Comparison of short- and mid-term outcomes of Italian- and German-speaking patients after an interdisciplinary pain management programme in Switzerland: A prospective cohort study

Abstract

This study examined the health of patients with chronic pain who participated in a specific rehabilitation programme for chronic pain. Patients' health was measured before participating in the programme, at the end of the programme, and after the programme. German-speaking patients were compared with Italianspeaking patients. Both groups participated in the same pain management programme with the same therapies, held either in German or in Italian. Italian-speaking and German-speaking patients improved immediately after the programme, but Italian-speaking patient reported lower improvements. The measurements after the programme showed that German-speaking patients could maintain the improvements, whereas the Italian-speaking patients lost the positive effects of the programme over time. In conclusion, Italian-speaking patients may have special needs in pain management and the level of acculturation may influence the results. Objective: To quantify and compare the course of health-related quality of life of immigrant native Italian-speaking and German-speaking patients before and after an interdisciplinary pain programme. Design: Prospective cohort study with 1-12 month follow-up. Subjects: Fibromyalgia, generalized widespread pain, and chronic non-specific back pain patients (Italian-speaking n = 96, German-speaking n = 199). Methods: Score changes measured with the Short Form 36 (SF-36) were compared with multivariate analysis using standardized mean differences (SMD), adjusted for sex, education and the baseline score. Results: At baseline, health of the Italian-speaking patients was worse than for the German-speaking patients. Adjusted SMDs showed significantly better improvements in the German group compared with the Italian group: SF-36 Physical functioning SMD = 0.54 (at discharge) and 0.49 (at 12 months), General health SMD = 0.71 and 0.44, Vitality SMD = 0.43 and 0.48 in one sample. In the other sample, the corresponding SMDs were 0.06 (discharge), 0.50 (3 months) and 0.47 (6 months) for Bodily pain. Conclusion: State of health was better and health improvements were greater in German-speaking patients compared with Italian-speaking patients. Patients with a migration background may have special needs in therapeutic management, and addressing these might enhance the positive outcome in the short-and mid-term.

Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation

“…The fact that the IPR-LI group showed a significantly worse health situation before the programme compared with the reference group is in line with other studies of patients participating in interdisciplinary pain rehabilitation programmes ( 25 , 26 ) and studies of immigrant patients with pain ( 27 ). In a Swedish population-based study ( 27 ), a poor health-related situation for immigrant patients was described, including an increased risk for immigrants of developing different sorts of pain, mediated by their state of mood.…”

“…In a study based on the SQRP registry, patients who were born outside Europe, of both sexes and different educational levels, were found to be the group with the poorest situation before the programme, based on pain intensity, depression, anxiety and health-related quality of life ( 25 ). Also, when the different patient groups are European, the non-native patients have been shown to have less favourable health ( 26 ). In this Swiss study by Benz et al ( 26 ), immigrant patients (Italian-speaking) showed worse self-reported health compared with native patients (German-speaking) before the programme.…”

Comprehensiveness and validity of a multidimensional assessment in patients with chronic low back pain: a prospective cohort study

“…At the time of the initial project in the mid 1990s, evidence of validity was still thin on the ground and further literature, especially on recommended core sets, did not exist. After the first phase of the project, the choice of measures was revised on the basis of the results of the previous studies in our institution [19][20][21][22]. In particular, relative weak responsive scales were eliminated [22].…”

“…Sociodemographic and potentially confounding parameters, such as age, gender, occupation (working capacity), living conditions, sports habits, and formal education, were recorded at admission to the clinic on a standardized form used in many previous studies [20,21].…”

Pain drawings, interpreter support and clinical findings among immigrant patients on sick leave in Swedish primary health care

“…Immigrants and refugees represent a growing portion of patients in primary health care (Allison et al, 2002;Brause et al, 2012). Both at group and individual levels they will explain ill-health in different ways, thus complicating the diagnostic process of, for example, non-European women with non-malignant widespread pain and long sickness absence (Aznar-Lou et al, 2017;Nyen and Tveit, 2018;Wang et al, 2019;Benz et al, 2019;Eid et al, 2019).…”