Long‐Term Outcomes of Multidisciplinary Rehabilitation for Chronic Musculoskeletal Pain

Volker, Gerard; Vree, Félicie van; Wolterbeek, Ron; Gestel, Marc van; Smeets, Rob; Köke, Albère; Vlieland, Thea Vliet

doi:10.1002/msc.1141

Cited by 30 publications

(22 citation statements)

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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%

“…The present cohort was considered to be a representative chronic musculoskeletal pain sample, with similar demographics to patients normally participating in IMPR programs both in Sweden and other Western countries as presented in other studies [ 8 , 9 , 10 , 41 ]. Since the present study targeted patients in specialist care, the external relevance extends to patients in specialist care units rather than to subjects seen in primary care.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

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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“…To account for the expected dependencies of patients within each of the 5 participating treatment locations, we applied the Donner et al [ 55 ] formula for the variance inflation factor, assuming an intracorrelation coefficient of 0.2 [ 56 , 57 ]. Furthermore, we corrected the analysis for an expected attrition of 20%, which is based on the average attrition of similar studies that used the PDI [ 21 , 58 , 59 ]. Based on these calculations, a minimum sample size of 157 participants, equally divided over 5 treatment locations, will be required.…”

Section: Methodsmentioning

confidence: 99%

Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial

Elbers¹,

Pool²,

Wittink³

et al. 2020

JMIR Res Protoc

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Background To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice. Trial Registration Netherlands Trial Register NL8076; https://www.trialregister.nl/trial/8076 International Registered Report Identifier (IRRID) DERR1-10.2196/18632

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“…To account for the expected dependencies of patients within each of the 5 participating treatment locations, we applied the Donner et al [55] formula for the variance inflation factor, assuming an intracorrelation coefficient of 0.2 [56,57]. Furthermore, we corrected the analysis for an expected attrition of 20%, which is based on the average attrition of similar studies that used the PDI [21,58,59]. Based on these calculations, a minimum sample size of 157 participants, equally divided over 5 treatment locations, will be required.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial (Preprint)

Elbers¹,

Pool²,

Wittink³

et al. 2020

Preprint

Self Cite

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BACKGROUND To facilitate adherence to adaptive pain management behaviours after interdisciplinary multimodal pain treatment, we developed an mHealth application (i.e. AGRIPPA app) that contains two behaviour regulation strategies. OBJECTIVE This study has three main objectives: (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app-users. METHODS We will perform a multicentre randomised controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the six participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months post-treatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and healthcare expenses. RESULTS The study was approved by the local Medical Research Ethics Committee in October 2019. As of 20 March 2020, we have recruited 88 patients. CONCLUSIONS This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After three years of development and feasibility testing, this formal evaluation will help determine to what extent the application will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice. CLINICALTRIAL The trial has been registered under NL8076 in the Netherlands Trial Register (https://www.trialregister.nl/trial/8076)

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Long‐Term Outcomes of Multidisciplinary Rehabilitation for Chronic Musculoskeletal Pain

Cited by 30 publications

References 20 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

Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial

Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial (Preprint)

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