Healthcare professional experiences with patients who participate in multimodal pain rehabilitation in primary care – a qualitative study

Stenberg, Gunilla; Holmner, Elisabeth Pietilä; Stålnacke, Britt-Marie; Enthoven, Paul

doi:10.3109/09638288.2015.1114156

Cited by 18 publications

(26 citation statements)

References 29 publications

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“…Some previous studies found that women were selected for MMRP more often than men (28). Qualitative interviews conducted in the same settings in primary care indicate that healthcare professionals were hesitant to refer single men to an MMRP (29).…”

Section: Discussionmentioning

confidence: 93%

“…Thus, further development of MMRP is warranted in order to improve the outcomes. Although national guidelines were published to support the assessment of patients with chronic pain with selection criteria to enhance MMRP at the appropriate level (specialist vs primary healthcare), healthcare professionals in primary care found it difficult to select patients for MMRP (29).…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

Pietilä-Holmner¹,

Enthoven²,

Gerdle³

et al. 2020

J Rehabil Med

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LAY ABSTRACTFor patients with chronic pain, studies have shown that multimodal rehabilitation programmes at specialist care level have positive effects. Since there is limited knowledge about the long-term effects of multimodal rehabilitation programmes in a primary care setting this study investigated the effects of multimodal rehabilitation programmes in 234 patients with chronic pain, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. At 1-year follow-up patients reported small improvements in pain, physical and emotional functioning, coping, and health-related quality of life. The proportion of patients on sick leave decreased, while there was no difference regarding the proportion of patients on sickness compensation/ disability pension. This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain.Objectives: To investigate the outcomes one year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after one year. Methods: A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and one year after multimodal rehabilitation programmes. Results: Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.21-1.06, p = 0.005). Conclusion: This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

Pietilä-Holmner¹,

Enthoven²,

Gerdle³

et al. 2020

J Rehabil Med

View full text Add to dashboard Cite

show abstract

“…A previous study found that MMR team personnel expressed fear of not adequately investigating the patient and they were afraid they might have missed a serious medical condition (12). This attitude increases the chance that a patient is referred for a wide variety of assessments and will get different solutions suggested for solving the pain.…”

Section: Discussionmentioning

confidence: 99%

“…Professional experiences of working with MMR showed that it sometimes was difficult to get enough participants in a group. They wondered why all patients who seek care for chronic pain were not referred to MMR (12). This might be because MMR was a new intervention in primary care.…”

Section: Discussionmentioning

confidence: 99%

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”The acceptance” of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care

Holmner¹,

Stålnacke²,

Enthoven³

et al. 2018

J Rehabil Med

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Objective: To explore patient experiences of participating in multimodal pain rehabilitation in primary care. Subjects: Twelve former patients (7 women and 5 men) in multimodal rehabilitation in primary care were interviewed about their experiences of multimodal rehabilitation. Methods: The interviews were analysed using qualitative content analysis. Results: Analysis resulted in 4 categories: (i) from discredited towards obtaining redress; (ii) from uncertainty towards knowledge; (iii) from loneliness towards togetherness; and (iv) "acceptance of pain": an ongoing process. The results show that having obtained redress, to obtain knowledge about chronic pain, and to experience fellowship with others with the same condition were helpful in the acceptance process. However, there were patients who found it difficult to reconcile themselves with a life with chronic pain after multimodal rehabilitation. To find what was "wrong" and to have a medical diagnosis and cure were important. Conclusion: Patients in primary care multimodal rehabilitation experience a complex, ongoing process of accepting chronic pain. Four important categories were described. These findings will help others to understand the experience and perspective of patients with chronic pain who engage in multimodal rehabilitation.

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

Löfvander

2019

Prim Health Care Res Dev

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Aim: To evaluate the spread of pain and its correlates among immigrant patients on sick leave. Background: Backache, outspread pain and sick-leave questions are problematic to handle primary health care, especially in multicultural settings. Methods: Two hundred and thirty-five patients 20–45 years on paid sick leave (59% women, 93% foreign-born, mostly non-Europeans). Many had little formal education. One-third had professional interpreter support. The patients pointed out on their bodies where they felt pain. This information was transferred on a pain drawing [pain drawing fields (PDFs) 0–18] by a doctor. Major depression and psychosocial stressors were assessed using Diagnostic and Statistical Manual of Mental Disorders. Nociceptive locations for pain were established (pain-sites 0–18). Dependent variable was the number of PDFs. Independent variables were social data, sick leave, interpreter, depression, stress levels and number of pain sites. Calculations were done using descriptive methods and multi-variable linear regression in full models, by gender. Findings: Many patients had depression (51% women versus 32% men). A majority were exposed to psychosocial stressors. Women had more PDFs, in median 5 [inter-quartile ranges (IQR) 4–8] versus men 3 (IQR 2–5), and also more pain sites, in median 3 (IQR 2–5) versus men in median 2 (IQR 1–3). For men, the regression calculations revealed that numbers of PDFs associated only with increasing numbers of pain sites (B 0.871 P < 0.001). For women, this association was weaker (B 0.364, P < 0.001), with significant values also for age (B 0.103) and sick leave > one year (B 0.767, P = 0.010), and a negative predicting value for interpreter support (B −1.198, P < 0.043). To conclude, PDFs associated often with somatic findings but varied much among the women. This implies potential problems regarding cause, function and sick leave questions. However, support by professional interpreters may facilitate a shared understanding with immigrant women having long-standing pain.

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Healthcare professional experiences with patients who participate in multimodal pain rehabilitation in primary care – a qualitative study

Cited by 18 publications

References 29 publications

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

”The acceptance” of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care

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

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