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Lindbäck, Y., Enthoven, P. & Öberg, B. (2019). Patients' experiences of how symptoms are explained and influences on back-related health after pre-surgery physiotherapy: A qualitative study. Musculoskeletal science & practice, 40, 34-39
Open this publication in new window or tab >>Patients' experiences of how symptoms are explained and influences on back-related health after pre-surgery physiotherapy: A qualitative study
2019 (English)In: Musculoskeletal science & practice, ISSN 2468-7812, Vol. 40, p. 34-39Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Since the pre-surgery phase is a new setting for physiotherapy, exploring patients' experiences might contribute to new insights for future development of care in patients with degenerative lumbar spine disorders.

OBJECTIVES: To describe patients' experiences of how symptoms are explained, and their experiences of the influences on back-related health after pre-surgery physiotherapy.

DESIGN: Explorative qualitative design using semi-structured interviews analysed with content analysis.

PARTICIPANTS: Eighteen patients with degenerative lumbar spine disorder scheduled for surgery, participated in pre-surgery physiotherapy.

FINDINGS: Five categories were identified: Influences on symptoms, physical function and sleep; Influences on coping and well-being; Explanations of back-related symptoms and wanting to be well-informed; Influence on social functioning; The ability of the model of care to influence reassurance and prevention.

CONCLUSION: Improvements in back-related health in all the biopsychosocial dimensions emerged. Even those who expressed no symptom improvements, felt better performing exercises than being inactive, and exercises improved their frame of mind, a useful experience in possible low back pain recurrences. Pre-surgery physiotherapy provided reassurance and gave time to reflect on treatments and lifestyle. Despite pre-surgery physiotherapy, back-related symptoms were mainly described in line with a biomedical explanatory model. Those using broader explanations were confident that physiotherapy and self-management could influence their symptoms. Suggesting more emphasis on explanatory models suitable for surgery, pre- and post-surgery physiotherapy and self-management in the professionals' dialogue with patients.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Content analysis, Exercise therapy, Patients' experience, Physiotherapy, Qualitative study, Spinal surgery
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-154072 (URN)10.1016/j.msksp.2019.01.003 (DOI)000460108500005 ()30665046 (PubMedID)2-s2.0-85060104361 (Scopus ID)
Funder
Region Östergötland
Note

This article had the status submitted when included in the thesis with the title "Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders" and the permanent link http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-150553.

Funding agencies: County Council of Ostergotland, Linkoping, Sweden

Available from: 2019-01-28 Created: 2019-01-28 Last updated: 2019-03-20Bibliographically approved
Abbott, A., Schröder, K., Enthoven, P., Nilsen, P. & Öberg, B. (2018). Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial. BMJ Open, 8(4), Article ID e019906.
Open this publication in new window or tab >>Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019906Article in journal (Refereed) Published
Abstract [en]

Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.

Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.

Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.

Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-147879 (URN)10.1136/bmjopen-2017-019906 (DOI)000435176700106 ()29691246 (PubMedID)
Note

Funding agencies: Research Council in Southeast Sweden [FORSS<SUP>star</SUP>660371]; Swedish Research Council [2017<SUP>star</SUP>01444]

Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-04-10Bibliographically approved
Lindbäck, Y., Tropp, H., Enthoven, P., Abbott, A. & Öberg, B. (2018). PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial. The spine journal, 18(8), 1347-1355
Open this publication in new window or tab >>PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial
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2018 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1347-1355Article in journal (Refereed) Published
Abstract [en]

Background Context

Surgery because of disc herniation or spinal stenosis results mostly in large improvement in the short-term, but mild to moderate improvements for pain and disability at long-term follow-up. Prehabilitation has been defined as augmenting functional capacity before surgery, which may have beneficial effect on outcome after surgery.

Purpose

The aim was to study if presurgery physiotherapy improves function, pain, and health in patients with degenerative lumbar spine disorder scheduled for surgery.

Study Design

A single-blinded, two-arm, randomized controlled trial (RCT).

Patient Sample

A total of 197 patients were consecutively included at a spine clinic. The inclusion criteria were patients scheduled for surgery because of disc herniation, spinal stenosis, spondylolisthesis, or degenerative disc disease (DDD), 25–80 years of age.

Outcome Measures

Primary outcome was Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, anxiety, depression, self-efficacy, fear avoidance, physical activity, and treatment effect.

