Change search
ReferencesLink to record
Permanent link

Direct link
Patients' pretreatment beliefs about recovery influence outcome of a pain rehabilitation program
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark.
2009 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, Vol. 45, no 3, 391-401 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study was to monitor the outcome of a five-week cognitive-behavioral interdisciplinary rehabilitation program for patients disabled by chronic pain, utilizing data collected for a national quality registry.

METHODS: The study included 255 consecutive patients from a university hospital setting. Demographic data and patient beliefs about recovery recorded on a five-category scale were collected before the program. Pain intensity (VAS), Disability Rating Index (DRI) and life satisfaction (LiSat-11) were collected before, immediately after and one year after the program. Partial respondents and non-respondents were excluded;168 patients remained.

RESULTS: Pain intensity decreased (''pain now''; Friedman's test, P<0.0001) by 13 mm (median) after the program, (Dunn's test; P<0.001) and by 5 mm after one year (P<0.05). Only one of twelve DRI items (activity), ''participating in exercise/sports'' improved significantly after rehabilitation (Wilcoxon's test; P=0.0009), and remained improved one year later (P=0.0144). Life satisfaction in the physical and psychological domains increased after the program. A clinically meaningful reduction in pain intensity (10 mm) was reported by 43% of patients at the one-year follow-up. This group had significant increases in life satisfaction. Only patients with positive beliefs about recovery before rehabilitation showed a decrease in pain intensity at the one-year follow-up (P<0.028).

CONCLUSIONS: The program influenced the pain, life satisfaction and, to a small extent, activity. A clinically relevant pain reduction and an increase in life satisfaction were related. Patients' pretreatment beliefs about recovery influenced the long-term decrease of pain intensity, indicating that more attention should be focused on patients' pretreatment beliefs.

Place, publisher, year, edition, pages
2009. Vol. 45, no 3, 391-401 p.
National Category
Medical and Health Sciences
Research subject
Rehabilitation Medicine
URN: urn:nbn:se:umu:diva-50432PubMedID: 19773732OAI: diva2:462969
Available from: 2011-12-08 Created: 2011-12-08 Last updated: 2012-08-07Bibliographically approved
In thesis
1. A follow-up of patients with chronic musculoskeletal pain, focusing on multimodal rehabilitation
Open this publication in new window or tab >>A follow-up of patients with chronic musculoskeletal pain, focusing on multimodal rehabilitation
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic pain is usually defined as pain of more than three months duration. The prevalence of chronic pain among the general population in Sweden is 18%. Compared with the general population, these patients report lower life satisfaction, decreased activity in daily life and higher levels of depression with decreased work ability, and increased sick leave. Research indicates that multimodal rehabilitation (MMR) programmes, including cognitive behavioural approaches for patients disabled by chronic pain, are effective for return to work.

The primary aim of this thesis was to assess outcomes by a long-term follow-up of patients with chronic musculoskeletal pain. Furthermore, the aim was to evaluate two different rehabilitation strategies regarding impact on pain intensity, activity, depression, life satisfactions, and sick leave.

Two groups, comprising 255 (between the years 1999-2002) and 296 (between 2007-2008) patients respectively, from the Pain Rehabilitation Clinic at Umeå University Hospital, Sweden, were all assessed by interdisciplinary teams. They completed questionnaires regarding pain intensity, disability, life satisfaction, anxiety and depression, and sick leave, before intervention, immediately after intervention (only the first group; n=255), and at one-year follow-up, after participating in a MMR programme in a specialist clinic, or after receiving a rehabilitation plan (RP) with follow-up in primary care. Allocation to either of the two groups was based on the initial interdisciplinary team assessment. Furthermore, a five-year follow-up of 158 patients with whiplash injury was conducted.

Pain intensity decreased and life satisfaction increased significantly regarding somatic health in both groups, at follow-up. In addition, depression improved and disability decreased to a higher extent after participating in the MMR programme as compared to RP and subsequent follow-up in primary care. Patients’ positive beliefs about recovery, and positive expectations about work correlated with favourable rehabilitation outcomes. Sick leave at one year follow-up decreased in both groups.

Regarding whiplash injury, patients who reported moderate or severe disability also reported significantly higher pain intensity, depression and post-traumatic stress scores and lower perception of general health compared with patients who reported mild or no disability.

In conclusion, MMR programmes seem to be beneficial by decreasing pain intensity, depression, disability and sick leave among patients with chronic musculoskeletal pain. Furthermore, patients’ positive beliefs correlate with more favourable long-term outcomes. An interdisciplinary team assessment based on a biopsychosocial approach may be of value for selection of rehabilitation strategy.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 48 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1503
Pain, pain measurement, disability, patient satisfaction, cognitive therapy, behaviour therapy, interdisciplinary health teams, motivation, sick leave, multimodal rehabilitation, whiplash injuries, stress disorders, posttraumatic
National Category
Public Health, Global Health, Social Medicine and Epidemiology
urn:nbn:se:umu:diva-54357 (URN)978-91-7459-425-6 (ISBN)
Public defence
2012-05-16, Bergasalen, byggnad 27, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Available from: 2012-04-25 Created: 2012-04-24 Last updated: 2012-11-08Bibliographically approved

Open Access in DiVA

No full text


Search in DiVA

By author/editor
Merrick, Daniel
By organisation
Rehabilitation Medicine
In the same journal
European Journal of Physical and Rehabilitation Medicine
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 75 hits
ReferencesLink to record
Permanent link

Direct link