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Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up
Örebro University, Department of Clinical Medicine. (Centre for Health and Medical Psychology (CHAMP), Örebro, Centre for Clinical Research, Västerås)
Örebro University, Department of Behavioural, Social and Legal Sciences. (Centre for Health and Medical Psychology (CHAMP), Örebro)ORCID iD: 0000-0001-5359-0452
Stressforskninginsinstitutet, Stockholms universitet.
Inst för medicin, Enh för kardiologi, Karolinska institutet, Stockholm.
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2006 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 7, 437-446 p.Article 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. Vol. 28, no 7, 437-446 p.
Keyword [en]
musculoskeletal pain, comprehensive treatment, return to work, quality of life, rehabilitation, sick leave
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:oru:diva-10031DOI: 10.1080/09638280500192694OAI: oai:DiVA.org:oru-10031DiVA: diva2:304415
Available from: 2010-03-18 Created: 2010-03-17 Last updated: 2015-03-10Bibliographically approved
In thesis
1. Musculoskeletal pain in primary health care: a biopsychosocial perspective for assessment and  treatment
Open this publication in new window or tab >>Musculoskeletal pain in primary health care: a biopsychosocial perspective for assessment and  treatment
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. 82 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 40
Keyword
musculoskeletal pain, biopsychosocial, multimodal, fear-avoidance, catastrophizing, distress, sick leave, function
National Category
Family Medicine 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:nbn:se:oru:diva-10084 (URN)978-91-7668-716-1 (ISBN)
Public defence
2010-04-23, Aulan, ingång 21, 721 89, Centrallasarettet, Västerås, 13:15 (Swedish)
Opponent
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Available from: 2010-03-19 Created: 2010-03-18 Last updated: 2011-04-26Bibliographically approved

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