Methods

Patients were randomized to either presurgery physiotherapy or standardized information, with follow-up after the presurgery intervention as well as 3 and 12 months post surgery. The study was funded by regional research funds for US$77,342. No conflict of interest is declared.

Results

The presurgery physiotherapy group had better ODI, visual analog scale (VAS) back pain, EuroQol-5D (EQ-5D), EQ-VAS, Fear Avoidance Belief Questionnaire-Physical Activity (FABQ-PA), Self-Efficacy Scale (SES), and Hospital Anxiety and Depression Scale (HADS) depression scores and activity level compared with the waiting-list group after the presurgery intervention. The improvements were small, but larger than the study-specific minimal clinical important change (MCIC) in VAS back and leg pain, EQ-5D, and FABQ-PA, and almost in line with MCIC in ODI and Physical Component Summary (PCS) in the physiotherapy group. Post surgery, the only difference between the groups was higher activity level in the physiotherapy group compared with the waiting-list group.

Conclusions

Presurgery physiotherapy decreases pain, risk of avoidance behavior, and worsening of psychological well-being, and improves quality of life and physical activity levels before surgery compared with waiting-list controls. These results were maintained only for activity levelspost surgery. Still, presurgery selection, content, dosage of exercises, and importance of being active in a presurgery physiotherapy intervention is of interest to study further to improve long-term outcome.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Disc herniation, Function, Physiotherapy, Spinal stenosis, Stratification, Surgery
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-147620 (URN)10.1016/j.spinee.2017.12.009 (DOI)000443585000006 ()29253630 (PubMedID)2-s2.0-85044627865 (Scopus ID)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2019-05-01Bibliographically approved
Pietilä Holmner, E., Stålnacke, B.-M., Enthoven, P. & Stenberg, G. (2018). ”The acceptance” of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care. Journal of Rehabilitation Medicine, 50(1), 73-79
Open this publication in new window or tab >>”The acceptance” of living with chronic pain – an ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care
2018 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 1, p. 73-79Article in journal (Refereed) Published
Abstract [en]

Objective: To explore patient experiences of participating in multimodal pain rehabilitation in primary care. Subjects: Twelve former patients (7 women and 5 men) in multimodal rehabilitation in primary care were interviewed about their experiences of multimodal rehabilitation. Methods: The interviews were analysed using qualitative content analysis. Results: Analysis resulted in 4 categories: (i) from discredited towards obtaining redress; (ii) from uncertainty towards knowledge; (iii) from loneliness towards togetherness; and (iv) "acceptance of pain": an ongoing process. The results show that having obtained redress, to obtain knowledge about chronic pain, and to experience fellowship with others with the same condition were helpful in the acceptance process. However, there were patients who found it difficult to reconcile themselves with a life with chronic pain after multimodal rehabilitation. To find what was "wrong" and to have a medical diagnosis and cure were important. Conclusion: Patients in primary care multimodal rehabilitation experience a complex, ongoing process of accepting chronic pain. Four important categories were described. These findings will help others to understand the experience and perspective of patients with chronic pain who engage in multimodal rehabilitation.

Place, publisher, year, edition, pages
FOUNDATION REHABILITATION INFORMATION, 2018
Keywords
chronic pain; multimodal rehabilitation; primary healthcare
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-149768 (URN)10.2340/16501977-2286 (DOI)000435532700012 ()29077130 (PubMedID)
Note

Funding Agencies|Vasterbotten County Council

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2019-04-10
Wijkman, M., Sandberg, K., Kleist, M., Falk, L. & Enthoven, P. (2018). The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.. The Journal of Clinical Hypertension, 20, 56-64
Open this publication in new window or tab >>The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.
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2018 (English)In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Journal of Clinical Hypertension, Vol. 20, p. 56-64Article in journal (Refereed) Published
Abstract [en]

The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice-weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom-limited ergometer exercise test. At follow-up, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise. This response was not altered by participation in a 12-week program of aerobic exercise.

