Improved Functioning and Activity According to the International Classification of Functioning and Disability after Multidisciplinary Telerehabilitation for Post-COVID-19 Condition-A Randomized Control Study.

This study investigates the outcomes and feasibility concerning the functioning and activity of multidisciplinary group telerehabilitation for a post-COVID-19 condition. Recruitment for the group rehabilitation was announced three times during 2021 and 2022 through the COVID-19 patient organization in Sweden. The key inclusion criteria were remaining symptoms and functional impairments beyond 12 weeks after SARS-CoV-2 infection; medical assessment and treatment regarding comorbidities or new postinfection symptoms; the ability to use the Internet. Participants were randomized into a rehabilitation group or onto a waiting list using an Internet program. Multiple outcomes included self-scored questionnaires and physical tests before and after eight weeks, and at six months follow-up. Here, we present the self-scored outcomes on the International Classification of Functioning and Disability questionnaire (ICF, 22 body functions and 16 activity/participation categories) and breathing scales. Of the 164 participants who registered for the study, 67 (mean age 43, 78% women) participated in an eight-week group rehabilitation compared to 42 who served as waiting list controls (mean age 47, 88% women). At six months follow-up, 60 participants from the rehabilitation group and 21 from the waiting list completed the data. The results indicate that a larger number of ICF body functions and activity/participation categories had improved in the rehabilitation group after eight weeks and six months. Overall credibility, as assessed by the Credibility Expectancy Questionnaire, was high, and the attrition rate in rehabilitation was low. The results indicate beneficial outcomes for multidisciplinary telerehabilitation in people suffering from a post-COVID-19 condition. Therefore, rehabilitation interventions should be further developed and implemented in clinical practice.

Pain Burden in Post-COVID-19 Syndrome following Mild COVID-19 Infection.

The global pandemic of SARS-CoV-2 has affected several hundred million people, and many infected people have suffered from a milder initial infection but have never fully recovered. This observational study investigates the pain burden in sufferers of post-COVID-19 syndrome after a milder initial infection. One hundred post-COVID-19 patients filled out questionnaires regarding sociodemographic data, previous comorbidities, present pharmacological treatment, pain intensity and pain localisation. Health-related quality of life, fatigue, emotional status, and insomnia were measured by validated questionnaires. Multiple post-COVID-19 symptoms, including post-exertional malaise, were evaluated by a symptom questionnaire. Among the 100 participants (mean age 44.5 years), 82% were women, 61% had higher education, and 56% were working full or part time. Nine participants reported previous pain or inflammatory conditions. Among the most painful sites were the head/face, chest, lower extremities, and migrating sites. Generalised pain was self-reported by 75 participants and was estimated in 50 participants. Diagnosis of fibromyalgia according to the 2016 criteria was suspected in 40 participants. Subgroup analyses indicated that comorbidities might play a role in the development of pain. In conclusion, a major part of sufferers from post-COVID-19 syndrome develop pain, and in addition to its many disabling symptoms, there is an urgent need for pain management in post-COVID-19 syndrome.

Self-scored impairments in functioning and disability in post-COVID syndrome following mild COVID-19 infection.

OBJECTIVES: To investigate functioning, activity and disability in people with post-COVID syndrome. DESIGN: Cross-sectional. SUBJECTS/PATIENTS: Participants were recruited online via Facebook and a stakeholders' organization for post-COVID syndrome in Sweden. METHODS: Sociodemographic data and International Classification of Functioning, Disability and Health (ICF)-based questionnaire were collected via an online platform and analysed. RESULTS: A total of 100 participants were included (mean age 44.5 years, 82% women, 61% with higher education, and 56% working full- or part-time). For the ICF component Body Functions, the most impaired functions were: fatigability and energy drive (98-99%); higher cognitive functions (74-94%); sleep functions (98%); muscle functions (93%); respiratory functions (92%); heart functions (82%); emotional functions (80%); sexual functions (77%); pain problems (56-90%); and thermoregulatory functions (68%). For the component Activity, the most frequent limitations were: handling stressful situations (98%); remunerative employment (95%); recreation and leisure (94%); climbing the stairs (94%); doing housework (84%); and informal socializing (64%). The most frequent degrees of impairment/limitations were light and moderate, except for severe-complete for fatigue, higher cognitive functions, multitasking, handling stressful situations; and recreation and leisure activities. CONCLUSION: Post-COVID syndrome following a mild COVID-19 infection can result in impaired body functions and activities. These results support the importance of a multidisciplinary rehabilitation approach for these patients.

