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Objectives: To determine whether coping profile changes after rehabilitation, assessed with the Multidimensional Pain Inventory (MPI), can predict which persons disabled by chronic musculoskeletal pain will be in receipt of sick leave benefits in the long term. Methods: Study of MPI data from 2,784 patients (709 men and 2,075 women) collected from the Swedish Quality Register for Pain Rehabilitation (SQRP) before and at the end of rehabilitation and compared with independent sick leave data for 1 year later. Results: After rehabilitation there was a significantly decreased share of Dysfunctional profiles (DYS) among both men (44% before, 31% after) and women (39% before, 26% after), but an increased share of Adaptive Coper profiles (men 15% before, 24% after, women 14% before, 24% after). The number of patients on full-time sick leave decreased significantly among men (from 57% to 46%) and women (from 57% to 50%). Persons with a DYS profile after rehabilitation had a low probability of having no or part-time sick leave. Conclusion: The number of persons with DYS profiles decreased after rehabilitation. Those with other profiles had less full-time sick leave one year later than those with DYS profiles, indicating that leaving the DYS profile is a positive prognostic sign long-term. Furthermore, the gender differences observed suggest the need to tailor rehabilitative strategies differently for men and women.

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.

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.

Objective: In order to facilitate comparisons of pain rehabilitationprogrammes in Sweden and to enable audit spirals for single programmes as well as outcome studies, the Swedish Association for Rehabilitation Medicine initiated a national quality registry in 1995.

Patients: Referred for rehabilitation due to pain-related disability.

Methods: The registry collects standardized self-reports before assessment, after rehabilitation and one year later, covering demographic, educational and psychometric data, pain intensity, physical disability and life satisfaction. Sick leave data are collected from the National Insurance Board before and up to two years after rehabilitation. At each programme unit self-reports are processed into individual assessment profiles relevant to plan rehabilitation. Data are sent annually to the central registry for analysis and compared with“return to work” data. Each unit can compare its results with national means.

Results and conclusion: The organization of the registry is described. Data indicating that contextual factors, but not pain characteristics, depression or activity limitations vary between patients referred to different centres, makes comparisons difficult. As of 2007, data from the multidisciplinary assessment of 19,833 patients have been collected. A total of 7289 patients attended a rehabilitation programme, generating two more self-reports. A limitation of the study is a lack of follow-up data from some units.

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.

Purpose: to study whether changes of coping profiles derived from the Multidimensional Pain Inventory MPI can predict which persons disabled by chronic pain will receive sick leave benefits 1 year after completing a pain rehabilitation programme.

Method: An observational study of MPI data derived from 2784 patients, 709 men and 2075 women, who had participated in interdisciplinary cognitive-behavioural oriented pain rehabilitation programmes in Sweden, collected from the Swedish Quality Register for Pain Rehabilitation, before and at the end of the programme.

Results: After a pain rehabilitation programme, there was a significantly decreased share of dysfunctional profile among both men (44 % before compared to 31% after), and women (39% to 26%) as well as an increased share of Adaptive coper profiles (men 15% to 24% and women 14% to 24%). The number of those with full-time sick leave decreased significantly (p<0.001) both among men (from 57% to 46%) and women (57% and 50% respectively). At the same time level of women who had part-time sick leave increased from 20% to 30%. Persons staying with or moving into a dysfunctional profile after a rehabilitation programme had a low probability of having no or part-time sick leave.

Conclusion: Persons with dysfunctional profiles have higher levels of sick-leave compared to adaptive coper and interpersonally distressed. The presently used cognitive behavioural pain rehabilitation programmes in Sweden, decreased the levels of full-time sick leave one year later. Our findings suggest also the need to tailor rehabilitative strategies differently for men and women

Keywords: Chronic pain, sick leave benefits, pain rehabilitation, Multidimensional Pain Inventory