amelioration of those issues which are mediated by psychological and
social factors may reduce symptoms.
PM R. 2012 Feb 17. [Epub ahead of print]
Positive Effects of a Musculoskeletal Pain Rehabilitation Program
Regardless of Pain Duration or Diagnosis.
Persson E, Lexell J, Eklund M, Rivano-Fischer M.
Department of Health Sciences, Lund University; and Department of
Rehabilitation Medicine, Skane University Hospital, SE-221 85 Lund,
Sweden.
Abstract
OBJECTIVES:
To investigate how sociodemographic and clinical factors are
associated with psychosocial functioning and disability at admission
to a musculoskeletal pain rehabilitation program and at 1-year
follow-up.
DESIGN:
A cohort pre-post study.
SETTING:
A University hospital specialized pain rehabilitation unit.
PARTICIPANTS:
Five hundred nine participants with musculoskeletal pain (neck
disorders, 29%; fibromyalgia, 24%; low back pain, 24%; myalgia, 14%;
and other pain diagnoses, 8%).
INTERVENTION:
A 5-week outpatient, group-based, and goal-oriented comprehensive
musculoskeletal interdisciplinary pain rehabilitation program based on
cognitive behavioral principles.
MAIN OUTCOME MEASURES:
The Multidimensional Pain Inventory (MPI), the Disability Rating Index
(DRI), and forms including sociodemographic factors (sex, age,
ethnicity, marital status, educational level, and vocational
situation) and clinical factors (pain duration and pain diagnoses).
Data were analyzed with multivariate logistic regression.
RESULTS:
At admission, factors associated with more positive scores on the MPI
were being older than 40 years, being at work, being Nordic born,
attainment of a higher educational level, and a diagnosis of
fibromyalgia (compared with a neck disorder) (P < .05). Being at work
and a diagnosis of fibromyalgia (compared with low back pain) were
associated with more positive scores on the DRI (P < .05).
On the basis of cut points for clinically important change on the MPI,
participants rated themselves as most improved on the Affective
Distress (52%), Life Control (49%), and Pain Severity (43%) subscales,
and on the DRI index, the improvement rate was 22%.
At the 1-year follow-up, neither sociodemographic nor clinical factors
were associated with clinically important improvements of the MPI and
the DRI, but younger age was related to deteriorations in pain
severity.
CONCLUSIONS:
The lack of an association between sociodemographic and clinical
factors and psychosocial functioning and disability at a 1-year
follow-up after a musculoskeletal pain rehabilitation program suggests
that the program was effective regardless of the participants' initial
characteristics, except for age.
The changes at the 1-year follow-up indicate that the program
influenced the participants' psychosocial functioning more than their
perception of disability.
Copyright =C2=A9 2012 American Academy of Physical Medicine and
Rehabilitation. Published by Elsevier Inc. All rights reserved.
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