The Functional Barometer - An analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain - Differences in age gender and origin of pain.

Long standing non-malignant pain leads to a variety of limitations which can be assessed by means of the self-assessment questionnaire Functional Barometer. It is designed to assess the extent and limitations in function, activity and decreased quality-of-life and is adapted to the International Classification of Functioning and Health. AIM: To investigate the outcome and differences in age, gender and origin of pain in patients with long-standing non-malignant pain regarding the subjective experience of functional-, activity- and quality-of-life limitations. METHOD: 300 patients with a median duration of pain of 49 months referred to a Pain Management Centre filled out the Functional Barometer questionnaire, adapted to the International Classification of Functioning and Health. RESULTS: 66% patients were women and 34% were men. Seventy-five percent were in working age, 18-64 years. The duration before being referred to a pain specialist was over 4 years and 65% reported pain from more than three origins. Significant differences in functioning, activity and quality-of-life were found in comparing gender, age and origin of pain. Men more often reported physiological limitations while women more often reported psychological limitations of functioning, activity and quality-of-life. The most important were that men more often had difficulties in walking and climbing stairs, while women reported problems with concentration, stress and psychological demands, family relations and contact with friends. CONCLUSION: The significant differences regarding functioning, activity and quality-of-life between women and men as age and origin of pain must be taken into account when tailoring individual treatment and rehabilitation programmes.

The functional barometer -a self-report questionnaire in accordance with the International Classification of Functioning, Disability and Health for pain related problems; validity and patient-observer comparisons.

BACKGROUND: The International Classification of Functioning, Disability and Health, (ICF) provides a unified, international standardized framework for describing and classifying health and health-related functioning and disability. Based on an ICF core sets the Functional Barometer, (FB), was developed for assessments of perceived pain-related problems with functions, activity and quality-of-life by patients suffering from long-term pain. The aim was to evaluate the construct validity, and to compare the assessments of a patient's problems from the perspectives of the patient and of the examining professional when using the validated FB and corresponding ICF-classification form, respectively. METHODS: Patients with long-term pain for more than 3 months that visited one of four pain clinics during specified time periods of data collections were eligible. The self-report Balanced Inventory for Spinal disorders was used for validation of the FB. Correspondingly to the validated FB an ICF-classification form for professional's assessment was developed. The data sets for these inter-scale and the patient-professional comparisons were collected adjacent to the clinical examination. By the statistical method used for evaluation of the pairs of ordinal data presence of systematic disagreement was identified and measured separately from additional individual variations. RESULTS: The validation process resulted in a revised FB(2.0) that meets the requirements of good construct and content validity. The professionals' ICF-classifications of the patients' problems disagreed with the patients' assessments on the FB(2.0); the percentage agreements ranged from 18% to 51%. The main reason was that the practitioners systematically underestimated the patients' levels of problems but the different professionals contributed also to a large individual variability (noise) in assessment. CONCLUSIONS: This study presents an ICF-based validated self-report questionnaire, The FB, to be used for identifying and describing pain-related problems with current functioning, activities and quality-of-life as perceived by patients suffering from long-term pain. The strong evidences of underestimation of the patients' problems and the variability in the professionals' ICF-classifications demonstrated the importance of describing the patient's problems both from the patient's and the professional's perspective beneficial for the patient's rehabilitation.

Beneficial long-term effects of multiprofessional assessment vs. rehabilitation program in patients with musculoskeletal pain.

OBJECTIVES: The aim of this study was to evaluate the differences in outcomes of long-term multiprofessional intervention in patients suffering from musculoskeletal pain. METHODS: Eighty-eight patients with persistent musculoskeletal pain who either experienced multiprofessional rehabilitation (44) or underwent a mutiprofessional assessment of their ability to work (44) were followed up after either 5 or 10 years. Data on pain intensity, health perception and physical function collected in either 1998 or 2003, were compared with data taken from patients in 2008. Patients were also interviewed regarding pain diagnoses and additional multiprofessional interventions that occurred after 1998 or 2003. RESULTS: Results indicate that patients who participated in multiprofessional rehabilitation were younger in both 5- and 10-year follow-up groups and remained at work longer when compared to assessment group. When comparing the rehabilitation vs. assessment groups, no differences in pain intensity, health perception, and physical function were found at the 5- and 10-year follow-up. Reduced pain intensity was reported by both rehabilitation and assessment groups at the 5-year follow-up. Functional status was improved in the assessment group after 10 years. CONCLUSION: These results indicate that multiprofessional assessment may also have beneficial effects in patients with musculoskeletal pain when measuring long-term outcomes.

