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Ghafouri N, Bäckryd E, Dragioti E, Rivano Fischer M, Ringqvist Å, Gerdle B. Effects of interdisciplinary pain rehabilitation programs on neuropathic and non-neuropathic chronic pain conditions - a registry-based cohort study from Swedish Quality Registry for Pain Rehabilitation (SQRP). BMC Musculoskelet Disord 2023; 24:357. [PMID: 37149571 PMCID: PMC10163768 DOI: 10.1186/s12891-023-06462-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND AND AIM Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. Pharmacological treatments for neuropathic pain often fail despite following guidelines. Interdisciplinary Pain Rehabilitation Programs (IPRP) are an effective intervention for chronic pain conditions. Little research has investigated whether IPRP can benefit patients with chronic neuropathic pain compared to other chronic pain conditions. This study assesses the real-world effects of IPRP on patients with chronic neuropathic pain compared to non-neuropathic patients using Patient-Reported Outcome Measures (PROMs) available in the Swedish Quality Registry for Pain Rehabilitation (SQRP). METHODS A neuropathic group of patients (n = 1,654) were identified in two steps. This group was compared to a non-neuropathic group (n = 14,355) composed of common diagnoses (low back pain, fibromyalgia, whiplash associated disorders, and Ehlers-Danlos Syndrome) in relation to background variables, three overall outcome variables, and mandatory outcome variables (pain intensity, psychological distress symptoms, activity/participation aspects and health-related quality of life variables). Of these patients 43-44% participated in IPRP. RESULTS At assessment, the neuropathic group reported significantly (with small effect sizes (ES)) more physician visits the previous year, older age, shorter pain durations, and less spatial extent of the pain (moderate ES). Moreover, for the 22 mandatory outcome variables, we found only clinically insignificant differences according to ESs between the groups. For patients participating in IPRP, the neuropathic group displayed equal or in some cases slightly superior results compared to the non-neuropathic group. DISCUSSION AND CONCLUSION After assessing the real-world effects of IPRP, this large study found that neuropathic pain patients can benefit from the IPRP intervention. Both registry studies and RCTs are needed to better understand which patients with neuropathic pain are most suitable for IPRP and to what extent special considerations need to be made for these patients within the framework of IPRP.
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Affiliation(s)
- Nazdar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
| | - Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, 221 85, Lund, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, 221 85, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden.
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Yu JK, Wong WWL, Keepanasseril A, Iorio A, Edginton AN. Cost-utility analysis of emicizumab for the treatment of severe hemophilia A patients in Canada. Haemophilia 2023; 29:488-497. [PMID: 36528890 DOI: 10.1111/hae.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION EHL FVIII products and emicizumab provide clinicians with other prophylactic options for treating hemophilia A, however, it is unclear if emicizumab is a cost-saving option. The objective of this study is to estimate the health and economic effects of using prophylactic EHL FVIII, SHL FVIII, and emicizumab in severe haemophilia A patients. MATERIALS AND METHODS A state-transition Markov model evaluated the cost-effectiveness of prophylactic SHL FVIII, EHL FVIII, and emicizumab in a cohort of 2-year-old male patients over a lifetime horizon in the form of a cost-utility analysis using a Canadian provincial ministry of health payer perspective. The transition probabilities, costs, and utilities were obtained from literature and the Canadian Bleeding Disorders Registry. Probabilistic sensitivity and scenario analyses were performed to test the robustness of the model. RESULTS The base-case analysis, over a lifetime horizon, resulted in a total cost and utilities per person for SHL FVIII, EHL FVIII, and emicizumab of $27.2 million (M), $36.7 M, and $26.2 M, respectively, and 31.30, 31.16, and 31.61 quality-adjusted life years, respectively. Emicizumab treatment resulted in 29 and 16 less bleeds in a lifetime compared to SHL FVIII and EHL FVIII, respectively. Probabilistic sensitivity analysis showed that emicizumab was cost-saving 100% of the time compared to SHL FVIII and EHL FVIII. CONCLUSION The cost-utility analysis showed that emicizumab is more effective and may be less costly than FVIII for Canadian haemophilia A patients, conditional on drug cost assumptions. Our model indicates that emicizumab may be a potentially favourable treatment option for minimising healthcare costs and providing higher effectiveness.
