Variability in patient characteristics and service provision of interdisciplinary pain rehabilitation: A study using the Swedish national quality registry for pain rehabilitation
Marcelo Rivano Fischer, Marie-Louise Schults, Britt-Marie Stålnacke, Jan Ekholm, Elisabeth B. Persson, Monika Löfgren
Department of Health Sciences/Rehabilitation, Lund University Hospital, 221 00 Lund, Sweden. E-mail: email@example.com
Objective: To describe the organization, content and dosage of interdisciplinary pain rehabilitation, and the differences in degree of severity of problems of patients admitted to clinical units reporting to a Swedish national quality pain registry, grouped according to unit size and possible affiliation with a university hospital.
Methods: Reports from 31 out of 39 clinical units in Sweden, on inclusion processes, organization, content and dosage of interdisciplinary pain rehabilitation, and patient-reported data from a Swedish national quality pain registry at assessment for interdisciplinary pain rehabilitation were analysed.
Results: the number of patients treated annually at each unit ranged from 3 to 340. In 17 units, teams comprised 5 professionals. Dosage of interdisciplinary pain rehabilitation ranged from 20–180 h per patient in total. Patients at the university-hospital units scored the highest levels of symptoms and lowest levels of health-related quality of life. Units used similar sets of inclusion criteria, and several treatments, such as education, self-training and psychological interventions, were used by most units.
Conclusion: When interpreting outcome data from registries, aspects other than rehabilitation outcomes must be considered. The interpretation of outcomes from quality registries would be facilitated if data, in addition to assessments and patient-reported outcomes, also includes standardized descriptions of the reporting clinical units.
The increasing interest in the contribution of quality reg-istries to clinical quality development demands satisfactory descriptions of input, i.e. clinical services delivered, for outcome comparisons. Interdisciplinary pain rehabilitation is a team-based coordinated intervention, with several professions delivering care for patients with chronic pain, which has shown better results than treatment by a single profession. There is a lack of knowledge about content and intensity of activities, and which professions are involved. This study shows that more than 50% of the clinical units in Sweden included the same 5 professions (physicians, physiotherapists, psychologists, social workers, and occupational therapists). Even though the units used similar inclusion criteria, and some treatments were alike, e.g. education, self-training and cognitive behavioural therapy, the number of patients treated and the length of treatment varied largely. Several admission criteria were used simultaneously, suggesting complex assessment processes. This study shows that when interpreting outcome data from registries, other aspects than those related only to rehabilitation interventions must be considered. We suggest that the interpretation of outcomes from quality registries would be facilitated if the data, in addition to assessments and patient-reported outcomes, also includes standardized descriptions of the reporting units.
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