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Can registry data be used as predictive factors for effective pain rehabilitation?
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.
Dep of Public Health, University of Southern Denmark, Odense.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: The aim of this study were: a) using registry data to analyse which patients with disability from chronic pain that were offered participation in the rehabilitation programme after assessment in interdisciplinary teams, and b) to analyse if there were registry data features which could already before the programme predict a positive outcome, i.e. less sick leave.

Method: An observational study of data derived from 8509 patients, 2588 men and 5951, collected from the Swedish Quality Register for Pain Rehabilitation.

Results: Being a woman, having higher education and being on full time sick leave increased, whereas being unemployed or being of non-Swedish origin decreased the chance to be offered a rehabilitation programme. Patients with shorter time outside work had higher probability to be offered a programme. On the other hand, the strongest predictive factors for a return to work were not being on full time sick leave and employment situation as well as patients’ own beliefs and expectations.

Conclusion: It seemed that variables that measured pain and its health consequences were of less importance for the future sick leave situation. It is possible that contextual factors not covered by the registry may play a crucial role here.

Key words: Chronic pain, sick leave benefits, pain rehabilitation, register study.

URN: urn:nbn:se:umu:diva-43806OAI: diva2:416136
Available from: 2011-05-12 Created: 2011-05-10 Last updated: 2011-05-27Bibliographically 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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1423
chronic pain, pain-related disability, pain rehabilitation, registry study, sick leave benefits, audit
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)
Available from: 2011-05-13 Created: 2011-05-12 Last updated: 2011-05-27Bibliographically approved

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