduction of MPI scale scores for Pain severity and Interference decreased the risk of being on full-time sick leave. On the other hand, the MPI coping profiles Dysfunctional, among both men and women, and Interpersonally distressed, among women, were associated with higher odds of being on full-time sick leave.

Conclusions: Attending cognitive-behavioural interdisciplinary pain rehabilitation programmes in Sweden resulted in improvements of the MPI scales after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, these programmes decreased the levels of full-time sick leave 1 year after completed programme. The findings suggest also the need to tailor rehabilitative strategies differently for men and women as well as for different pain coping profiles.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2011. 49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1423
Keyword
chronic pain, pain-related disability, pain rehabilitation, registry study, sick leave benefits, audit
Identifiers
urn:nbn:se:umu:diva-43852 (URN)978-91-7459-210-8 (ISBN)
Public defence
2011-06-10, Sal B, 9 tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-13 Created: 2011-05-12 Last updated: 2011-05-27Bibliographically approved

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Nyberg, Vanja ENovo, Mehmed

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