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Affiliation(s)
- Jacky K Yu
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Arun Keepanasseril
- Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada.,McMaster-Bayer Endowed Research Chair for Clinical Epidemiology of Congenital Bleeding Disorders, Department of Medicine, McMaster University, Ontario, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Bergerot C, Young Rha S, Pal S, Koralewski P, Stroyakovskiy D, Alekseev B, Parnis F, Castellano D, Lyun Lee J, Sunela K, Ciuleanu T, Heng D, Glen H, Wang J, Bennett L, Pan J, O’Hara K, Puente J. Health-Related Quality of Life Outcomes With Two Different Starting Doses of Lenvatinib in Combination With Everolimus for Previously Treated Renal Cell Carcinoma. Oncologist 2023; 28:59-71. [PMID: 35881028 PMCID: PMC9847563 DOI: 10.1093/oncolo/oyac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preserving health-related quality of life (HRQOL) is an important goal during renal cell carcinoma treatment. We report HRQOL outcomes from a phase II trial (NCT03173560). PATIENTS AND METHODS HRQOL data were collected during a multicenter, randomized, open-label phase II study comparing the safety and efficacy of 2 different starting doses of lenvatinib (18 mg vs. 14 mg daily) in combination with everolimus (5 mg daily), following one prior vascular endothelial growth factor-targeted treatment. HRQOL was measured using 3 different instruments-FKSI-DRS, EORTC QLQ-C30, and EQ-5D-3L-which were all secondary endpoints. Change from baseline was assessed using linear mixed-effects models. Deterioration events for time to deterioration (TTD) analyses were defined using established thresholds for minimally important differences in the change from baseline for each scale. TTD for each treatment arm was estimated using the Kaplan-Meier method. RESULTS Baseline characteristics of the 343 participants randomly assigned to 18 mg lenvatinib (n = 171) and 14 mg lenvatinib (n = 172) were well balanced. Least-squares mean estimates for change from baseline were favorable for the 18 mg group over the 14 mg group for the FKSI-DRS and most EORTC QLQ-C30 scales, but differences between treatments did not exceed the minimally important thresholds. Median TTD was longer among participants in the 18 mg group than those in the 14 mg group for most scales. CONCLUSIONS Participants who received an 18 mg lenvatinib starting dose had favorable HRQOL scores and longer TTD on most scales compared with those who received a 14 mg starting dose.
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Affiliation(s)
- Cristiane Bergerot
- Corresponding author: Cristiane Bergerot, Instituto Unity de Ensino e Pesquisa, Centro de Câncer de Brasília.
