Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: Results from a national quality registry in Sweden

Abstract

Chronic pain is a common condition that negatively affects most areas of a persons' life and is difficult to alleviate. Research indicates that interdisciplinary multimodal pain rehabilitation is effective in improving physical and emotional functioning, but little is known about the prognostic factors for a good treatment outcome. Therefore, this study investigated how different patient characteristics related to these outcomes, by following 2,876 patients across Sweden over a 1-year period. It was found that patients who were either currently working or on short-term sick leave clearly had a better prognosis in both outcomes than those with a longer time off from work. In addition, positive treat ment expectations, levels of emotional health, and coping strategies played an important role, but were not consistent for both outcomes, suggesting a complex prognostic picture for the overall understanding of improvement. These results emphasize the importance of early intervention before patients are too distanced from the labour market. Objective: To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures. Methods: A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, derived from principal component analyses of the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional func tioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes. Conclusion: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.

Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study

“…Our sample included 76% women (31/41), which is in line with other studies describing people with chronic pain in Sweden [65,66] and other countries [67]. Patients in our sample had lived with pain for a shorter time than what is described in other studies of this population [68,69], and they rated their pain severity at baseline as equal to what have been reported in another study [70] describing patients participating in primary care management of low back pain patients.…”

The Mediating Role of Pain Catastrophizing on the Association Between Depression and Pain Severity and Interference Among Elderly Asian Immigrants with Chronic Pain

“…29 The negative influence of depression on chronic pain outcomes found in this study is consistent with previous studies. Previous studies have reported emotional distress is a risk factor of prognostic indicators for patients with chronic pain, 30 and patients with depression are more likely to suffer from chronic pain. 31 In this study, participants with depression expressed higher levels of pain severity and interference for daily life activities compared to those without depression.…”

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)

“…Few large studies have examined the sex differences in outcomes of IMMRPs. 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].…”