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- Grooten, Wilhelmus Johannes Andreas, et al.
(författare)
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Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS-aspects of interrater agreement
- 2019
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Ingår i: Diagnostic and Prognostic Research. - : Springer Science and Business Media LLC. - 2397-7523. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many studies have been performed to identify important prognostic factors for outcomes after rehabilitation of patients with chronic pain, and there is a need to synthesize them through systematic review. In this process, it is important to assess the study quality and risk of bias. The "Quality In Prognosis Studies" (QUIPS) tool has been developed for this purpose and consists of several prompting items categorized into six domains, and each domain is judged on a three-grade scale (low, moderate or high risk of bias). The aim of the present study was to determine the interrater agreement of the risk of bias assessment in prognostic studies of patients with chronic pain using QUIPS and to elaborate on the use of this instrument.Methods: We performed a systematic review and a meta-analysis of prognostic factors for long-term outcomes after multidisciplinary rehabilitation in patients with chronic pain. Two researchers rated the risk of bias in 43 published papers in two rounds (15 and 28 papers, respectively). The interrater agreement and Cohen's quadratic weighted kappa coefficient (κ) and 95% confidence interval (95%CI) were calculated in all domains and separately for the first and second rounds.Results: The raters agreed in 61% of the domains (157 out of 258), with similar interrater agreement in the first (59%, 53/90) and second rounds (62%, 104/168). The overall weighted kappa coefficient (kappa for all domains and all papers) was weak: κ = 0.475 (95%CI = 0.358-0.601). A "minimal agreement" between the raters was found in the first round, κ = 0.323 (95%CI = 0.129-0.517), but increased to "weak agreement" in the second round, κ = 0.536 (95%CI = 0.390-0.682).Conclusion: Despite a relatively low interrater agreement, QUIPS proved to be a useful tool in assessing the risk of bias when performing a meta-analysis of prognostic studies in pain rehabilitation, since it demands of raters to discuss and investigate important aspects of study quality. Some items were particularly hard to differentiate in-between, and a learning phase was required to increase the interrater agreement. This paper highlights several aspects of the tool that should be kept in mind when rating the risk of bias in prognostic studies, and provides some suggestions on common pitfalls to avoid during this process.Trial registration: PROSPERO CRD42016025339; registered 05 February 2016.
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| 2. |
- Tseli, Elena
(författare)
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Interdisciplinary rehabilitation in patients with chronic pain : prognostic factors and effectiveness
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Interdisciplinary multimodal pain rehabilitation (IMPR) is currently considered best practice for combatting chronic pain. However, it is believed that health-related outcomes could be improved with more adequately tailored treatment programs, but consensus of what grounds these adaptations should be based on is yet to be reached. Well-powered evaluations of naturalistic, real-world practices provide an evidence base for the evaluation of important characteristics that may facilitate the informed development of IMPR. The aim of the present work was to meta-synthesize existing evidence and add new data to the body of published evidence on prognostic factors for a positive outcome in patients receiving rehabilitation for chronic pain. An additional aim was to evaluate the effectiveness of different IMPR program durations on health-related quality of life in this major patient group. Methods: Published international evidence of prognostic factors for physical functioning after IMPR was evaluated through a systematic review and meta-analyses (Study I), followed by the investigation of the inter-rater reliability of the Quality in Prognostic Studies tool (QUIPS), used in the Risk of Bias assessment (Study II). Prognostic factors (Study III) and effectiveness (Study IV) of Swedish pain specialist IMPR on physical and mental functioning and related measures of disease impact were investigated using large-scale nationwide data obtained from the Swedish Quality Registry for Pain Rehabilitation. Results: Meta analyses showed, with moderate to low levels of evidence, that better physical functioning at follow-up was predicted by high levels of self-reported functioning, low levels of emotional distress and cognitive-behavioral risk factors, and high levels of cognitive-behavioral protective factors. Pain-related factors (intensity and chronicity) were not associated. Weak to moderate inter-rater agreement emerged for QUIPS, and suggestions for improving the inter-rater agreement and functionality were presented. Swedish registry data showed the most important prognostic factors were retaining a connection with work, having high optimistic treatment expectations, sense of control, and less interference from pain. Pain itself was of secondary significance. Also for improvement of physical functioning, better initial mental wellbeing was of importance, while for mental functioning the opposite emerged. Results on within-group effectiveness showed improvements on all outcomes, while no between-group comparison emerged on short (4-9 wks) vs. moderate (10 wks) vs. long (11-18 wks) IMPR program duration. In summary, evidence for prognostic factors was identified, providing suggestions for the targeting of modifiable factors in clinics and in future clinical trials. Clearly, the quality assessment of published results needs systematic consensus work between assessors. Work connection, treatment expectations, levels of physical and emotional health, and coping strategies played an important prognostic role but were not consistent for physical and emotional functioning, suggesting a complex prognostic picture for the overall understanding of improvement. Finally, IMPR is effective across a biopsychosocial specter, but treatment duration seems not to play an important role.
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| 5. |
- Tseli, Elena, et al.
(författare)
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Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain : A Systematic Review and Meta-Analysis
- 2019
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:2, s. 148-173
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
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