Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation—A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Ringqvist, Åsa; Dragioti, Elena; Björk, Mathilda; Larsson, Björn; Gerdle, Björn

doi:10.3390/jcm8060905

Cited by 56 publications

(109 citation statements)

References 77 publications

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“…Our findings are mostly consistent with several systematic reviews, which have concluded that IMPR generally is effective, but with small to moderate effects [ 7 , 8 , 9 , 10 , 13 ]. They are also in line with previous primary studies reporting long-term improvements on pain and quality of life [ 40 , 41 ]. In contrast, an umbrella review from 2018 assessing the strength of the evidence for the effectiveness of IMPR concluded that there is currently no robust evidence for the effectiveness of IMPR in any outcome, with the possible exception of decreased pain short term [ 42 ].…”

Section: Discussionsupporting

confidence: 91%

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study

Tseli

LoMartire

Vixner

et al. 2020

JCM

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Chronic pain is a leading cause of disability globally. Interdisciplinary multimodal pain rehabilitation (IMPR) targets pain with a bio-psycho-social approach, often delivered as composite programs. However, evidence of optimal program duration for the rehabilitation to succeed remains scarce. This study evaluated the effectiveness of different duration IMPR-programs—using within- and between-effects analyses in a pragmatic multicenter register-based controlled design. Using the Swedish Quality Registry for Pain Rehabilitation, data from fifteen clinics specialized in chronic pain rehabilitation across Sweden were retrieved. Participants were patients with chronic musculoskeletal pain who had taken part in short (4–9 weeks; n = 924), moderate (10 weeks; n = 1379), or long (11–18 weeks; n = 395) IMPR programs. Longitudinal patient-reported outcome data were assessed at baseline, post-intervention, and at a 12-month follow-up. Primary outcomes were health-related quality of life, presented as perceived physical and mental health (SF-36). Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS), pain intensity (NRS 0-10), the Multidimensional Pain Inventory (MPI), and perceived health (EQ-5D). Overall, all groups showed improvements. No clinically important effect emerged for different duration IMPR. In conclusion, while our results showed that patients following IMPR report improvement across a bio-psycho-social specter, a longer program duration was no more effective than a shorter one.

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Section: Discussionsupporting

confidence: 91%

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study

Tseli

LoMartire

Vixner

et al. 2020

JCM

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“…Several systematic reviews have reported that MMRP is effective for patients with chronic pain (2,5). Although patients in this study improved significantly in all PROMs, except for satisfaction with vocation, the ES were lower than in specialist care based on national data (31,32) and also from the same county councils for pain intensity during the last week, CPAQ-AE, CPAQ-PW, pain catastrophizing and EQ-VAS, but similar for HADS Anxiety and Depression, LiSat life, EQ5D-Index, and physical functioning for men (27).Since the ES were small, a possible explanation is that MMRP in primary care is a new intervention and specialist clinics have larger resources and more years of experience of the management of MMRP. Thus, further development of MMRP is warranted in order to improve the outcomes.…”

Section: Discussionmentioning

confidence: 58%

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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“…Thus, it is necessary to investigate whether the evidence obtained from SRs and RCTs can be replicated within a consecutive non-selected flow of patients in clinical settings. Few studies have investigated the real-life outcomes of IMMRPs for chronic pain, but a large study from the Swedish Quality Registry for Pain Rehabilitation (SQRP) found small to moderate effect sizes for 22 outcomes [22]. Complex interventions such as IMMRPs should have several outcomes measured at multiple levels and include strategies for handling multiple outcomes [7,8,23,24], but most SRs of IMMRPs evaluate the outcomes as independent from each other.…”

Section: Introductionmentioning

confidence: 99%

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)

Gerdle

Boersma

Åsenlöf

et al. 2020

JCM

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This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.

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Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation—A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Cited by 56 publications

References 77 publications

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study

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

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)

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