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

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Summary

Introduction

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

Materials and Methods
Subjects
Variables
Background
Repeated Self-Reported Measures
Pain Aspects
Psychological Distress Variables
Estimations of Changes in Pain and in Life Situation
Statistics
Background Data
Pairwise Comparisons of Repeated Measures
Patients Not Participating in the 12-Month FU
Multivariate Correlation Pattern of Changes in Outcomes
Longitudinal Regression of MIS Using Baseline Data
Discussions
Important Clinical Implications
Strengths and Limitations
Conclusions

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