oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Musculoskeletal pain in primary health care: a biopsychosocial perspective for assessment and  treatment
Örebro University, School of Health and Medical Sciences. (Centre for Health and Medical Psychology (CHAMP), Örebro universitet)
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care.

To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV).

Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2010. , p. 82
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 40
Keywords [en]
musculoskeletal pain, biopsychosocial, multimodal, fear-avoidance, catastrophizing, distress, sick leave, function
National Category
General Practice Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine; Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:oru:diva-10084ISBN: 978-91-7668-716-1 (print)OAI: oai:DiVA.org:oru-10084DiVA, id: diva2:304497
Public defence
2010-04-23, Aulan, ingång 21, 721 89, Centrallasarettet, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-03-19 Created: 2010-03-18 Last updated: 2018-01-12Bibliographically approved
List of papers
1. Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up
Open this publication in new window or tab >>Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up
Show others...
2006 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 7, p. 437-446Article in journal (Refereed) Published
Abstract [en]

Purpose. There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

Method. The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

Results. Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

Conclusions. These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2006
Keywords
musculoskeletal pain, comprehensive treatment, return to work, quality of life, rehabilitation, sick leave
National Category
General Practice
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-10031 (URN)10.1080/09638280500192694 (DOI)
Available from: 2010-03-18 Created: 2010-03-17 Last updated: 2018-01-12Bibliographically approved
2. Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain?: A validation of the Örebro Musculoskeletal Pain Screening Questionnaire
Open this publication in new window or tab >>Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain?: A validation of the Örebro Musculoskeletal Pain Screening Questionnaire
Show others...
2008 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 5, p. 641-649Article in journal (Refereed) Published
Abstract [en]

Purpose

Early identification and intervention with those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering associated with long-term work absenteeism. The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) has been used and validated in several studies for participants with mainly acute pain problems. The aim of this study was to validate the ÖMPSQ for patients with non-acute pain problems (e.g. 1–6 months sick leave) and compare to other relevant questionnaires.

Method

One hundred and fifty-eight patients with musculoskeletal pain and disability recruited to a multidisciplinary rehabilitation project completed a battery of questionnaires at baseline and at 3-year follow-up visits. The main analysis involved the relationship between risk levels in the questionnaire and sick leave and perceived health after 3 years.

Results

The ÖMSPQ predicted future sick leave and health and was found to have six factors. The function and pain factors were the best predictors of sick leave after 3 years, while the distress factor was the best predictor of perceived mental health and return to work-expectancy was borderline significant. Perceived physical health at 3 years was best predicted by the function and pain factors with the fear-avoidance factor being marginally significant.

Conclusion

The results demonstrate that psychosocial factors as measured by ÖMPSQ are related to work disability and perceived health even 3 years after treatment for patients with non-acute pain problems. The ÖMSPQ was a good predictor of outcome.

Keywords
back pain, screening, risk factors, follow-up
National Category
Psychology Medical and Health Sciences
Research subject
Clinical Psychology; Medicine
Identifiers
urn:nbn:se:oru:diva-6696 (URN)10.1016/j.ejpain.2007.10.007 (DOI)
Available from: 2009-05-11 Created: 2009-05-11 Last updated: 2017-12-13Bibliographically approved
3. Controlled 3-year follow-up of a multidisciplinary pain rehabilitation program in primary health care
Open this publication in new window or tab >>Controlled 3-year follow-up of a multidisciplinary pain rehabilitation program in primary health care
Show others...
2010 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 4, p. 307-316Article in journal (Refereed) Published
Abstract [en]

Purpose: The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden.

Methods: An experimental group comprising 89 patients from two primary health care units received individualised treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine. All participants completed questionnaires measuring pain, sick leave, quality of life, health care utilisation, drug consumption and psychosocial factors at baseline and at 3-year follow-up.

Results: After 3 years, utilisation of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The control group showed a trend of having a higher risk of high consumption after 3 years compared to the intervention group. There was no significant difference between the two groups concerning remaining variables such as function, catastrophising and pain.

Conclusion: Both groups demonstrated considerable improvement over the course of 3 years. The experimental group had lower health care utilisation and a reduced risk of using large amounts of medication at the 3-year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain.

Place, publisher, year, edition, pages
Oxon, United Kingdom: Taylor & Francis, 2010
Keywords
Musculoskeletal pain, sick leave, multidisciplinary rehabilitation
National Category
General Practice
Research subject
Family Medicine; Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-10061 (URN)10.3109/09638280903095924 (DOI)000274263400006 ()20055569 (PubMedID)2-s2.0-75149145056 (Scopus ID)
Available from: 2010-03-18 Created: 2010-03-18 Last updated: 2018-09-06Bibliographically approved
4. Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain
Open this publication in new window or tab >>Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain
2011 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 27, no 7, p. 567-577Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups.

Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain.

Results: Five distinct profiles were found: “low scores cluster,” “high score cluster,” “fear-avoidance beliefs and catastrophizing cluster,” “distress only cluster,” and “medium catastrophizing cluster.” The “low scores cluster” and “distress only cluster” had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological “high risk cluster” and a “low risk cluster” showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points.

Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011
Keywords
musculoskeletal pain, fear-avoidance beliefs, catastrophizing, emotional distress, function, sick leave
National Category
General Practice Psychology
Research subject
Family Medicine; Rehabilitation Medicine; Psychology
Identifiers
urn:nbn:se:oru:diva-10064 (URN)10.1097/AJP.0b013e318219ab6c (DOI)000293730800002 ()21540739 (PubMedID)2-s2.0-80051798113 (Scopus ID)
Available from: 2010-03-18 Created: 2010-03-18 Last updated: 2018-05-02Bibliographically approved

Open Access in DiVA

fulltext(428 kB)483 downloads
File information
File name FULLTEXT01.pdfFile size 428 kBChecksum SHA-512
72dc70801aeb9b7f696052b721b353aff8a8766b68cedacfb259fc81921b7a4f343580427dea7a1c9b9f02b616cb83db2b8cbf79eb07020f5cb65a9b3b0219b9
Type fulltextMimetype application/pdf
fulltext(2016 kB)2497 downloads
File information
File name FULLTEXT02.pdfFile size 2016 kBChecksum SHA-512
da4005cf823e476d5bab84fb91b83cde50a095afc2057d4d8f60e873bb683be31de5a0148c99a1af029851653e71cbe3546b92596b618189f9d8686e06b49614
Type fulltextMimetype application/pdf
cover(1615 kB)139 downloads
File information
File name COVER01.pdfFile size 1615 kBChecksum SHA-512
07aa41fd1db5a73f3b4ff4d6e83898eac4ed2a1723182a0d5de7d5aa3b345a45d80609a311220c661320c0d894335eeef491475349146bacdaed2b9018dd05dc
Type coverMimetype application/pdf

Authority records BETA

Westman, Anders

Search in DiVA

By author/editor
Westman, Anders
By organisation
School of Health and Medical Sciences
General PracticeMedical and Health SciencesPublic Health, Global Health, Social Medicine and EpidemiologyPublic Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar
Total: 2980 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1728 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf