Multimodal Rehabilitation Program Research Articles

Tolerability and psychological effects of a multimodal day-care rehabilitation program for persons with Huntington's disease.

ObjectiveTo determine whether the psychological benefits of intense, inpatient, multimodal rehabilitation for persons with Huntington’s disease (HD), as found in earlier studies, also apply in a shorter, day-care setting.DesignProspective, non-randomized cohort study.SubjectsTwenty patients attending a group-based 8-week (3 days/week) rehabilitation programme aimed at persons in early stages of HD.MethodsAn explorative cohort study on register data from a specialized rehabilitation centre, including descriptive data, number of cancellations, a self-reported evaluation, and measures of psychiatric symptoms, health-related quality of life, sense of coherence and physical function at baseline and at the end of rehabilitation.ResultsPatients’ attendance rate was almost 90%. Patients were satisfied, and displayed significantly reduced anxiety and depression and improved health-related quality of life after rehabilitation. Baseline measures of sense of coherence showed significant negative correlation with the number of cancelled days of rehabilitation. Physical function improved, but did not correlate significantly with psychological outcome measures.ConclusionThese results indicate that an 8-week multimodal day-care rehabilitation programme can be tolerable, reduce psychiatric symptoms, and improve health-related quality of life for people with HD. A higher sense of coherence seems to promote attendance rates. Further larger studies, including the impact of cognition and disease progression on the treatment effect, are warranted.LAY ABSTRACTHuntington’s disease (HD) is characterized by a triad of clinical features; motor, cognitive, and psychiatric. Physical training seems to have positive effects on motor symptoms. Earlier studies have shown that intense, inpatient, multimodal rehabilitation may also reduce psychiatric symptoms. The present study aimed to explore whether the psychological benefits are retained in a shorter, day-care setting.This study included 20 patients attending a group-based rehabilitation programme. The results show that participants had an almost 90 % attendance rate and were satisfied with the programme. After rehabilitation, they displayed significantly reduced anxiety and depression and improved quality of life. Sense of coherence showed a significant negative correlation with the number of cancelled days of rehabilitation. These results indicate that a shorter multimodal day-care rehabilitation programme can be easier to tolerate than longer programmes, and still reduce psychiatric symptoms and improve quality of life for people with HD. A higher sense of coherence appears to promote the attendance rate.

The feasibility of implementing an exercise programme for deconditioned cancer survivors in a national cancer centre: FIXCAS Study.

Introduction: As both the number of cancer survivors and the length of survival time are increasing, long-term health issues related to cancer and its treatment are becoming more prevalent. Research suggests that exercise can mitigate several negative health consequences in cancer survivors and improve physical function and quality of life. Multi-modal exercise interventions have been proposed as a cornerstone for survivorship care. However, studies evaluating exercise programmes within the Irish population are lacking. Purpose: To evaluate the introduction, implementation and acceptability of a multi-modal exercise rehabilitation programme for deconditioned cancer survivors in a real-world, standard practice setting. Methods and analysis: In this single-arm prospective feasibility study, cancer survivors (n=40) will undergo a 10-week multi-modal exercise programme. The study population will comprise of cancer survivors attending outpatient services in an Irish national cancer centre. Participants will be aged 18 or older and have completed treatment with curative intent. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes will examine physical function and quality of life measures. In addition, the acceptability of the programme will be assessed through stakeholder feedback. Ethics and dissemination: Ethical approval through the St. James's Hospital and Tallaght University Hospital Research and Ethics Committee is currently pending. The study results will be used to optimise the intervention content and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses and relevant clinical groups. Trial registration: ClinicalTrials.gov NCT04026659 (19/07/19).

Nasogastric tube utilization after esophagectomy: An unnecessary gesture?