| | - Sun Young Rha
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Sumanta Pal
- Department of Medical Oncology & Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Daniil Stroyakovskiy
- Moscow City Oncology Hospital #62 of Moscow Healthcare Department, Moscow, Russia
| | - Boris Alekseev
- P.A. Hertzen Moscow Oncological Research Institute, Moscow, Russia
| | - Francis Parnis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Jae Lyun Lee
- Asan Medical Center, Seoul, Republic of Korea,University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kaisa Sunela
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tudor Ciuleanu
- Prof Dr Ion Chiricuta Cancer Institute and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Heng
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - Hilary Glen
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jinyi Wang
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Lee Bennett
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Åström M, Rolfson O, Burström K. Exploring EQ-5D-Y-3L Experience-Based VAS Values Derived Among Adolescents. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:383-393. [PMID: 35083734 PMCID: PMC9021108 DOI: 10.1007/s40258-021-00713-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The EQ-5D-Y-3L is a generic health-related quality of life (HRQoL) instrument, developed from the adult version to be suitable for children and adolescents aged 8-15 years. To derive values for the EQ-5D-Y-3L different valuation methods and perspectives have been applied. The aim of this study was to explore EQ-5D-Y-3L experience-based visual analogue scale (VAS) values derived among adolescents. METHODS Data were derived from a cross-sectional population survey administered via schools in 2014 to adolescents aged 13-18 years, in Sweden. Regression analyses were performed on individual data with the VAS value as dependent variable. Ordinary least-squares (OLS) and generalised linear models (GLM) were estimated with two dummy variables for each of the EQ-5D-Y-3L dimensions. Interaction variables were tested. One way of anchoring VAS at dead and full health by using the predicted values for worst and best health states defined by the EQ-5D-Y-3L descriptive system was explored. RESULTS Of the 243 possible health states in EQ-5D-Y-3L, 92 were reported by the 6,468 respondents. The largest decrements in VAS values were observed for the dimension 'feeling worried, sad or unhappy' followed by 'doing usual activities'. All models performed similarly in terms of monotonicity and goodness of fit but in terms of simplicity and understandability, the OLS main effect model was superior. CONCLUSIONS We have explored experience-based VAS values for the EQ-5D-Y-3L derived among adolescents. The findings suggest that it is possible for adolescents to value their own health state using the VAS, which makes it possible to capture aspects that are important for young people.
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Affiliation(s)
- Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden.
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Schneider P. The QALY is ableist: on the unethical implications of health states worse than dead. Qual Life Res 2022; 31:1545-1552. [PMID: 34882282 PMCID: PMC9023412 DOI: 10.1007/s11136-021-03052-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A long-standing criticism of the QALY has been that it would discriminate against people in poor health: extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of 'more healthy' individuals. Proponents of the QALY counter that this only reflects the general public's preferences and constitutes an efficient allocation of resources. A pivotal issue that has thus far been overlooked is that there can also be negative QALYs. METHODS AND RESULTS Negative QALYs are assigned to the times spent in any health state that is considered to be worse than dead. In a health economic evaluation, extending the lives of people who live in such states reduces the overall population health; it counts as a loss. The problem with this assessment is that the QALY is not based on the perspectives of individual patients-who usually consider their lives to be well worth living-but it reflects the preferences of the general public. While it may be generally legitimate to use those preferences to inform decisions about the allocation of health care resources, when it comes to states worse than dead, the implications are deeply problematic. In this paper, I discuss the (un)ethical aspects of states worse than dead and demonstrate how their use in economic evaluation leads to a systematic underestimation of the value of life-extending treatments. CONCLUSION States worse than dead should thus no longer be used, and a non-negative value should be placed on all human lives.
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Affiliation(s)
- Paul Schneider
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
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6
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Meili KW, Månsdotter A, Sundberg LR, Hjelte J, Lindholm L. An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire. PLoS One 2022; 17:e0263231. [PMID: 35134053 PMCID: PMC8824323 DOI: 10.1371/journal.pone.0263231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. Material and methods For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. Results The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. Conclusion We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.
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Affiliation(s)
- Kaspar Walter Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | - Anna Månsdotter
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Living Conditions and Lifestyles, Public Health Agency Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Jan Hjelte
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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7
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Spencer A, Rivero-Arias O, Wong R, Tsuchiya A, Bleichrodt H, Edward R, Norman R, Lloyd A, Clarke P. The QALY at 50: One story many voices. Soc Sci Med 2021; 296:114653. [DOI: 10.1016/j.socscimed.2021.114653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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Peterson A, Aas S, Wasserman D. What Justifies the Allocation of Health Care Resources to Patients with Disorders of Consciousness? AJOB Neurosci 2021; 12:127-139. [PMID: 33787458 DOI: 10.1080/21507740.2021.1896594] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness.
