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One-year follow-up of two different rehabilitation strategies for patients with chronic pain
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
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.

Place, publisher, year, edition, pages
2012. Vol. 44, no 9, 764-773 p.
Keyword [en]
pain, pain measurement, disability, patient satisfaction, cognitive therapy, behaviour therapy, interdisciplinary health teams, motivation
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-61206DOI: 10.2340/16501977-1022ISI: 000309149000009OAI: oai:DiVA.org:umu-61206DiVA: diva2:565696
Note

Published in manuscript form in Daniel Merricks thesis.

Available from: 2012-11-08 Created: 2012-11-07 Last updated: 2017-12-07Bibliographically 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.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1503
Keyword
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: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)
Opponent
Supervisors
Available from: 2012-04-25 Created: 2012-04-24 Last updated: 2012-11-08Bibliographically approved

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Merrick, DanielSundelin, GunneviStålnacke, Britt-Marie

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