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Elbers S, Wittink H, Konings S, Kaiser U, Kleijnen J, Pool J, Köke A, Smeets R. Longitudinal outcome evaluations of Interdisciplinary Multimodal Pain Treatment programmes for patients with chronic primary musculoskeletal pain: A systematic review and meta-analysis. Eur J Pain 2021; 26:310-335. [PMID: 34624159 PMCID: PMC9297911 DOI: 10.1002/ejp.1875] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022]
Abstract
Background and objectives Although Interdisciplinary Multimodal Pain Treatment (IMPT) programmes share a biopsychosocial approach to increase the wellbeing of patients with chronic pain, substantial variation in content and duration have been reported. In addition, it is unclear to what extent any favourable health outcomes are maintained over time. Therefore, our first aim was to identify and analyse the change over time of patient‐related outcome measures in cohorts of patients who participated in IMPT programmes. Our second aim was to acquire insight into the heterogeneity of IMPT programmes. Databases and data treatment The study protocol was registered in Prospero under CRD42018076093. We searched Medline, Embase, PsycInfo and Cinahl from inception to May 2020. All study selection, data extraction and risk of bias assessments were independently performed by two researchers. Study cohorts were eligible if they included adult patients with chronic primary musculoskeletal pain for at least 3 months. We assessed the change over time, by calculating pre‐post, post‐follow‐up and pre‐follow‐up contrasts for seven different patient‐reported outcome domains. To explore the variability between the IMPT programmes, we summarized the patient characteristics and treatment programmes using the intervention description and replication checklist. Results The majority of the 72 included patient cohorts significantly improved during treatment. Importantly, this improvement was generally maintained at follow‐up. In line with our expectations and with previous studies, we observed substantial methodological and statistical heterogeneity. Conclusions This study shows that participation in an IMPT programme is associated with considerable improvements in wellbeing that are generally maintained at follow‐up. The current study also found substantial heterogeneity in dose and treatment content, which suggests different viewpoints on how to optimally design an IMPT programme. Significance The current study provides insight into the different existing approaches regarding the dose and content of IMPT programs. This analysis contributes to an increased understanding of the various approaches by which a biopsychosocial perspective on chronic pain can be translated to treatment programs. Furthermore, despite theoretical and empirical assertions regarding the difficulty to maintain newly learned health behaviors over time, the longitudinal analysis of health outcomes did not find a relapse pattern for patients who participated in IMPT programs
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Affiliation(s)
- Stefan Elbers
- Research group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands
| | - Harriët Wittink
- Research group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Sophie Konings
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Ulrike Kaiser
- Comprehensive Pain Center, Medical Faculty Technical University Dresden, Dresden, Germany.,University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Jos Kleijnen
- Department of Family Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jan Pool
- Research group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Albère Köke
- Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands.,Centre of Expertise in Pain and Rehabilitation, Adelante, Maastricht, The Netherlands.,South University of Applied Sciences, Heerlen, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands.,CIR Revalidatie, Eindhoven, The Netherlands
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Long-term follow-up of patients with chronic musculoskeletal pain attending interdisciplinary pain rehabilitation: outcomes and predictive factors. Int J Rehabil Res 2021; 44:110-117. [PMID: 33859116 DOI: 10.1097/mrr.0000000000000467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The long-term outcomes of interdisciplinary pain rehabilitation (IPR) in patients with chronic musculoskeletal pain (CMP) and its predictors has been studied to a limited extent. In this historical cohort study, functioning, satisfaction with life domains, and pain were assessed at baseline, discharge, and at 6-15 years follow-up. At follow-up, most patients (77%) rated the effects of the IPR as temporarily or persistently positive. The gains in functioning, satisfaction with life domains, and pain made during IPR remained for 6-15 years after the IPR. Patients who were single, retired, or not in work, and those having higher pain and lower functioning at baseline, had lower functioning at follow-up, while patients with traumatic pain disorders had higher functioning at follow-up. Gains made during IPR, particularly gains in social and mental functioning and in pain predicted functioning at follow-up. Treatments and events between discharge and follow-up also influenced the long-term outcome. In conclusion, on average, outcomes achieved during IPR persisted at long-term follow-up. Predictors of a better long-term outcome were mainly baseline characteristics.
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Lewis GN, Bean DJ. What Influences Outcomes From Inpatient Multidisciplinary Pain Management Programs?: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:504-523. [PMID: 33883414 DOI: 10.1097/ajp.0000000000000941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although inpatient multidisciplinary pain management programs (PMPs) are effective for chronic pain, not all patients benefit equally and there is limited evidence regarding predictors of outcome. This meta-analysis aimed to identify patient or program characteristics associated with outcomes from inpatient PMPs, and to examine the time course of effects following discharge. MATERIALS AND METHODS Medline, EBSCO, and Scopus were searched to identify articles reporting outcomes from inpatient multidisciplinary PMPs. Information was extracted on study design, participant and program characteristics, and outcomes. Effect sizes were computed for pain, physical function, depression, anxiety, and mental health outcomes. Study-level predictors of outcome were investigated with moderator analyses and meta-regression. A risk of bias assessment and sensitivity analyses were conducted and the GRADE criteria for prognostic studies were applied to assess confidence in findings. RESULTS In all, 85 studies (111 cohorts; 15,255 participants) were included. Three quarters of studies demonstrated low risk of bias. Larger effect sizes (for at least 1 outcome measure) occurred in studies where participants had more severe pain (greater intensity/longer duration), participants with alcohol or drug problems were not excluded, samples comprised mixed pain conditions, and programs included a cognitive component and/or a passive therapy component. Effect sizes for pain and physical function were maintained at follow-up, but effect sizes for depression and anxiety declined over time. DISCUSSION Inpatient multidisciplinary PMPs may be well suited to patients with severe or long-lasting pain. Programs should adopt broad patient inclusion criteria, and outcomes were similar for programs based on cognitive-behavioral versus mindfulness/acceptance-based therapies.