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Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University
| | - Sean Aas
- Kennedy Institute of Ethics, Georgetown University
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9
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Gerdle B, Cervin M, Rivano Fischer M, Ringqvist Å. Outcomes of Interdisciplinary Pain Rehabilitation Across Subgroups of the Multidimensional Pain Inventory - A Study From the Swedish Quality Registry for Pain Rehabilitation. Pain Pract 2021; 21:662-679. [PMID: 33759355 DOI: 10.1111/papr.13007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: adaptive coper (AC), dysfunctional (DYS), and interpersonally distressed (ID). The primary aim of this study was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups. METHODS Patients with chronic pain (N = 34,513), included in the Swedish Quality Registry for Pain Rehabilitation, were classified into MPI subgroups and a subset that participated in IMMRPs (N = 13,419) was used to examine overall treatment outcomes using a previously established Multivariate Improvement Score (MIS) and 2 retrospective patient-evaluated benefits from treatment. RESULTS The subgroups differed on sociodemographic characteristics, pain duration, and spatial spreading of pain. DYS and ID had the best overall outcomes to MIS. AC had the best outcomes according to the 2 retrospective items. Transition into other subgroups following IMMRP was common and most prominent in DYS and least prominent in AC. CONCLUSION The validity of the MPI subgroups was partially confirmed. DYS and ID had the most severe clinical presentations at baseline and showed most improvement following IMMRP, but overall severity in DYS and ID at post-treatment was still higher than in the AC group. Future studies should examine how processes captured by MPI interact with neurobiological, medical, sociodemographic, and adaptation/coping factors and how these interactions impact severity of chronic pain and treatment outcome.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Matti Cervin
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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10
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Clement ND, Scott CEH, Murray JRD, Howie CR, Deehan DJ. The number of patients "worse than death" while waiting for a hip or knee arthroplasty has nearly doubled during the COVID-19 pandemic. Bone Joint J 2021; 103-B:672-680. [PMID: 33752468 DOI: 10.1302/0301-620x.103b.bjj-2021-0104.r1] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. METHODS During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state "worse than death" (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group. RESULTS The 2020 group had a significantly worse EQ-5D score compared to the control group for both THA (p < 0.001) and KA (p < 0.001). Over one-third (35.0%, n = 138/394) of patients waiting for a THA and nearly a quarter (22.3%, n = 100/449) for KA were in a health state WTD, which was significantly greater than the control group (odds ratio 2.30 (95% confidence interval (CI) 1.83 to 2.93) and 2.08 (95% CI 1.61 to 2.70), respectively; p < 0.001). Over 80% (n = 680/843) of the 2020 group felt that their quality of life had deteriorated while waiting. Each additional month spent on the waiting list was independently associated with a decrease in quality of life (EQ-5D: -0.0135, p = 0.004). There were 117 (13.9%) patients who wished to defer their surgery and the main reason for this was health concerns for themselves and or their family (99.1%, n = 116/117). CONCLUSION Over one-third of patients waiting for THA and nearly one-quarter waiting for a KA were in a state WTD, which was approaching double that observed prior to the pandemic. Increasing length of time on the waiting list was associated with decreasing quality of life. Level of evidence: Level III retrospective case control study Cite this article: Bone Joint J 2021;103-B(4):672-680.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - James R D Murray
- Avon Orthopaedic Centre, Southmead Hospital & University of Bristol, Bristol, UK
| | - Colin R Howie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - David J Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle, UK
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11
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Gerdle B, Rivano Fischer M, Cervin M, Ringqvist Å. Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Pain Res 2021; 14:173-187. [PMID: 33542650 PMCID: PMC7850976 DOI: 10.2147/jpr.s288638] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined. Methods Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1–6 regions with pain (20.6% of patients), 7–12 regions (26.8%), 13–18 regions (22.0%) and 19–36 regions (30.6%). Results More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both posttreatment and at a 12-month follow-up, but effect sizes were small. Discussion Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-58185, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund SE-22185, Sweden.,Research Group Rehabilitation Medicine,Dept of Health Sciences, Lund University, Lund, Sweden
| | - Matti Cervin
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund SE-22100, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund SE-22185, Sweden
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12
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Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med 2020; 9:jcm9082374. [PMID: 32722367 PMCID: PMC7466148 DOI: 10.3390/jcm9082374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022] Open
Abstract
This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.