A cost-utility study of the use of pregabalin added to usual care in refractory neuropathic pain patients in a Swedish setting.

OBJECTIVES: Patients refractory to older therapies for neuropathic pain (NeP) have few remaining therapeutic options. This study evaluates the cost-utility of pregabalin in the treatment of patients with refractory neuropathic pain in Sweden, from a healthcare and a societal perspective. STUDY LIMITATIONS: The use of non-randomized (observational) data to determine the effectiveness of treatments for NeP. The use of non-Swedish data for some input parameters in the model. METHODS: A previously constructed discrete event simulation model was adapted to compare pregabalin combined with usual care to usual care alone in a Swedish setting. Pain profiles were generated using clinical data from five non-randomized pregabalin studies in refractory NeP patients. Utility data were generated from a UK survey of patients with NeP. Cost data were generated from the Swedish Dental and Pharmaceutical Benefits Board (TLV's) product price database, a national NeP register, and a regional registry study. Indirect costs were estimated from published sources. One-way and probabilistic sensitivity analyses evaluated uncertainty in the model's output. RESULTS: The incremental cost-effectiveness ratio (ICER) for pregabalin plus usual care treatment compared to usual care was 51,616 SEK/€5364 and 123,993 SEK/€12,886 with and without indirect costs, respectively. One-way sensitivity analyses confirmed the clinical input data as the main driver of the model; even considerable changes to all other input parameters had only a modest effect on the ICER. The ICER remained well below a conservative threshold of 347,495 SEK/€36,113/£30,000 in all scenarios modelled. CONCLUSIONS: This study found pregabalin combined with usual care to be cost-effective compared to usual care in patients with refractory NeP from a Swedish Health Care perspective. Moreover, sensitivity analysis showed pregabalin's cost-effectiveness to be robust in all scenarios modelled.

Effect on work ability after team evaluation of functioning regarding pain, self-rated disability, and work ability assessment.

To evaluate the effect of a 1-2 week multiprofessional team assessment, without a real rehabilitation effort, 60 patients suffering from long-standing pain and on long-lasting time on sick leave were studied. A questionnaire concerning their daily activities, quality of life, pain intensity, sick-leave level, and their work state was filled out by all patients before starting the assessment and at a 1-year follow-up. The results from the assessment period and the multiprofessional team decision of the patient's working ability were compared with the actual working rate after 1 year. The follow-up showed a significant reduction of sick leave and a higher level of activity (P < 0.001). One year after the initial evaluation, 40% showed a reduction in sickness benefit level and 12% resumed full-time work. However, the team evaluation of the patient's work ability did not correlate to predict the actual outcome. The patient's pain intensity, life satisfaction, gender, age, ethnic background, and time absent from work before the start of the evaluation showed no correlation to reduction on time on sickness benefit level. These parameters could not be used as predictors in this study.

Evaluation of a multiprofessional rehabilitation programme for persistent musculoskeletal-related pain: economic benefits of return to work.

OBJECTIVE: The aim of this study was to evaluate the economic consequences of an 8-week multiprofessional rehabilitation programme for patients with persistent pain. SUBJECTS: A group of 67 patients following the programme and a comparison group of 322 patients. METHODS: The effect on return to work was estimated using 3 different methods: (i) a matched sample approach; (ii) regression analysis; and (iii) propensity score matching. The economic benefit of the programme was estimated as a reduction in production losses due to sick-leave. This benefit was compared with the actual cost of the programme. RESULTS: The benefit of the programme was estimated to be euro3,799-7,515 per treated patient and year. The total cost of the programme was estimated to be euro5,406 per patient. Based on these figures the total cost of the programme, including costs for patients remaining on sick-leave, had been recovered when the successfully rehabilitated patients had worked for 9-17 months. Any additional work after that yielded net economic benefits. CONCLUSION: Since other studies indicate that a large proportion of the patients working after one year also work after 3 and 6 years, we conclude that this multiprofessional rehabilitation programme for patients with persistent pain most likely generates substantial net economic gains.