IntroductionNasogastric decompressive tube utilization has been accepted as one of the basic perioperative care measures after esophageal resection surgery. However, with the development of multimodal rehabilitation programs and without clear evidence to support their use, the systematic indication of this measure may be controversial. Material and methodsRetrospective, descriptive and comparative study of patients who had undergone Ivor-Lewis esophagectomy in our center – from January 2015 to December 2018 – with placement (Group S), or without placement (Group N) of a decompressive tube in gastroplasty during postoperative period. Epidemiological variables and differences between groups in post-surgical morbidity and mortality, hospital stay, onset of oral tolerance and the need for nasogastric tube placement were evaluated. ResultsA total of 43 patients were included in this study, with a median age of 61 years, being 86% male. 46.5% were hypertensive, 25.5% had lung disease and 16.3% had diabetes mellitus. The median length of hospital stay was 9 days in group S versus 11.5 days in group N, with no differences in the onset of oral tolerance. Anastomotic dehiscence rate was 5% and 0% respectively. The overall mortality was 2.3% in the first 90 days, without differences between the groups. Placement of nasogastric tube during postoperative period was required only in 1 patient (4.3%) of the group N. ConclusionsNon-use of nasogastric tube during postoperative period of an Ivor-Lewis esophagectomy is a safe measure, as it is not associated with a higher rate of complications or hospital stay. This fact may be able to improve patients’ comfort and postoperative recovery.

Neurocognitive measures and self-reported symptoms following a short intensive multimodal neurorehabilitation program in individuals with post-concussion syndrome: Retrospective case-series study

This case-series study investigates the effect of a condensed multi-modal neurorehabilitation program on neurocognitive measures and self-reported symptoms using the C3Logix assessment tool on 137 individuals with diagnosed Post-Concussion Syndrome (PCS). In PCS, neurocognitive dysfunction is typically accompanied by symptoms of the physical, affective, and sleep domains. While most individuals recover within weeks of sustaining a head injury, evidence shows that those who do not recover in 3 months, may never. Recovery methods are usually prescribed with varying success, but the pathophysiologic complexity of concussion may require additional rehabilitation strategies that address the impaired neural networks to accelerate recovery. 137 individuals (M: 81, F: 56; mean (SD) age: 32.0 (14.0)) with a diagnosed PCS were treated at an outpatient rehabilitation center specializing in functional neurology. Using the C3Logix platform, individuals were evaluated at the intake and discharge of a 5-day program. Interventions included neuromuscular re-education, vestibular rehabilitation, orthoptics and cognitive training. Neurocognitive components and symptoms were exported and analyzed in Graphpad PRISM v. 8.4.3 using an rmANOVA. Results are reported as difference-of-means (95% CI). An alpha level of 0.05 was considered statistically significant. The C3Logix modified Graded Symptom Checklist score (0-150) decreased by 19.45 (15.16-23.75) (p < 0.0001), Trails A and B decreased 3.9 s (2.2-5.5) and 4.8 s (2.1-7.5) (p < 0.0001), respectively. Simple- and Choice Reaction Time decreased 31.3 ms (21.5-41.1) and 50.7 ms (37.9-63.6) (p < 0.0001), respectively. Static and Dynamic Visual Acuity decreased 0.03 LogMAR (0.0085-0.059) (p = 0.0021) and 0.05 LogMAR (0.021-0.073), respectively. Standardized Assessment of Concussion score (0-30) increased 0.8 (0.3-1.3) (p = 0.001) and digit-symbol coding increased 4.6 symbols (3.0-6.2) (p < 0.0001). The results of the present case-series study suggest clinically relevant improvements in neurocognitive measures and subjective symptoms in individuals with PCS following a multi-modal 5-day rehabilitation program.

Effect of Long-Term Repeated Interval Rehabilitation on the Gross Motor Function Measure in Children with Cerebral Palsy.

The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common. In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP. The study was a retrospective analysis of children with CP (2-13 years) participating for a second (n = 262) and third year (n = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference). After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]). Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.