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Abstract
AIMS The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state 'worse than death' (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identify associations with this state. Secondary aims were to examine the effect of WTD status on one-year outcomes. PATIENTS AND METHODS A cross-sectional analysis of 2073 patients undergoing 2073 THAs (mean age 67.4 years (sd 11.6; 14 to 95); mean body mass index (BMI) 28.5 kg/m2 (sd 5.7; 15 to 72); 1253 female (60%)) and 2168 patients undergoing 2168 TKAs (mean age 69.3 years (sd 9.6; 22 to 91); BMI 30.8 kg/m2 (sd 5.8; 13 to 57); 1244 female (57%)) were recorded. Univariate analysis was used to identify variables associated with an EQ-5D score < 0: age, BMI, sex, deprivation quintile, comorbidities, and joint-specific function measured using the Oxford Hip Score (OHS) or Oxford Knee Score (OKS). Multivariate logistic regression was performed. EQ-5D and OHS/OKS were repeated one year following surgery in 1555 THAs and 1700 TKAs. RESULTS Preoperatively, 391 THA patients (19%) and 263 TKA patients (12%) were WTD. Multivariate analysis identified preoperative OHS, deprivation, and chronic obstructive pulmonary disease in THA, and OKS, peripheral arterial disease, and inflammatory arthropathy in TKA as independently associated with WTD status (p < 0.05). One year following arthroplasty EQ-5D scores improved significantly (p < 0.001) and WTD rates reduced to 35 (2%) following THA and 53 (3%) following TKA. Patients who were WTD preoperatively achieved significantly (p < 0.001) worse joint-specific Oxford scores and satisfaction rates one year following joint arthroplasty, compared with those not WTD preoperatively. CONCLUSION In total, 19% of patients awaiting THA and 12% awaiting TKA for degenerative joint disease are in a health state WTD. Although specific comorbidities contribute to this, hip- or knee-specific function, mainly pain, appear key determinants and can be reliably reversed with an arthroplasty. Cite this article: Bone Joint J 2019;101-B:941-950.
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Affiliation(s)
- C E H Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D J MacDonald
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - C R Howie
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Ringqvist Å, Dragioti E, Björk M, Larsson B, Gerdle B. Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation-A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med 2019; 8:jcm8060905. [PMID: 31238588 PMCID: PMC6617026 DOI: 10.3390/jcm8060905] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022] Open
Abstract
Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported presentation pre-IMMRP predicts the multivariate outcome. To this end, this study analysed chronic pain patients in specialist care included in the Swedish Quality Registry for Pain Rehabilitation for 22 outcomes (pain, psychological distress, participation, and health) on three occasions: pre-IMMRP, post-IMMRP, and 12-month follow-up. Moderate stable ES were demonstrated for pain intensity, interference in daily life, vitality, and health; most other outcomes showed small ES. Using a Multivariate Improvement Score (MIS), we identified three clusters. Cluster 1 had marked positive MIS and was associated with the overall worst situation pre-IMMRP. However, the pre-IMMRP situation could only predict 8% of the variation in MIS. Specialist care IMPRPs showed moderate ES for pain, interference, vitality, and health. Outcomes were best for patients with the worst clinical presentation pre-IMMRP. It was not possible to predict who would clinically benefit most from IMMRP.
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Affiliation(s)
- Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, SE-221 85 Lund, Sweden.
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Mathilda Björk
- Department of Social and Welfare Studies, Linköping University, SE-602 21 Norrköping, Sweden.
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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