Outpatient interdisciplinary multimodal pain treatment programme for patients with chronic musculoskeletal pain: a longitudinal cohort study.

PURPOSE: To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment. MATERIALS AND METHODS: Data were gathered during routine clinical practice during a 3-year period (2019-2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates. RESULTS: Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain. CONCLUSIONS: At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients.

Chronic musculoskeletal pain can be very disabling and impacting participation and quality of life.Often several psychosocial factors contribute to the maintenance of pain and its evolving consequences.In this study, a 61 hours highly individualized interdisciplinary multimodal pain treatment resulted in significant improvements with moderate to very large effect sizes for all important domains like pain, fatigue, disability, work capacity, and quality of life.Care providers as well as health insurers should acknowledge the interdisciplinary multimodal pain programme as an effective treatment in their clinical decision making.

Measurement properties of patient-reported outcome measures used in rehabilitation of adults with chronic musculoskeletal pain: A mapping review.

BACKGROUND: Choosing measurement tools for diagnostic, prognostic, or evaluative purposes in a chronic musculoskeletal pain (CMP) population is challenging for rehabilitation practice. Implementation of measurement tools for clinical practice is impaired by gaps in knowledge about measurement properties. OBJECTIVE: Identifying evidence about the measurement properties of tools frequently used in Dutch pain rehabilitation practice. METHODS: A mapping review was conducted of eligible studies that investigated reliability, validity, or responsiveness, and interpretability, as defined by the COSMIN taxonomy, of original versions or Dutch translations of predefined Patient-Reported Outcome Measures (PROMs) in a CMP population. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched in March 2021. Results were visually mapped. RESULTS: Thirty-five studies were included. The results show many knowledge gaps in both original and translated versions. In general, aspects of validity were most frequently reported. The Pain Disability Index, Pain Catastrophizing Scale, and the 12-Item Short Form Health Survey were the most studied measurement tools. No results were found for the Checklist Individual Strength, Illness Perception Questionnaire, and Utrecht Coping List. CONCLUSION: Little evidence of the measurement properties of PROMs used in rehabilitation of patients with CMP in the Netherlands was found. PROMs need to be used and interpreted with caution in daily practice.

Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data.

BACKGROUND: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. METHODS: The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands. RESULTS: A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented. CONCLUSIONS: The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed. SIGNIFICANCE: A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and can be used to evaluate, monitor and improve rehabilitation care in care settings nationwide as well as internationally.

Development and content of the biopsychosocial primary care intervention 'Back on Track' for a subgroup of people with chronic low back pain.

Biopsychosocial interventions provided in multidisciplinary settings are promising for improving functional disability levels in patients with chronic low back pain (CLBP). These multidisciplinary biopsychosocial interventions mainly focus on cognitive-behavioural approaches that aim to change negative cognitions, emotions, behaviour, work and social factors. As some patients with CLBP treated in primary care settings also experience psychosocial factors that influence their level of disability, these patients may benefit from the provision of a biopsychosocial intervention in primary care. This paper will provide a detailed description of the development and content of the biopsychosocial primary care intervention 'Back on Track' for this specific subgroup of patients. The Back on Track intervention was developed based on available scientific evidence and clinical experience from multidisciplinary pain rehabilitation programmes, and its effectiveness is currently being tested. CLINICAL TRIAL REGISTRATION NUMBER: NCT02220543.

Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: a randomized controlled trial.

OBJECTIVES: The aim of this trial was to evaluate the difference in treatment effect, at 26 and 52 weeks after the start of treatment, between cognitive behavioural therapy (CBT) and multidisciplinary rehabilitation treatment (MRT) for patients with chronic fatigue syndrome (CFS). DESIGN: Multicentre, randomized controlled trial of patients with CFS. Participants were randomly assigned to MRT or CBT. SETTING: Four rehabilitation centres in the Netherlands. SUBJECTS: A total of 122 patients participated in the trial. MAIN OUTCOME MEASURES: Primary outcomes were fatigue measured by the fatigue subscale of the Checklist Individual Strength and health-related quality of life measured by the Short-Form 36. Outcomes were assessed prior to treatment and at 26 and 52 weeks after treatment initiation. RESULTS: A total of 114 participants completed the assessment at 26 weeks, and 112 completed the assessment at 52 weeks. MRT was significantly more effective than CBT in reducing fatigue at 52 weeks. The estimated difference in fatigue between the two treatments was -3.02 [95% confidence interval (CI) -8.07 to 2.03; P = 0.24] at 26 weeks and -5.69 (95% CI -10.62 to -0.76; P = 0.02) at 52 weeks. Patients showed an improvement in quality of life over time, but between-group differences were not significant. CONCLUSION: This study provides evidence that MRT is more effective in reducing long-term fatigue severity than CBT in patients with CFS. Although implementation in comparable populations can be recommended based on clinical effectiveness, it is advisable to analyse the cost-effectiveness and replicate these findings in another multicentre trial.

Responsiveness of functional status in low back pain: a comparison of different instruments.

This study compares the responsiveness of three instruments of functional status: two disease-specific questionnaires (Oswestry and Roland Disability Questionnaires), and a patient-specific method (severity of the main complaint). We compared changes over time of functional status instruments with pain rated on a visual analog scale. Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used: effect size statistics and receiver-operating characteristic method. We chose global perceived effect as external criterion. A cohort of 81 patients with non-specific low back pain for at least 6 weeks assessed these measures before and after 5 weeks of treatment. According to the external criterion 38 patients improved. The results of both strategies were the same. All instruments were able to discriminate between improvement and non-improvement. The effect size statistics of the instruments were higher in the improved group than in the non-improved group. For each instrument the receiver-operating characteristic curves showed some discriminative ability. The curves for the Roland Questionnaire and pain were closer to the upper left than the curves for the other instruments. The sensitivity to change of the rating of Oswestry Questionnaire was lower than that of the other instruments. The main complaint was not very specific to change. The two strategies for evaluating the responsiveness were very useful and appeared to complement each other.