1870P Response of post-curative survivors suffering from fatigue to a multimodal inpatient cancer rehabilitation program

Cancer-treatment related Fatigue is a frequent and distressing consequence of anticancer treatment. Multimodal interventions are required (see ESMO CPGL 2020), however, little is known about the effects of structured inpatient cancer rehabilitation programs including both physical and emotional-social components. Prospective data collection of inpatients of an integrated cancer rehabilitation service including weekly assessments for goal-directed rehabilitation interventions, steered by a transprofessional rehabilitation team. Rehab-Intervention includes: endurance training incl. water-therapy, proteinrich nutrition, invisible disability directed psychooncolocigal, art and music therapy, mind-body interventions, cognitive-behavioural training to cope with energy levels, social support for back to work and meaning-centered group therapy. Definition of endurance-training responders and non-responders based on five-time-sit-to-stand test. Testing the hypothesis that endurance-training non-responders profit from rehab in the psycho-social domains. Descriptive statistics and t-tests. Fifty-six patients (54y [31-88], 42 female, BMI 27 [median; 16, 42]; breast (29), lung (4), GI (7), GU (5), HemOnc (9), or other (1) cancer) had chemo/immuntherapy 387 (0, 3678) days before rehab. LOS 29 days (0, 53). Co-factors: CINP 22 (8 >= G2), depression/psychiatric comorbidity (39), endocrine (11) or chronic pain (26). FTSTS: 9.1 sec (4.8; 30), Hand-Grip-Strength 25 / 23 kg, 6 min walking-test 493 meters (58, 661). Brief-Fatigue Inventory 45/90 (0, 74), Fatigue 7/10 (0, 10), cognitive 5, emotional 4, physical 7; QoL 5 (0, 10). HADS-A 7/21 (0, 18), HADS-D 8/21 (0, 18). After Rehab: FTSTS 6.1 (-36%), 6MWT 568, HADS-A 4.5, HADS-D 5; BFI 25, Fatigue 4, cogn 3, emot 1, phys 3. All physical and psychological outcomes improved clinically meaningful in "fit” (non-responding by FTSTS) and unfit patients. Cancer-treatment related fatigue syndrome rehabilitation is both effective in endurance training responders and non-responders fpr psychological and social outcomes. Further research is justified testing different types of interventions tailored to subgroups.

Restoring confidence in return to work: A qualitative study of the experiences of persons with exhaustion disorder after a dialogue-based workplace intervention.

Stress-induced exhaustion disorder (SED) is a primary cause for sickness absence among persons with mental health disorders in Sweden. Interventions involving the workplace, and supporting communication between the employee and the supervisor, are proposed to facilitate return to work (RTW). The aim of this study was to explore experiences of persons with SED who participated in a dialogue-based workplace intervention with a convergence dialogue meeting performed by a rehabilitation coordinator. A qualitative design based on group interviews with 15 persons with SED who participated in a 24-week multimodal rehabilitation program was used. The interviews were analyzed with the methodology of grounded theory. The analysis resulted in a theoretical model where the core category, restoring confidence on common ground, represented a health promoting process that included three phases: emotional entrance, supportive guidance, and empowering change. The health promoting process was represented in participant experiences of personal progress and safety in RTW. The intervention built on a health-promoting pedagogy, supported by continuous guidance from a rehabilitation coordinator and structured convergence dialogue meetings that enhanced common communication and collaboration with the supervisor and others involved in the RTW process. The intervention balanced relationships, transferred knowledge, and changed attitudes about SED among supervisors and colleagues in the workplace. The inclusion of a rehabilitation coordinator in the intervention was beneficial by enhancing RTW and bridging the gaps between healthcare, the workplace, and other organizational structures. In addition, the intervention contributed to a positive re-orientation towards successful RTW instead of an endpoint of employment. In a prolonged process, a dialogue-based workplace intervention with convergence dialogue meetings and a rehabilitation coordinator may support sustainable RTW for persons with SED.

Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.

One-Year Follow-Up after Multimodal Rehabilitation for Patients with Whiplash-Associated Disorders.

