Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres.
BACKGROUND
For patients with chronic pain, the heterogeneity of clinical presentations makes it difficult to identify patients who would benefit from multimodal rehabilitation programs (MMRP). Yet, there is limited knowledge regarding the predictors of MMRP's outcomes. This study identifies predictors of outcome of MMRPs at a 12-month follow-up (FU-12) based on data from the Swedish Quality Registry for Pain Rehabilitation (SQRP).


METHODS
Patients with chronic pain from two clinical departments in Sweden completed the SQRP questionnaires-background, pain characteristics, psychological symptoms, function, activity/participation, health and quality of life-on three occasions: 1) during their first visit; 2) immediately after the completion of their MMRP; and 3) 12 months after completing the MMRP (n = 227). During the FU-12, the patients also retrospectively reported their global impressions of any changes in their perception of pain and their ability to handle their life situation in general.


RESULTS
Significant improvements were found for pain, psychological symptoms, activity/participation, health, and quality of life aspects with low/medium strong effects. A general pattern was observed from the analyses of the changes from baseline to FU-12; the largest improvements in outcomes were significantly associated with poor situations according to their respective baseline scores. Although significant regressors of the investigated outcomes were found, the significant predictors were weak and explained a minor part of the variation in outcomes (15-25%). At the FU-12, 53.6% of the patients reported that their pain had decreased and 80.1% reported that their life situation in general had improved. These improvements were associated with high education, low pain intensity, high health level, and work importance (only pain perception). The explained variations were low (9-11%).


CONCLUSIONS
Representing patients in real-world clinical settings, this study confirmed systematic reviews that outcomes of MMRP are associated with broad positive effects. A mix of background and baseline variables influenced the outcomes investigated, but the explained variations in outcomes were low. There is still a need to develop standardized and relatively simple outcomes that can be used to evaluate MMRP in trials, in clinical evaluations at group level, and for individual patients.
['Gerdle|Björn|B|', 'Molander|Peter|P|', 'Stenberg|Gunilla|G|', 'Stålnacke|Britt-Marie|BM|', 'Enthoven|Paul|P|']
D000223:Adaptation, Psychological D000328:Adult D059350:Chronic Pain D002986:Clinical Trials as Topic D003131:Combined Modality Therapy D005081:Exercise Therapy D005260:Female D005500:Follow-Up Studies D006304:Health Status D006801:Humans D008297:Male D008875:Middle Aged D059408:Pain Management D010147:Pain Measurement D058748:Pain Perception D010549:Personal Satisfaction D011379:Prognosis D011788:Quality of Life D012042:Registries D012047:Rehabilitation Centers D012189:Retrospective Studies D011795:Surveys and Questionnaires D013548:Sweden D016896:Treatment Outcome
Outcome Multimodal Rehabilitation Pain Multidisciplinary