Abstract
BackgroundThe effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP.MethodsData were used from baseline and 6 months follow-up measurements of a prospective cohort study of 120 CWP. Regression models were used to assess whether baseline variables predicted treatment outcome. Outcome domains included: pain, pain interference, depression, and global perceived effect (GPE). Potential predictors included: psychological distress, illness and self-efficacy beliefs, fear-avoidance beliefs and behaviour, symptoms, disability, and socio-demographic factors.ResultsGreater improvement in pain was predicted by more pain at baseline and male gender. Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline, lower levels of anxiety, a stronger belief in personal control, less belief in consequences, male gender, and a higher level of education. Greater improvement in depression was predicted by higher baseline values of depression, stronger beliefs in personal control, and a higher level of education. Better outcome on GPE was predicted by less pain, less fatigue, and a higher level of education.ConclusionLess anxiety, stronger beliefs in personal control, less belief in consequences, less pain, less fatigue, higher level of education, and male gender are predictors of better outcome of multidisciplinary treatment in CWP. Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome.
Highlights
The effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited
This study aims to evaluate these hypotheses on predictors of the outcome of multidisciplinary treatment in patients with CWP
Inclusion criteria for the study were: (i) a diagnosis of CWP according to the American College of Rheumatology criteria (ACR) [3]; (ii) eligible for multidisciplinary treatment according to the criteria the Dutch Consensus Report of Pain Rehabilitation [28], as assessed by both a rehabilitation physician and a psychologist; these criteria require patients to experience restrictions in daily living and/or psychosocial functioning; and (iii) age between 18 and 75 years
Summary
The effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP. Evidence for positive effects of multidisciplinary treatment in FM has been reported [7,8,9]. A plausible explanation for this limited effect is the considerable heterogeneity among patients [7,10]. It is likely that the outcome of multidisciplinary treatment depends on the specific combination of symptoms, patient characteristics and treatment characteristics. Our systematic review revealed preliminary evidence for several de Rooij et al BMC Musculoskeletal Disorders 2013, 14:133 http://www.biomedcentral.com/1471-2474/14/133 patient characteristics and symptoms as predictors of the outcome of multidisciplinary treatment [11]. Further studies are needed to establish the relationship between patients characteristics and the outcome of multidisciplinary treatment
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