Long-term symptoms after whiplash injury often comprise neck pain, headache, anxiety, depression, functional impairment and low quality of life. In an observational cohort study, we examined physical and mental health effects in patients with subacute to chronic whiplash-associated disorders (WAD) after participation in a multimodal rehabilitation (MMR) program. MMR is a team-based multi-professional method based on a bio-psycho-social model with a cognitive focus to reach an individualized and common goal for the team and patient together. Standardized self-report questionnaires were filled in three times: before MMR, after MMR, and one year after MMR. A total of 322 participants completed the program, 161 of whom responded in full and were further analyzed. At one-year follow-up after MMR, a significant improvement was seen in the evaluation of the primary outcomes (physical and mental health) and secondary outcomes (anxiety, depression, pain intensity and interference with life). Women improved on all outcomes while men did not improve on the psychological measures (mental health, depression and anxiety). This study indicates that a MMR program could be beneficial for patients with subacute to chronic WAD, at least for women, since the outcomes at one-year follow-up were positive.

Factors of importance for return to work, experienced by patients with chronic pain that have completed a multimodal rehabilitation program – a focus group study

Background and purpose To reduce the individual, societal, and economic burden of the high sick leave rates due to chronic pain, it is essential to find effective strategies for increasing return to work (RTW). Although multimodal rehabilitation programs (MMRPs) may have positive effects on RTW, the results are inconsistent. This study explores the factors that contribute to decreasing sick leave and increasing RTW in patients with chronic pain who completed a MMRP. Method Four focus groups and three individual interviews were conducted. In total, 18 patients were interviewed. All patients had chronic pain and had completed a MMRP. They were either employed or unemployed, either working to some degree or fully on sick leave. The data were analysed using qualitative content analysis. Results Three main categories were identified: Knowledge and understanding–prerequisites for tailored solutions; Individual adaptations–necessary but difficult to implement; and Stakeholder collaboration–needs improvement. Conclusion The participants described a variety of facilitating and limiting factors that created complex prerequisites for RTW. This finding makes it clear that these patients need tailored interventions and strong collaboration among all stakeholders throughout the rehabilitation process. Tailored interventions and collaborations could improve the effectiveness of MMRPs. IMPLICATIONS FOR REHABILITATION Patients with chronic pain need tailored solutions and adaptations based on their individual needs in the RTW rehabilitation process. To return to work, patients with chronic pain needs support to strengthen their selfconfidence and to be prepared with knowledge and strategies about their abilities and their rights and obligations in relation to the labour market. A well-designed and communicated RTW rehabilitation plan supports the patient in the RTW rehabilitation process. To improve the possibility for employees and employers to create a sustainable work situation, stakeholder reconciliation meetings should be held routinely over time to strengthen the transfer of knowledge and collaboration.

Uso de sonda nasogástrica en pacientes sometidos a esofaguectomía: ¿Un gesto innecesario?

IntroductionNasogastric decompressive tube utilization has been accepted as one of the basic perioperative care measures after esophageal resection surgery. However, with the development of multimodal rehabilitation programs and without clear evidence to support their use, the systematic indication of this measure may be controversial. Material and methodsRetrospective, descriptive and comparative study of patients who had undergone Ivor-Lewis esophagectomy in our center -from January 2015 to December 2018- with placement (Group S), or without placement (Group N) of a decompressive tube in gastroplasty during postoperative period. Epidemiological variables and differences between groups in post-surgical morbidity and mortality, hospital stay, onset of oral tolerance and the need for nasogastric tube placement were evaluated. ResultsA total of 43 patients were included in this study, with a median age of 61 years, being 86% male. 46.5% were hypertensive, 25.5% had lung disease and 16.3% had diabetes mellitus. The median length of hospital stay was 9 days in group S versus 11.5 days in group N, with no differences in the onset of oral tolerance. Anastomotic dehiscence rate was 5% and 0% respectively. The overall mortality was 2.3% in the first 90 days, without differences between the groups. Placement of nasogastric tube during postoperative period was required only in 1 patient (4.3%) of the group N. ConclusionsNon-use of nasogastric tube during postoperative period of an Ivor-Lewis esophagectomy is a safe measure, as it is not associated with a higher rate of complications or hospital stay. This fact may be able to improve patients’ comfort and postoperative recovery.