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Affiliation(s)
- Gwyn N Lewis
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
| | - Debbie J Bean
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology
- Chronic Pain Service, Department of Anaesthesiology & Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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De Wit M, Horreh B, Daams JG, Hulshof CTJ, Wind H, de Boer AGEM. Interventions on cognitions and perceptions that influence work participation of employees with chronic health problems: a scoping review. BMC Public Health 2020; 20:1610. [PMID: 33109123 PMCID: PMC7590449 DOI: 10.1186/s12889-020-09621-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cognitions and perceptions, such as motivation and return to work (RTW) expectations, can influence work participation of employees with chronic health problems. This makes these cognitions and perceptions important factors for occupational health professionals to intervene upon in order to increase work participation. There is, however, no overview of interventions that influence these factors and are aimed at increasing work participation. Therefore, the purpose of this scoping review is to explore available interventions that are focused on cognitions and perceptions of employees with chronic health problems and aimed at increasing work participation. METHODS A scoping review was carried out following the framework of Arksey and O'Malley. Ovid MEDLINE and PsycINFO were searched for original papers published between January 2013 and June 2020. We included studies that describe interventions that focus on at least one of ten cognitions and perceptions and on work participation. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. RESULTS In total, 29 studies were identified that studied interventions aimed at changing at least one of ten cognitions and perceptions in order to change work participation. The interventions that were included mainly focused on changing recovery and RTW expectations, self-efficacy, feelings of control, perceived health, fear-avoidance beliefs, perceived work-relatedness of the health problem, coping strategies and catastrophizing. No interventions were found that focused on changing motivation or on optimism/pessimism. Four interventions were judged as effective in changing coping, self-efficacy, fear-avoidance beliefs, or perceived work-relatedness and work participation according to results of randomized controlled trials. CONCLUSIONS This review provides an overview of interventions that focus on changing cognitions and perceptions and work participation. Evidence was found for four effective interventions focused on changing these factors and increasing work participation. Occupational health professionals may use the overview of interventions to help employees with chronic health problems to increase their work participation.
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Affiliation(s)
- Mariska De Wit
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands.
| | - Bedra Horreh
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Joost G Daams
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Haije Wind
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
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Letzel J, Angst F, Weigl MB. Multidisciplinary biopsychosocial rehabilitation in chronic neck pain: a naturalistic prospective cohort study with intraindividual control of effects and 12-month follow-up. Eur J Phys Rehabil Med 2019; 55:665-675. [DOI: 10.23736/s1973-9087.18.05348-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Investigation of the Effect of Neck Muscle Active Force on Whiplash Injury of the Cervical Spine. Appl Bionics Biomech 2018; 2018:4542750. [PMID: 29849760 PMCID: PMC5904778 DOI: 10.1155/2018/4542750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/11/2018] [Accepted: 03/13/2018] [Indexed: 12/23/2022] Open
Abstract
The objective of the present study is to investigate the influence of neck muscle activation on whiplash neck injury of the occupants of a passenger vehicle under different severities of frontal and rear-end impact collisions. The finite element (FE) model has been used as a versatile tool to simulate and understand the whiplash injury mechanism for occupant injury prevention. However, whiplash injuries and injury mechanisms have rarely been investigated in connection with neck active muscle forces, which restricts the complete reappearance and understanding of the injury mechanism. In this manuscript, a mixed FE human model in a sitting posture with an active head-neck was developed. The response of the cervical spine under frontal and rear-end collision conditions was then studied using the FE model with and without neck muscle activation. The effect of the neck muscle activation on the whiplash injury was studied based on the results of the FE simulations. The results indicated that the neck active force influenced the head-neck dynamic response and whiplash injury during a collision, especially in a low-speed collision.
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Abstract
Zusammenfassung. Chronische Kopfschmerzen stellen ein häufiges Problem in der Praxis dar. Die Behandlung beinhaltet eine Kombination von medikamentösen und nichtmedikamentösen Therapieverfahren im Rahmen eines multimodalen Settings. Neben der chronischen Migräne steht der Medikamentenübergebrauchskopfschmerz im Vordergrund. Hierbei ist ein zusätzliches Ziel, die Patienten vorausgehend im ambulanten oder stationären Setting von den übermässig konsumierten Schmerz- und Migränemittel zu entziehen. Mit der Kombination von einem Medikamentenentzug mit der nachfolgenden Optimierung der Migränebehandlung akut und prophylaktisch lässt sich in den allermeisten Fällen eine Verminderung der Kopfschmerzfrequenz und dadurch eine Verbesserung der Lebensqualität erreichen.
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Affiliation(s)
- Andreas R Gantenbein
- 1 Neurorehabilitation & Kopfschmerzprogramme, RehaClinic Bad Zurzach
- 2 Universität Zürich
| | | | - Monika Zemp
- 1 Neurorehabilitation & Kopfschmerzprogramme, RehaClinic Bad Zurzach
| | - Thomas Benz
- 1 Neurorehabilitation & Kopfschmerzprogramme, RehaClinic Bad Zurzach
| | - Peter S Sandor
- 1 Neurorehabilitation & Kopfschmerzprogramme, RehaClinic Bad Zurzach
- 2 Universität Zürich
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