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A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.
Res & Dev Ctr Spenshult, Halmstad, Sweden.; Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
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2017 (Engelska)Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 2, s. 186-196Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.

Ort, förlag, år, upplaga, sidor
2017. Vol. 31, nr 2, s. 186-196
Nyckelord [en]
Chronic pain, behavioural medicine, primary care, physical exercise, long-term compliance
Nationell ämneskategori
Sjukgymnastik
Identifikatorer
URN: urn:nbn:se:uu:diva-281461DOI: 10.1177/0269215516639356ISI: 000394758500005PubMedID: 27009057OAI: oai:DiVA.org:uu-281461DiVA, id: diva2:914458
Forskningsfinansiär
ReumatikerförbundetTillgänglig från: 2016-03-24 Skapad: 2016-03-24 Senast uppdaterad: 2017-08-22Bibliografiskt granskad
Ingår i avhandling
1. Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy
Öppna denna publikation i ny flik eller fönster >>Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy
2017 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.

Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.

Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.

Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved. 

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2017. s. 83
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1360
Nyckelord
Chronic pain, health care utilization, behavioral medicine, stratified treatment, prognostic factors, physical therapy, primary care
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicinsk vetenskap
Identifikatorer
urn:nbn:se:uu:diva-328363 (URN)978-91-513-0044-3 (ISBN)
Disputation
2017-10-13, A7:107a, Biomedicinsk centrum, Husargatan 3, Uppsala, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2017-09-21 Skapad: 2017-08-22 Senast uppdaterad: 2017-10-17

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