A 6-year follow-up study of 122 patients attending a multiprofessional rehabilitation programme for persistent musculoskeletal-related pain.

The aim of the study was to evaluate the outcome 6 years after completing a multiprofessional 8-week rehabilitation programme regarding the following objectives: (1) return to work, (2) level of activity and (3) pain intensity. Of 149 patients attending a rehabilitation programme, 122 were followed up after 6 years, through a structured telephone interview, and their present work situation, level of activity, sleeping habits, their estimated pain intensity and consumption of analgesics were recorded. The questions presented were the same as they had answered before entering the programme. The return-to-work rate was compared to 79 patients in a control group. At the 6-year follow-up, compared to before entering the programme, 52% had returned to work (P<0.001). In the control group the return-to-work rate was 13%. This difference was statistically significant (P<0.001). There was a statistically significant higher level of activity (P=0.037). A pain reduction was experienced by 58% of the patients (P<0.001) and 47% of the patients had decreased their consumption of analgesics (P<0.001). In conclusion, after completing the structured 8-week rehabilitation programme, the return-to-work rate was higher at a 6-year follow-up than in a control group. Furthermore, they had a higher level of activity and lower level of pain intensity than before entering the programme, indicating that the rehabilitation programme had a long-term positive effect on the return-to-work-rate, activity and pain as well as on the analgesic consumption.

Ethnic background does not influence outcome for return-to-work in work-related interdisciplinary rehabilitation for long-term pain: 1- and 3-year follow-up.

BACKGROUND: It is often suggested that immigrants with long-term pain do not benefit from rehabilitation to the same extent as native Swedish patients. In this study, an 8-week rehabilitation programme was evaluated according to its adaptation for immigrants. OBJECTIVES: To establish whether there is a difference between immigrants and native Swedes concerning: (i) return-to-work, the patients' own estimation and their actual ability; (ii) higher level of activity; (iii) reduction in pain and analgesic use. PATIENTS: A total of 67 patients with persistent non-malignant pain completed the rehabilitation programme. Thirty (45%) of the patients were immigrants. METHODS: A 1- and a 3-year follow-up were made to compare the outcome between the 2 groups. RESULTS: There was no significant difference in the return-to-work rate between immigrants and native Swedes. However, the patients' prediction of their ability to return to work was higher among the non-immigrants. The level of activity was lower and pain intensity and use of analgesics were higher among the immigrants than the non-immigrants. CONCLUSION: Immigrants can benefit from a rehabilitation programme to the same extent as native Swedes concerning return-to-work rate, but seem to have limitations in assimilating the other objectives of the programme.

Can the back-to-work rate of patients with long-term non-malignant pain be predicted?

The objective of this study was to evaluate the outcome of a structured multidisciplinary rehabilitation programme regarding the return-to-work rate. Sixty-seven patients were enrolled in an 8-week, structured rehabilitation programme. The prediction of the return-to-work rate was evaluated before entering the programme. The patients' own perception of returning to work as well as their pain intensity were estimated on a visual analogue scale and their period of sick leave was also recorded. The multidisciplinary rehabilitation team made an impairment and disability evaluation and analysis (IDEA) to assess possible work ability. This evaluation was made during the first 3 weeks of the 8-week programme. The return-to-work rate was also evaluated by means of the modified somatic perception questionnaire (MSPQ) and the disability rating index (DRI) before entering the programme. The results were compared with the actual return-to-work rate 1 year after completing the programme. A comparison group of 14 patients who were rejected due to lack of space in the programme was used in this study. There was a positive, statistically significant correlation (P<0.01) between the evaluation of the multidisciplinary rehabilitation team and the actual outcome of the return-to-work rate 1 year after completing the programme. At the 1-year follow-up, 63% of the patients had returned to work or were in work-related activities. The results on MSPQ or DRI, the patients' own perception of returning to work, the pain intensity, age or the period of time out of work did not predict the return-to-work ability. This study has shown that 63% of the patients with long-term non-malignant pain were back to work or in work-related activities 1 year after completing the rehabilitation programme. The IDEA made by the rehabilitation team was crucial in predicting the return-to-work rate in this patient group. The MSPQ and DRI questionnaires, the patients' own prediction, pain intensity, age and time out of work had a low value for predicting the return-to-work rate following a structured multidisciplinary rehabilitation programme.