The Effects of Cognitive-Behavioral and Physical Therapy Preventive Interventions on Pain-Related Sick Leave

Linton, Steven J.; Boersma, Katja; Jansson, Markus; Svärd, Lennart; Botvalde, Marianne

doi:10.1097/00002508-200503000-00001

Cited by 177 publications

(124 citation statements)

References 35 publications

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“…There is evidence that identifying patients with elevated fearavoidance beliefs and managing them accordingly may reduce fear and improve outcomes. [3][4][5][10][11][12][13][14][15][16][17][18][19][20]36,40,41,56,68 The purpose of this study was to determine the effect of adding a single-item screening variable that classified patients with elevated versus not elevated fearavoidance beliefs of physical activities on a model that predicts risk-adjusted FS outcomes.…”

Section: T T Conclusionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

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Section: T T Conclusionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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“…327f.). Bendix et al (1996); Lambeek et al (2010); Linton et al (2005); Lukinmaa (1989); Strand et al (2001); Von Korff et al (2005) ** Bendix et al (1996); Bendix et al (1998); Lambeek et al (2010); Linton et al (2005); Lukinmaa (1989); Strand et al (2005); Von Korff et al (2005) …”

Section: Das Gesundheitsproblem Das Gesundheitsproblem Und Die Folgenmentioning

confidence: 99%

“…Bei Lukinmaa (1989) wird die MBRIntervention nicht genauer beschrieben. Im Rahmen der MBR-Interventionen wird nur in zwei Studien (Bendix et al, 1996;Bendix et al, 1998;Linton, Boersma, Jansson, Svärd & Botvalde, 2005) von Schmerzedukation oder einem Training des Copings berichtet. Die Kontrollintervention ("usual care") war nur unzureichend als "normale" Versorgung durch medizinische Spezialisten in den Niederlanden (Lambeek et al, 2010), "normale" Versorgung in Dänemark (Bendix et al, 1996;Bendix et al, 1998), "normale" Versorgung in der Gesellschaft und gewöhnliche Medikation (Von Korff et al, 2005) sowie als orthopädische ambulante Intervention nach biomedizinischem Konzept (Lukinmaa, 1989) beschrieben.…”

Section: Endpunktspezifische Zusammenfassung Der Evidenzlage Und Idenunclassified

Potential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain / Potentialanalyse der multidisziplinären biopsychosozialen Rehabilitation für Patienten/-innen mit chronischen Rückenschmerzen

Schüßler¹,

Abel²,

Holzer³

et al. 2017

International Journal of Health Professions

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Health problem: The prevalence of low back pain ranges from 74 to 85%, almost everybody in Germany suffers from low back pain once in his or her life. The recurrence rate within twelve months is 62%, which often leads to inability to work and reduction in earning capacity. The rate of chronic manifestation of low back pain is 5%. Subsequent loss of mobility and functional disability lowers quality of life and participation in private life and at work. Evidence: A recent Cochrane review (Kamper et al., 2014) analysed six (outcome disability) and seven (outcome pain) studies with 722 and 821 participants respectively and showed that multidisciplinary rehabilitation compared to usual care has a small, but clinically relevant effect (pain: SMD -0,21 [CI 95% -0,37; -0,04]; disability: SMD -0,23 4;06]). There is a lack of evidence about the intervention conception, patient-centred outcomes and the cost effectiveness. Implication for research: Prior to a randomised controlled trial a feasibility study about individualised multidisciplinary biopsychosocial rehabilitation compared to usual care considering people with chronic low back pain at employable age in Germany is needed. The applicability of available manuals, patient-centred outcomes and cost effectiveness should be explored.Potential analyse -chronic low back pain -multidisciplinary biopsychosocial rehabilitation Issue 1, 2017, Pages 33-42, ISSN 2296-990X, DOI: 10.1515/ijhp-2017 Keywords Abstract INTERNATIONAL JOURNAL OF HEALTH PROFESSIONSPotential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain Gesundheitsproblem: Rückenschmerz hat eine Lebenszeitprävalenz von 74-85 %, sodass fast jeder Mensch in Deutschland einmal von einer Rückenschmerzepisode betroffen sein wird. 62 % der Betroffenen bekommen innerhalb von zwölf Monaten nach der ersten Rückenschmerzepisode ein Rezidiv, was häufig zu Arbeitsunfähigkeit oder langfristig zu Erwerbsminderung führen kann. Die Chronifizierungsrate von Rückenschmerzen liegt bei 5-8 %. Durch Mobilitätsverlust und Funktionseinschränkung kann es zu einem Verlust an Lebensqualität sowie zu Einschränkungen der Partizipation im privaten sowie beruflichen Bereich kommen. Evidenzlage: Ein Cochrane Review von Kamper et al. (2014) zeigt auf Grundlage von sechs Studien für den Endpunkt "funktionelle Beeinträchtigung" bzw. sieben Studien für den Endpunkt "Schmerz" mit 722 bzw. 821 Teilnehmenden, dass multidisziplinäre Rehabilitation im Vergleich zu "normaler" Versorgung hinsichtlich funktioneller Beeinträchtigung und Schmerz einen kleinen, jedoch klinisch relevanten Effekt zeigt (Schmerz: SMD -0,21 37;04]; Beeinträchtigung SMD -0,23 4;06] METHODE Für die Informationen zu dem Gesundheitsproblem wurde eine Recherche im Januar und Februar 2015 sowie imNovember 2016 in PubMed mit den Suchworten "chronic low back pain", "multidisciplinary biopsychosocial rehabilitation", "patient centered outcomes" durchgeführt. Bei der Suche nach qualitätsgesicherten Reviews wurde ein relevantes Cochrane Re...

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“…14,33,39,43,115,135 The fear of pain and the catastrophic vision of pain also occur in pain-free people, so these beliefs can play an important role in the development of new episodes of pain. In studies performed in subjects without low back pain, 49,71,72,120 it was observed that fear of pain increased the risk of suffering episodes of low back pain, and therefore the risk of a disability was increased. Picavet 94 performed a longitudinal study in a population of 1,571 subjects without any important illness during 6 months.…”

Section: Fear-avoidance Model In Musculoskeletal Painmentioning

confidence: 99%

Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

Doménech

Sanchis-Alfonso²,

Espejo³

2011

Anterior Knee Pain and Patellar Instability

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The Effects of Cognitive-Behavioral and Physical Therapy Preventive Interventions on Pain-Related Sick Leave

Cited by 177 publications

References 35 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Potential analysis of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain / Potentialanalyse der multidisziplinären biopsychosozialen Rehabilitation für Patienten/-innen mit chronischen Rückenschmerzen

Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients

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