Does a Train-the-Trainer Approach for Enhancing Healthcare Professionals' Skills in Patient Education during Inpatient Medical Rehabilitation Improve Patient Outcomes?

This study is aimed at identifying the impact of a team-based train-the-trainer program (TTT-P) to enhance healthcare professional (HCP) skills in patient education during medical rehabilitation. Focusing on patient-reported outcomes, a prospective, sequential two-cohort study was conducted in the fields of psychosomatic and oncological rehabilitation. Two hundred fifteen patients were evaluated before (Cohort 1) and 196 post implementation of TTT-P (Cohort 2). Patients of both cohorts completed validated questionnaires on self-management (heiQ®), general self-efficacy (GSE scale), and quality of life (WHOQOL-Bref) at the beginning, at the end, and at the 6-month follow-up to analyze short- and intermediate-term effects. Analyses were conducted separately for the psychosomatic and oncological setting. Results showed that TTT-P had no impact on patient outcomes in both rehabilitation settings. Patients did report positive outcomes as a result of the whole inpatient rehabilitation programs, though effects at follow-up were mostly small to medium size. Concerning self-management competencies, cancer patients gained less benefit during rehabilitation than psychosomatic patients. In conclusion, TTT-P did not result in measurable improvements at the patient level, likely because of the limited nature of the intervention. However, these populations of rehabilitants took benefit from participating in a multimodal rehabilitation program, of which patient education is one part.

Hopeful struggling for health: Experiences of participating in computerized cognitive training and aerobic training for persons with stress-related exhaustion disorder.

It is important to understand how people with exhaustion disorder (ED) perceive interventions aiming to facilitate cognitive functioning. Therefore, the overall aim of this study was to explore experiences from persons with ED after participating in a 12-week intervention of either computerized cognitive training or aerobic training. Both interventions were performed in addition to a multimodal rehabilitation programme. Thirteen participants, 11 women and 2 men, were interviewed about pros and cons with participating in the training. The interviews were analysed with Qualitative Content Analysis. The analyses resulted in the theme hopeful struggling for health and the categories support, motivation and sensations. It was hard work recovering from ED. Support from others who are in the same situation, family members, and technology and routines for the training were strongly emphasized as beneficial for recovery. Timing, i.e., matching activities to the rehabilitation programme, getting feedback and perceiving joy in the training were important for motivation. Participants in both interventions experienced positive sensations with improved memory performance, everyday life functioning and increased faith in the prospect of recovery. However, it is important to consider various aspects of support and motivation in both computerized cognitive training and aerobic training to enable participants to pursue their participation.

The feasibility of implementing an exercise programme for deconditioned cancer survivors in a national cancer centre: FIXCAS Study

Introduction: As both the number of cancer survivors and the length of survival time are increasing, long-term health issues related to cancer and its treatment are becoming more prevalent. Research suggests that exercise can mitigate several negative health consequences in cancer survivors and improve physical function and quality of life. Multi-modal exercise interventions have been proposed as a cornerstone for survivorship care. However, studies evaluating exercise programmes within the Irish population are lacking. Purpose: To evaluate the introduction, implementation and acceptability of a multi-modal exercise rehabilitation programme for deconditioned cancer survivors in a real-world, standard practice setting. Methods and analysis: In this single-arm prospective feasibility study, cancer survivors (n=40) will undergo a 10-week multi-modal exercise programme. The study population will comprise of cancer survivors attending outpatient services in an Irish national cancer centre. Participants will be aged 18 or older and have completed treatment with curative intent. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes will examine physical function and quality of life measures. In addition, the acceptability of the programme will be assessed through stakeholder feedback. Ethics and dissemination: Ethical approval through the St. James’s Hospital and Tallaght University Hospital Research and Ethics Committee is currently pending. The study results will be used to optimise the intervention content and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses and relevant clinical groups. Trial registration: ClinicalTrials.gov NCT04026659 (19/07/19)

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain.

