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Multimodal rehabilitation for patients with chronic pain in northern Sweden, focusing on gender and age
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. (Arcum)ORCID iD: 0000-0003-4750-1868
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study outcomes and experiences of multimodal rehabilitation programmes (MMRP) for patients with chronic pain in northern Sweden, focusing on gender and age. 

This thesis is based on four studies that used both quantitative and qualitative methods. The quantitative studies (I-III) investigated patient-reported outcome measures (PROM) from the Swedish Quality Registry for Pain Rehabilitation (SQRP) collected during 2011-2016 at two specialist clinics in northern Sweden. Adults aged 18-65 years were included, n=436 (356 women and 83 men), divided into three age groups (18-30, 31-45 and 46-65 years of age). Data from the two programmes at three measurement occasions were used, at the start of MMRP, immediately after MMRP and at one-year follow-up. Descriptive and multivariate statistics were used in Studies I-III.

The analyses were performed separately for women, men and three different age groups. In Study I, the analysis was performed in two steps: in the first step the two patient populations in the two MMRPs were analysed separately and in the next step, the patients in the two programmes were analysed together. In Studies (II-III), the patient in the programmes were analysed together. In Study IV, a qualitative design was used to explore how patients with chronic pain experienced staying at a residency during participation in MMRP. In Study IV, a grounded theory method with emergent design was used for data collection and analysis. Individual semi-structured interviews with 12 patients (8 women and 4 men) with experiences of MMRP were conducted.

In Study I, patients improved regardless of the design of the MMRP in terms of pain intensity, emotional functioning, activity and physical functioning at the one-year follow-up. For both programmes, the women were found to improve in more variables than the men did.

In Study II, all subgroups (men, women and age groups) improved in terms of pain intensity and emotional functioning immediately after MMRP. The results revealed that the men showed greater short-term improvements than the women did. The women improved in more variables at one-year follow-up than the men did. The youngest age group was found to have greater positive effects of MMRP in terms of pain intensity and emotional functioning, immediately after MMRP and at one-year follow-up, than the other two age groups.

In Study III, a number of interacting factors influenced whether patients participating in MMRP ended up on full-time sick leave at one-year follow-up, or not. Sick leave at start was an important factor for all subgroups. For women at start, low physical functioning, low health-related quality of life, low work importance and low affective distress were related to full-time sick leave at one-year follow-up. 

The results showed that unemployed men who reported widespread pain were related to full-time sick leave at one-year follow-up. The 31-45 years age group, which reported high pain intensity, low emotional functioning and low activity and physical functioning, was related to full-time sick leave at one-year follow-up. Those in the 46-65 years age group with low education, low work importance, low belief in recovery and long duration of pain were found to be related to full-time sick leave at one-year follow-up.

In Study IV, the analysis resulted in a core category “Finding my self-worth”, consisting of the four categories: “Space for myself”, “Mirroring myself”, “I am of value” and “Dealing with returning to everyday life”. The results showed that the patients who stayed at a residency during MMRP were more likely to be released from the obligations of chores in their everyday life at home. This created space and time for reflection and interaction with others. The patients’ participation in MMRP while staying at a residency contributed to experiences of awareness of their own value and the significance of taking care of themselves and changing their behaviour after returning home.

In conclusion, the results showed that MMRP seems to be an effective method of treating patients with chronic pain, in terms of reduced pain, improved emotional functioning, activity and physical functioning and health. The results also revealed that men seemed to need more support after MMRP to sustain the effects of MMRP while woman were more likely to sustain the positive effects at one-year follow-up. Full-time sick leave for patients with chronic pain at one-year follow-up can be affected by a number of interacting factors and these factors differ for women, men and different age groups. The opportunity to be released from everyday obligations, enjoy time for reflection and interaction with others can contribute to personal awareness which facilitates the implementation of changes at home following MMRP. 

Place, publisher, year, edition, pages
Umeå: Umeå University , 2021. , p. 62
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2141
Keywords [en]
Chronic pain, multimodal rehabilitering, gender, age
National Category
Other Health Sciences
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-182703ISBN: 978-91-7855-562-8 (print)ISBN: 978-91-7855-563-5 (electronic)OAI: oai:DiVA.org:umu-182703DiVA, id: diva2:1549113
Public defence
2021-06-04, Triple Helix, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-05-12 Created: 2021-05-04 Last updated: 2024-07-02Bibliographically approved
List of papers
1. Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age
Open this publication in new window or tab >>Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age
Show others...
2018 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 7, p. 619-628Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up.

Design: Longitudinal retrospective study.

Subjects: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups.

Methods: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics.

Results: Significant improvements in activity and physical functions, pain intensity and emotional functions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety.

Conclusion: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.

