Abstract
Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported presentation pre-IMMRP predicts the multivariate outcome. To this end, this study analysed chronic pain patients in specialist care included in the Swedish Quality Registry for Pain Rehabilitation for 22 outcomes (pain, psychological distress, participation, and health) on three occasions: pre-IMMRP, post-IMMRP, and 12-month follow-up. Moderate stable ES were demonstrated for pain intensity, interference in daily life, vitality, and health; most other outcomes showed small ES. Using a Multivariate Improvement Score (MIS), we identified three clusters. Cluster 1 had marked positive MIS and was associated with the overall worst situation pre-IMMRP. However, the pre-IMMRP situation could only predict 8% of the variation in MIS. Specialist care IMPRPs showed moderate ES for pain, interference, vitality, and health. Outcomes were best for patients with the worst clinical presentation pre-IMMRP. It was not possible to predict who would clinically benefit most from IMMRP.
Highlights
Pain is an unpleasant experience with complex interactions between sensorimotoric, affective, and cognitive brain networks
Unlike single/unimodal interventions, interdisciplinary multimodal pain rehabilitation programs (IMMRPs) for chronic pain—an interdisciplinary treatment according to the International Association for the Study of Pain (IASP)—distinguish themselves as well-coordinated complex interventions
There were 14,666 chronic pain patients registered in the Swedish Quality Registry for Pain Rehabilitation (SQRP) that fulfilled the inclusion criteria: chronic pain; >18 years of age; and completed the SQRP questionnaire before and on at least one of the two time points after the IMMRP
Summary
Pain is an unpleasant experience with complex interactions between sensorimotoric, affective, and cognitive brain networks. It would be motivating for patients to endure increases in pain, which is often observed in clinical practise during the start-up period of rehabilitation characterised by an increase in activity levels, if it were known that the long-term effects include the reduction of pain levels Complex interventions such as IMMRP should have several outcomes measured at multiple levels and strategies for handling multiple outcomes [17,30]. The above knowledge gaps motivated this PBE study of chronic pain patients based on patient reported outcome measures (PROMs) from the Swedish Quality Registry for Pain Rehabilitation (SQRP) [31] This registry offers an opportunity to investigate clinical outcomes and patterns of change, since all the relevant specialist care units throughout Sweden deliver data to SQRP. To define a multivariate outcome measure of IMMRP. To investigate if the clinical self-reported presentation pre-IMMRP can predict the multivariate outcome measure
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