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- Bergström, Gunnar
(författare)
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The assessment and treatment of long-term, non-specific spinal pain : behavioural medicine, a cognitive-behavioural perspective
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Matching treatment specifically to the needs of long-term, non-specific spinal pain (LTSP) patients might greatly enhance treatment efficacy, but the heterogeneity of patients has hindered this development. There is a wide array of treatments for LTSP. The scientific support for many treatments is, however, limited. Aims: The aims of this thesis were to: (a) evaluate a method for the assessment of psychosocial and behavioural factors in patients suffering from LTSP (studies I and II), (b) to evaluate whether reliable and valid patient groups could be identified among these patients (study III), (c) to evaluate the predictive validity of these subgroups regarding the outcome of a vocational rehabilitation programme (study IV) and, (b) to evaluate a behavioural medicine rehabilitation (BM) programme as a whole and divided into its two main components, behaviour-oriented physical therapy (PT) and cognitive behavioural therapy (CBT) (study V). Materials and Methods: Three samples of patients (sample 1, n = 682; sample 2, n = 235; sample 3, n = 273) suffering from LTSP were used. The Multidimensional Pain Inventory (MPI) was translated into Swedish (MPI-S) and used as a measure of psychosocial and behavioural factors in the patients' adjustment to pain. In the component analysis, patients were randomised to one of four alternatives (BM, PT, C13T or a "treatment-as-usual" control group (CG)). Results: The analyses showed that the factor structure, reliability, generalisability and construct validity of sections I and 2 of the MPI-S were acceptable between genders. However, section 3 was excluded from the MPI-S due to its weak validity. Subsequently, the MPI-S was used to identify three reliable and valid subgroups of patients across two of the patient samples. These subgroups were similar to the "dysfunctional" (DYS), "interpersonally distressed" (ID) and "adaptive coper" (AC) patient types described in earlier research. The MPI-S subgroup classification was shown to be predictive of total absence from work (sick-listing plus early retirement), utilisation of health care, and health-related quality of life over the 18-month follow-up period. However, subgroup affiliation was not predictive of the percentage of improved patients in the three patient groups. It was found in the component analysis that the active treatment conditions were superior to the CG condition in one or two of the three primary endpoints at the 18-month follow-up and that the positive effects were restricted to women. The results did not support the superiority of the complete BM programme over its main components, PT and C13T. Females in the CBT and PT groups had a significantly lower risk of being granted full-time early retirement and females in the CBT and BM groups reported a significantly better health-related quality of life over the 18-month follow-up period, than females in the CG. A non-significant positive trend towards both decreased total absence from work and improved health-related quality of life was demonstrated among males in the BM and PT conditions compared to the CG. Conclusions: The MPI-S (sections 1 and 2) is a reliable and valid instrument in the assessment of psychosocial and behavioural factors in LTSP patients and can be used as a tool to derive subgroups of patients which has been shown to be predictive of treatment outcome. For female LTSP patients, CBT was shown to decrease the risk of full-time early retirement and for improving the health-related quality of life. For male LTSP patients, the results indicated that BM or PT might be used as treatments for decreasing the total absence from work and improving the health-related quality of life. Further research is needed, however, regarding effective treatments for males.
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| 2. |
- Jensen, Irene B., et al.
(författare)
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Assessing the Needs of Patients in Pain: A Matter of Opinion?
- 2000
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Ingår i: Spine. - : LWW. - 0362-2436 .- 1528-1159. ; 25:21, s. 2816-2823
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A prospective cohort study including patients with nonspecific spinal pain was performed.Objectives. To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment.Summary of Background Data. A wide range of instruments and techniques are used to assess and treat patients with spinal pain. Many instruments are used without being clinimetrically tested.Methods. A questionnaire concerning the patients’ need of treatment and their potential to assimilate it was sent to experts in the health care arena: physicians, physical therapists, social insurance officers. The experts included were those connected with patients participating in a larger outcome study. Two cohorts of patients (sample 1, n = 217; sample 2, n = 257) were followed for 6 and 12 months, during which time the patients’ health and work status were mapped.Results. No acceptable agreement was found between any of the experts’ ratings of patients’ needs and potential for rehabilitation. Logistic regression showed that the experts’ judgments were based almost solely on the age of the patient. The prediction analyses showed that the most consistent predictor of the patients’ status at the 6-month follow-up assessment was the patients’ own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition.Conclusions. Expert judgment as exercised in routine practice cannot be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient’s ability to benefit from treatment.
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