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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

Elena Tseli, Linda Vixner, Riccardo LoMartire, Wilhelmus J.A. Grooten, Björn Gerdle, Björn O. Äng
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden. E-mail: elena.tseli@ki.se
DOI: 10.2340/16501977-2648

Preview of fully accepted paper, still not published in any volume

Abstract

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 Re-gistry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, base-line 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 Emot-ional 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 signifi-cance 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.

Lay 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.

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