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  • Gerdle, BjörnLinköpings universitet,Linköping University,Avdelningen för samhällsmedicin,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum (author)

The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients

  • Article/chapterEnglish2019

Publisher, publication year, extent ...

  • 2019-05-31
  • Walter de Gruyter GmbH,2019
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:du-30129
  • https://urn.kb.se/resolve?urn=urn:nbn:se:du-30129URI
  • https://doi.org/10.1515/sjpain-2019-0016DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-77587URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-166510URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-396657URI
  • https://lup.lub.lu.se/record/29f0e9f6-8f39-4c6e-bdb1-9a068c573fb3URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:231150362URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-161625URI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Funding Agency:Swedish Research Council, County Council of Ostergotland (Research-ALF)
  • Funding Agencies|Swedish Research Council, County Council of Ostergotland (Research-ALF); AFA insurance
  • Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Åkerblom, SophiaLund University,Lunds universitet,Institutionen för psykologi,Samhällsvetenskapliga institutioner och centrumbildningar,Samhällsvetenskapliga fakulteten,Department of Psychology,Departments of Administrative, Economic and Social Sciences,Faculty of Social Sciences,Skåne University Hospital,Skane Univ Hosp, Sweden; Lund Univ, Sweden(Swepub:lu)psyc-sab (author)
  • Stålnacke, Britt-Marie,1955-Umeå University,Umeå universitet,Rehabiliteringsmedicin,Umea Univ, Rehabil Med, Dept Community Med & Rehabil, Umea, Sweden(Swepub:umu)brst0005 (author)
  • Brodda Jansen, GunillaDepartment of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden,Danderyd Hosp, Dept Clin Sci, Div Rehabil Med, Stockholm, Sweden (author)
  • Enthoven, PaulLinköpings universitet,Linköping University,Avdelningen för fysioterapi,Medicinska fakulteten(Swepub:liu)pauen91 (author)
  • Ernberg, MalinKarolinska Institutet,Karolinska Institute,Scandinavian Center for Orofacial Neuroscience,Karolinska Inst, Sweden; SCON, Sweden (author)
  • Dong, Huan-JiLinköpings universitet,Linköping University,Avdelningen för samhällsmedicin,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum(Swepub:liu)huado29 (author)
  • Äng, BjörnKarolinska Institutet,Karolinska Institute,Dalarna University College,Uppsala universitet,Högskolan Dalarna,Medicinsk vetenskap,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden; Center for Clinical Research Dalarna – Uppsala University, Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden,Centrum för klinisk forskning Dalarna,Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, S-23100 Huddinge, Sweden;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden,Karolinska Inst, Sweden; Uppsala Univ, Sweden; Dalarna Univ, Sweden(Swepub:du)bja (author)
  • Boersma, Katja,professor,1973-Örebro University,Örebro universitet,Institutionen för juridik, psykologi och socialt arbete,Orebro Univ, Sch Law Psychol & Social Work, Orebro, Sweden(Swepub:oru)kba (author)
  • Linköping UniversityAvdelningen för samhällsmedicin (creator_code:org_t)

Related titles

  • In:Scandinavian Journal of Pain: Walter de Gruyter GmbH19:4, s. 693-7111877-88601877-8879

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