Place, publisher, year, edition, pages
FOUNDATION REHABILITATION INFORMATION, 2018
Keywords
chronic pain, musculoskeletal pain, rehabilitation, sex, age
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-150738 (URN)10.2340/16501977-2352 (DOI)000438084000007 ()29881867 (PubMedID)2-s2.0-85051041391 (Scopus ID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2025-02-11Bibliographically approved
2. Outcomes after multimodal rehabilitation for patients with chronic pain in northern Sweden with focus on gender and age
Open this publication in new window or tab >>Outcomes after multimodal rehabilitation for patients with chronic pain in northern Sweden with focus on gender and age
(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-182861 (URN)
Available from: 2021-05-07 Created: 2021-05-07 Last updated: 2025-02-11
3. Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age
Open this publication in new window or tab >>Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age
2022 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 29, no 8, p. 645-659Article in journal (Refereed) Published
Abstract [en]

Background: Chronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work. Aim: To investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP.

Material and Methods: Data were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups.

Results: There were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups.

Conclusions: These findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
age, gender, multivariate statistics, Pain rehabilitation
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-182163 (URN)10.1080/11038128.2021.1903990 (DOI)000640008600001 ()33784480 (PubMedID)2-s2.0-85103401596 (Scopus ID)
Available from: 2021-04-21 Created: 2021-04-21 Last updated: 2022-11-30Bibliographically approved
4. Finding self-worth: Experiences during a multimodal rehabilitation program when living at a residency away from home
Open this publication in new window or tab >>Finding self-worth: Experiences during a multimodal rehabilitation program when living at a residency away from home
2020 (English)In: Canadian journal of pain, ISSN 2474-0527, Vol. 4, no 1, p. 237-246Article in journal (Refereed) Published
Abstract [en]

Background: Patients with chronic pain who live in rural areas often need to travel long distances to participate in multimodal rehabilitation programs. To reduce traveling during the programs, patients sometimes live at a residency close to the clinic and thus far from home.

Aims: The aim of this study was to explore how patients with chronic pain experience participation in an multimodal rehabilitation program while living at a residency.

Method: Twelve patients from two specialist clinics in northern Sweden were interviewed about their experiences of participating in a multimodal rehabilitation program. The data were analyzed qualitatively using a grounded theory method with an emergent design.

Results: The analyses resulted in a model with the core category “finding my self-worth” consisting of four categories: “space for myself,” “mirroring myself,” “I am of value,” and “dealing with returning to everyday life.” The model illustrates the process whereby participants are given space for themselves and an opportunity to mirror themselves in interaction with other participants. That provided insight about their self-worth that was valuable for return to everyday life at home and work.

Conclusion: Living at a residency during multimodal rehabilitation provided added value when patients were relived from the obligations of everyday life at home and given time for reflection and interaction with others in similar situations. This contributed to awareness of their own value and the necessity of taking care of themselves. This new insight led to increased motivation to act differently at home.

Abstract [fr]

Contexte: Les patients souffrant de douleur chronique qui vivent en milieu rural doivent souvent parcourir de longues distances pour participer à des programmes de réhabilitation multimodale. Pour réduire les déplacements pendant les programmes, les patients vivent parfois dans une résidence à proximité de la clinique et donc loin de chez eux.

Objectifs: Le but de cette étude était de se pencher sur la façon dont les patients souffrant de douleur chronique vivent leur participation à un programme de réadaptation multimodale lors-qu’ils vivent en résidence.

Méthode: Douze patients provenant de deux cliniques spécialisées du Nord de la Suède ont été interviewés sur leur participation à un programme de réadaptation multimodale. Les données ont été analysées de manière qualitative en utilisant la méthode de la théorie ancrée et un devis émergent.

Résultats: Les analyses ont donné lieu à un modèle dont la catégorie principale, « trouver ma valeur personnelle », consiste en quatre catégories : « un espace pour moi », « mon reflet », « j’ai de la valeur » et « le retour à la vie de tous les jours ». Ce modèle illustre le processus par lequel les participants disposent d’un espace pour eux-mêmes et ont l’occasion de voir leur propre reflet, en interaction avec les autres participants. Cela leur a permis de mieux percevoir leur propre valeur personnelle, ce qui a été d’une grande utilité pour leur retour à la vie quotidienne à la maison et au travail.

Conclusion: Le fait de vivre en résidence pendant une réadaptation multimodale a apporté une valeur ajoutée lorsque les patients ont été libérés des obligations de la vie quotidienne à la maison et ont eu le temps de réfléchir et d’interagir avec d’autres personnes dans des situations similaires. Cela a contribué à la prise de conscience de leur propre valeur et de la nécessité de prendre soin d’eux-mêmes. Cette nouvelle perspective a conduit à une motivation accrue pour agir différemment à la maison.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
chronic pain, MMRP, grounded theory, group rehabilitation, interview
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:umu:diva-178511 (URN)10.1080/24740527.2020.1810001 (DOI)000616380400023 ()33987502 (PubMedID)2-s2.0-85108993221 (Scopus ID)
Available from: 2021-01-13 Created: 2021-01-13 Last updated: 2023-03-24Bibliographically approved

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