To Örebro University

Background: Pain catastrophizing and emotional distress can act as prognosticfactors for pain and disability. Research on how these variables interact withinindividuals and over time is in an early stage. Understanding various patterns ofprognostic factors and how these factors change during treatment is important fordeveloping treatments targeting important factors.

Objective: The primary aim of this study was to investigate relationships betweenpain catastrophizing and depressed mood in people seeking primary care for mus-culoskeletal pain. An additional aim was to relate these patterns of prognostic factorsto outcomes during a 6-month period.

Design: The design was prospective; data were obtained at baseline and atfollow-up.

Methods: Forty-two physical therapists taking part in an educational programrecruited, from their clinical practices in primary care, consecutive patients whowere currently experiencing a pain problem. Patients received various physicaltherapy interventions between baseline and follow-up.

Results: On the basis of patterns of scoring for pain catastrophizing and depressedmood, 4 subgroups of participants were found. Belonging to a subgroup withelevated levels of either pain catastrophizing or depressed mood at baseline wasrelated to the absence of improvement and elevated levels of disability after physicaltherapy interventions. Furthermore, elevated levels of both variables were related tothe highest levels of disability.

Limitations: The analyses relied on self-report. Neither treatment content norpain-related fear was measured. The sample was a mixture of participants reportingacute pain and subacute pain.

Conclusions: The results stress the importance of assessing and targeting prog-nostic factors. Moreover, the results suggest the need to tailor treatments to matchpatterns of prognostic factors and the need to target depressed mood and paincatastrophizing in physical therapy interventions.

Purpose: This randomized controlled trial had two main aims. The first aim was to investigate the effect of early preventive, psychologically informed, interventions for pain-related disability. The second aim was explore whether people who are matched to an intervention specifically targeting their psychological risk profile had better outcomes than people who were not matched to interventions.

Methods: A total of 105 participants were recruited from their workplace, screened for psychological risk factors and classified as being at risk for long-term pain-related disability. They were subgrouped into one of three groups based on their psychological profile. Three behaviorally oriented psychological interventions were developed to target each of the three risk profiles. Half of the participants were assigned a matched intervention developed to target their specific profile, and half were assigned an unmatched intervention. After treatment, repeated measure ANOVAs and χ² tests were used to determine if treatments had an effect on primary and secondary outcomes including perceived disability, sick leave, fear and avoidance, pain catastrophizing and distress, and if matched participants had better outcomes than did unmatched.

Results: Treatments had effects on all outcome variables (effect sizes d ranging between 0.23 and 0.66), but matched participants did not have better outcomes than unmatched.

Conclusions: Early, preventive interventions have an impact on a number of outcome variables but it is difficult to realize a matching procedure. More in-depth research of the process of matching is needed.

Purpose A previous study [1] showed that matching people at risk for pain-related disability to an intervention aimed at targeting their psychological problem profile did not, as hypothesized, improve the effect of the intervention. Methodological issues were suggested to explain the lack of differential effect. It was questioned whether the profiles used to allocate people to treatment were adequate. The aim of this study was to investigate if the risk profiles used to determine matching were sufficiently stable and valid by comparing the original profiles withprofiles constructed using other methods.

Methods Ninety-five people suffering musculoskeletal problems were screened, profiled, and matched to workplace based early interventions according to profiles. We studied stability and validity of their psychological risk profiles by investigating their concordance at different time points. People were originally assigned to profiles at inclusion, using a brief screening questionnaire. Then, they were profiled just before treatment start,using the same items. Finally, they were profiled again at treatment start, using extensive questionnaires. Concordance among the three sets of profiles was investigated.

Results Profiles at inclusion were unstable until treatment start. People moved from profiles with more severe elevations in psychological variables, to a profile with moderate elevations. Concordance between the two means of profiling at treatment start was better; the brief screening and the extensive questionnaires assigned people to similar profiles.

Conclusions Risk level may be determined with brief instruments at an early stage of problem development. However, profiles and targets for interventions should be determined immediately prior to treatment start, preferably using full questionnaires.

We know little about why some people get better after psychological treatments for pain disability, whereas other people do not. In order to understand differences in treatment response, we need to explore processes of change during treatment. It has been suggested that people with pain complaints who change early in treatment have better outcomes. Therefore, we aimed to investigate whether changes in psychological variables at different time points are related to outcome, and whether early or late changes are better predictors of outcome. We used the fear avoidance model as a theoretical framework. We followed 64 patients weekly over 6–7 weeks and then determined outcome. Our findings indicate that people who decrease in catastrophizing and function early in treatment as well as in depressive symptoms, worry, fear avoidance beliefs and function late in treatment have better outcomes. Early decreases in function, and late decreases in depressive symptoms and worry uniquely predict improvements in disability. While early and late changes covaried concurrently, there were no significant sequential relationships between early and late changes. Changes in the proposed process variables in the fear avoidance model, early as well as late in treatment, thus add valuable information to the explanation of outcome.