Content » Vol 52, Issue 2

Original report

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

Elisabeth Pietilä-Holmner, Paul Enthoven, Björn Gerdle, Peter Molander, Britt-Marie Stålnacke
Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden. E-mail: elisabeth.pietila.holmner@umu.se
DOI: 10.2340/16501977-2649

Abstract

Objectives: To investigate the outcomes one year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after one year.
Methods: A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18–65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and one year after multimodal rehabilitation programmes.
Results: Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, 95% confidence interval (CI) 1.21–1.06, p = 0.005).
Conclusion: This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.

Lay Abstract

For patients with chronic pain, studies have shown that multimodal rehabilitation programmes at specialist care level have positive effects. Since there is limited knowledge about the long-term effects of multimodal rehabilitation programmes in a primary care setting this study investigated the effects of multimodal rehabilitation programmes in 234 patients with chronic pain, 34 men and 200 women, age range 18–65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. At 1-year follow-up patients reported small improvements in pain, physical and emotional functioning, coping, and health-related quality of life. The proportion of patients on sick leave decreased, while there was no difference regarding the proportion of patients on sickness compensation/disability pension. This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain.

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