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

Abstract

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.

A cost-utility analysis of multimodal pain rehabilitation in primary healthcare

“…These gains are important, bearing in mind the severe clinical condition of the patients illustrated by Table 1 and that the patients constitute a selection of patients that have already tried various unimodal treatments with no manifest improvements in their condition. These findings are reinforced by a recent study [61] based on the same data as the present study from SQRP-PC as well as the yearly report from the SQRP-PC [62]. Both conclude that MMRPs in primary healthcare contribute to significant improvements in pain, function, daily activity and HRQoL.…”

Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

“…The existing literature is conflicting: women benefit more [68,70,71], no sex differences [43,72,73], and men benefit more [74,75]. The outcomes of IMMRPs in a primary care SQRP study were better in women than in men [76]. The overall outcome variable MIS in this study showed the same pattern at 12-month follow-up, i.e., significantly better results for women but ES did not display clinical importance.…”

Interventions on cognitions and perceptions that influence work participation of employees with chronic health problems: a scoping review

“…Seven studies, of which three RCTs, studied the effect of an intervention on perceived health and work participation [ 17 – 19 , 28 , 29 , 32 , 33 ]. The interventions of Pedersen et al [ 18 ], Fauser et al [ 17 ] and Van Eijk-Hustings et al [ 19 ] did not have a significant effect on perceived health.…”

“…However, no results were reported regarding whether the increase in perceived health caused the increase in work participation. In addition, the intervention in the cohort of Pietilä-Holmner et al [ 33 ] with physical exercise, education in pain management and training coping strategies, increased perceived health and decreased sick leave among employees with chronic musculoskeletal pain. However, they did not report whether the increase in perceived health caused the increase in work participation either.…”

“…Most of the studies we found which focused on cognitions and perceptions and work participation were aimed at the factor catastrophizing. In total, ten studies were found that focused on this factor and work participation [ 14 , 20 , 28 , 32 , 33 , 35 – 39 ]. Among these studies there were two RCTs [ 14 , 20 ].…”