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A follow-up of patients with chronic musculoskeletal pain, focusing on multimodal rehabilitation
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
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.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1503
Keyword [en]
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
Identifiers
URN: urn:nbn:se:umu:diva-54357ISBN: 978-91-7459-425-6 (print)OAI: oai:DiVA.org:umu-54357DiVA: diva2:517620
Public defence
2012-05-16, Bergasalen, byggnad 27, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-25 Created: 2012-04-24 Last updated: 2012-11-08Bibliographically approved
List of papers
1. Patients' pretreatment beliefs about recovery influence outcome of a pain rehabilitation program
Open this publication in new window or tab >>Patients' pretreatment beliefs about recovery influence outcome of a pain rehabilitation program
2009 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, 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.

National Category
Medical and Health Sciences
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-50432 (URN)19773732 (PubMedID)
Available from: 2011-12-08 Created: 2011-12-08 Last updated: 2017-12-08Bibliographically approved
2. One-year follow-up of two different rehabilitation strategies for patients with chronic pain
Open this publication in new window or tab >>One-year follow-up of two different rehabilitation strategies for patients with chronic pain
2012 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 9, 764-773 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To determine outcomes for 2 rehabilitation strategies for patients with chronic pain: a 2-day interdisciplinary team assessment followed by either: (i) a 4-week outpatient multimodal rehabilitation programme, or (ii) a subsequent rehabilitation plan. Methods: After a 2-day interdisciplinary team assessment at our pain rehabilitation clinic 296 consecutive patients were selected to either multimodal rehabilitation (n = 76) or rehabilitation plan (n = 220). They completed questionnaires regarding pain intensity (Visual Analogue Scale), disability (Disability Rating Index), life satisfaction (LiSat-11), anxiety and depression (Hospital Anxiety and Depression Scale) at assessment and again at 1-year follow-up. Results: Both groups showed significant improvements at 1-year follow-up regarding pain intensity. In addition, the multimodal rehabilitation group improved in the disability items ("light work" and "heavy work"), depression and life satisfaction ("leisure", "somatic health", and "psychological health"). In the rehabilitation plan group "somatic health" improved, although not statistically significant. Conclusion: This study indicates that multimodal rehabilitation may have long-term positive effects on pain, disability, depression and domains of life satisfaction. However, a minor intervention, rehabilitation plan with follow-up in primary care, can improve pain and "somatic health". Based on the biopsychosocial approach, an interdisciplinary assessment of patients with chronic pain seems to be of value for selecting patients to different rehabilitation interventions.

Keyword
pain, pain measurement, disability, patient satisfaction, cognitive therapy, behaviour therapy, interdisciplinary health teams, motivation
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-61206 (URN)10.2340/16501977-1022 (DOI)000309149000009 ()
Note

Published in manuscript form in Daniel Merricks thesis.

Available from: 2012-11-08 Created: 2012-11-07 Last updated: 2017-12-07Bibliographically approved
3. A follow-up of two different rehabiliation strategies for patients with chronic pain, focusing on sick leave
Open this publication in new window or tab >>A follow-up of two different rehabiliation strategies for patients with chronic pain, focusing on sick leave
(English)Manuscript (preprint) (Other academic)
Keyword
Pain, sick leave, multimodal rehabilitation
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-54274 (URN)
Available from: 2012-04-24 Created: 2012-04-23 Last updated: 2015-11-13Bibliographically approved
4. Five years post whiplash injury: symptom and psychological factors in recovered versus non-recovered
Open this publication in new window or tab >>Five years post whiplash injury: symptom and psychological factors in recovered versus non-recovered
2010 (English)In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 3, 190- p.Article in journal (Refereed) Published
Abstract [en]

Background Few studies have focused on the differences between persons who are recovered after whiplash injury and those who suffer from persistent disability. The primary aim of this study was therefore to examine differences in symptoms, psychological factors and life satisfaction between subjects classified as recovered and those with persistent disability five years after whiplash injury based on the Neck Disability Index (NDI).

Methods A set of questionnaires was answered by 158 persons (75 men, 83 women) to assess disability (NDI), pain intensity (VAS), whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), post-traumatic stress (Impact of Event Scale, IES), depression (Beck's depression inventory, BDI) and life satisfaction (LiSat-11).

The participants were divided into three groups based on the results of the NDI: recovered (34.8%), mild disability (37.3%) and moderate/severe disability (27.3%).

Results The moderate/severe group reported significantly higher VAS, BDI and IES scores and lower level of physical health and psychological health compared to the mild and the recovered groups. Less significant differences were reported between the mild and the recovered groups.

Conclusions The group with the highest disability score reported most health problems with pain, symptoms, depression, post-traumatic stress and decreased life satisfaction. These findings indicate that classifying these subjects into subgroups based on disability levels makes it possible to optimize the management and treatment after whiplash injury.

Place, publisher, year, edition, pages
BioMed Central, 2010
National Category
Other Health Sciences
Identifiers
urn:nbn:se:umu:diva-42867 (URN)10.1186/1756-0500-3-190 (DOI)20626861 (PubMedID)
Available from: 2011-12-08 Created: 2011-04-14 Last updated: 2017-12-08Bibliographically approved

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