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People with multi-morbidity are seldom supported by health professionals in resolving the dilemmas they must face. This study suggests an increased focus on patient-centredness and argues in favour of planning health care through cooperation between health professionals and people with multi-morbidity in a way that integrates both health and everyday life priorities.

ObjectiveThis systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients.SettingGeneral practice and other primary care facilities.ParticipantsAdults (>18 years) with a subacute (≤3-month) non-malignant pain condition. Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders.Primary and secondary outcome measuresThe primary outcome was long-term disability (>3 months) due to a pain condition. The secondary outcome was sick leave, defined as ‘absence from work’ or ‘return-to-work’.ResultsPubMed, EMBASE, CINAHL and PEDro databases were searched from 16 January 2003 to 16 January 2014. The quality of evidence was presented according to the GRADE WG recommendations. Several factors were found to be associated with disability at follow-up for at least two different pain symptoms. However, owing to insufficient studies, no generic risk factors for sick leave were identified.ConclusionsMultiple site pain, high pain severity, older age, baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites. There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain, indicating that these factors may not play as large a role as expected in developing disability due to a pain condition. Quality of evidence was moderate, low or very low, implying that confidence in the results is limited. Large prospective prognostic factor studies are needed with sufficient study populations and transparent reporting of all factors examined.Trial registration numberCRD42014008914.

Data collection and analysisWe identified 34 references in the initial searches. Of these, seven were actual or possible RCTs, but only two were found to meet the requirements of the set of minimal methodological criteria. Main resultsThe very limited amount of reliable evidence available is in favour of massage and touch interventions for problems associated with dementia. However, this evidence addresses only two specific applications: hand massage for the immediate or short-term reduction of agitated behaviour, and the addition of touch to verbal encouragement to eat for the normalization of nutritional intake. The existing evidence does not support general conclusions about the effect or possible side effects of such interventions. No severe side effects were identified.

Service users experience stress and discomfort in the ED. Service users highly appreciate knowing staff who can ease the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users' needs are more likely to be recognized and accommodated.