To investigate the outcomes 1 year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after 1 year. A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and 1 year after multimodal rehabilitation programmes. Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, confidence interval (CI) 1.21-1.06, p = 0.005). This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.

Finding self-worth—Experiences during a multimodal rehabilitation program when living at a residency away from home

ABSTRACT Background Patients with chronic pain who live in rural areas often need to travel long distances to participate in multimodal rehabilitation programs. To reduce traveling during the programs, patients sometimes live at a residency close to the clinic and thus far from home. Aims The aim of this study was to explore how patients with chronic pain experience participation in an multimodal rehabilitation program while living at a residency. Method Twelve patients from two specialist clinics in northern Sweden were interviewed about their experiences of participating in a multimodal rehabilitation program. The data were analyzed qualitatively using a grounded theory method with an emergent design. Results The analyses resulted in a model with the core category “finding my self-worth” consisting of four categories: “space for myself,” “mirroring myself,” “I am of value,” and “dealing with returning to everyday life.” The model illustrates the process whereby participants are given space for themselves and an opportunity to mirror themselves in interaction with other participants. That provided insight about their self-worth that was valuable for return to everyday life at home and work. Conclusion Living at a residency during multimodal rehabilitation provided added value when patients were relived from the obligations of everyday life at home and given time for reflection and interaction with others in similar situations. This contributed to awareness of their own value and the necessity of taking care of themselves. This new insight led to increased motivation to act differently at home.

Evaluation of a multimodal pain rehabilitation programme in primary care based on clinical register data: a feasibility study.

Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data. There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings. We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010-2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups. There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118-102 days, P < 0.001) and in the reference group (50-42 days, P < 0.001) from one year before baseline to two years after. It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care.

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.

To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures. 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 Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, fused by principal component analyses using the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional 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 functioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes. Employment was consistently found to be an important prognostic factor, suggesting the significance 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.

A 12-Week Multi-Modal Exercise Program: Feasibility of Combined Exercise and Simplified 8-Style Tai Chi Following Lung Cancer Surgery.

Objective:To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment.Methods:Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes.Results:Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels.Conclusion:This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention.

Effectiveness of adding a workplace intervention to an inpatient multimodal occupational rehabilitation program: A randomized clinical trial.

ObjectivesThis study aimed to evaluate the effectiveness of a workplace intervention (WI) added to an inpatient multimodal occupational rehabilitation program (I-MORE) on sickness absence.MethodsIn this researcher-blinded randomized controlled trial with parallel groups, individuals on sick leave due to musculoskeletal, unspecified- or common mental health disorders were randomized to I-MORE (N=87) or I-MORE+WI (N=88). I-MORE lasted 2+1 weeks (with one week at home in between) and consisted of “acceptance and commitment therapy”, physical exercise, and work-related problem solving. The additional WI consisted of a preparatory part, a workplace meeting involving the sick-listed worker, the employer, and the primary rehabilitation therapist at the rehabilitation center, and follow-up work related to the meeting. The primary outcomes were number of sickness absence days and time until sustainable return to work (RTW) during 12 months of follow-up, measured by registry data.ResultsThe median number of sickness absence days during the 12-month follow-up for I-MORE was 115 days [interquartile range (IQR) 53–183] versus 130 days (IQR 81–212) for I-MORE+WI. The difference between groups was not statistically significant (P=0.084). The hazard ratio for sustainable RTW was 0.74 (95% confidence interval 0.48–1.16; P=0.192) in favor of I-MORE.ConclusionsThis study provided no evidence in favor of I-MORE+WI compared to only I-MORE for long-term sickness absent individuals with musculoskeletal-, common mental- or unspecified disorders.