Place, publisher, year, edition, pages
Hoboken, United States: Le Jacq Communications, Inc., 2018
National Category
Cardiac and Cardiovascular Systems Physiotherapy
Identifiers
urn:nbn:se:liu:diva-144586 (URN)10.1111/jch.13157 (DOI)000426039300010 ()29338111 (PubMedID)2-s2.0-85040842943 (Scopus ID)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2019-04-03Bibliographically approved
Molander, P., Dong, H.-J., Äng, B., Enthoven, P. & Gerdle, B. (2018). The role of pain in chronic pain patients' perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients.. Scandinavian Journal of Pain, 18(3), 417-429, Article ID /j/sjpain.2018.18.issue-3/sjpain-2018-0003/sjpain-2018-0003.xml.
Open this publication in new window or tab >>The role of pain in chronic pain patients' perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients.
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2018 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, no 3, p. 417-429, article id /j/sjpain.2018.18.issue-3/sjpain-2018-0003/sjpain-2018-0003.xmlArticle in journal (Refereed) Published
Abstract [en]

Background and aims Health-related quality of life (Hr-QoL) reflects the burden of a condition on an overarching level. Pain intensity, disability and other factors influence how patients with chronic pain perceive their condition, e.g. Hr-QoL. However, the relative importance of these factors is unclear and there is an ongoing debate as to what importance pain measures have in this group. We investigated the importance of current pain level and mood on aspects of Hr-QoL in patients with chronic pain and investigated whether such relationships are influenced by demographics. Methods Data was obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP), between 2008 and 2016 on patients ≥18 years old who suffered from chronic pain and were referred to participating specialist clinics. Dependent variables were general Hr-QoL [using two scales from European Quality of Life instrument: EQ5D Index and the European Quality of Life instrument health scale (EQ thermometer)] and specific Hr-QoL [from the Short Form Health Survey (SF36) the physical component summary (SF36-PCS) and the mental (psychological) component summary (SF36-MCS)]. Independent variables were sociodemographic variables, pain variables, psychological distress and pain attitudes. Principal component analysis (PCA) was used for multivariate correlation analyses of all investigated variables and Orthogonal Partial Least Square Regression (OPLS) for multivariate regressions on health aspects. Results There was 40,518 patients (72% women). Pain intensity and interference showed the strongest multivariate correlations with EQ5D Index, EQ thermometer and SF36-PCS. Psychological distress variables displayed the strongest multivariate correlations with SF36-MCS. Demographic properties did not significantly influence variations in the investigated Hr-QoL variables. Conclusions Pain, mood and pain attitudes were significantly correlated with Hr-QoL variables, but these variables cannot explain most of variations in Hr-QoL variables. The results pinpoint that broad assessments (including pain intensity aspects) are needed to capture the clinical presentation of patients with complex chronic pain conditions.

Keywords
acceptance, health, mood, pain, quality of life
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-155122 (URN)10.1515/sjpain-2018-0003 (DOI)29794267 (PubMedID)
Available from: 2019-03-19 Created: 2019-03-19 Last updated: 2019-04-10
Lindbäck, Y., Tropp, H., Enthoven, P., Gerdle, B., Abbott, A. & Öberg, B. (2017). Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery. BMC Musculoskeletal Disorders, 18, Article ID 264.
Open this publication in new window or tab >>Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery
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2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 264Article in journal (Refereed) Published
Abstract [en]

Background: Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods: In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results: On a group level, the patients somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF 36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions: On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keywords
Disc herniation; Spinal stenosis; Spondylolisthesis; Degenerative disc disease; Spine surgery; Quantitative sensory testing; Outcome
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-139285 (URN)10.1186/s12891-017-1581-6 (DOI)000403494900001 ()28623897 (PubMedID)
Note

Funding Agencies|Swedish Research Council [521-2019-3578]; Faculty of Medicine and Health, Linkoping University; County Council of Ostergotland, Linkoping, Sweden

Available from: 2017-07-07 Created: 2017-07-07 Last updated: 2018-08-28
Lindbäck, Y., Tropp, H., Enthoven, P., Gerdle, B., Abbott, A. & Öberg, B. (2017). Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.. European spine journal, 26(10), 2581-2588
Open this publication in new window or tab >>Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.
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2017 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 26, no 10, p. 2581-2588Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.

METHODS: This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.

RESULTS: Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.

CONCLUSIONS: Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Disc herniation, Quantitative sensory testing, Spinal stenosis, Spinal surgery, Widespread pain
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-136688 (URN)10.1007/s00586-017-4979-9 (DOI)000412841000013 ()28168345 (PubMedID)2-s2.0-85011710070 (Scopus ID)
Note

Funding agencies: Swedish Research Council [521-2019-3578]; Faculty of Medicine and Health, Linkoping University; County Council of Ostergotland, Linkoping, Sweden

Available from: 2017-05-12 Created: 2017-05-12 Last updated: 2018-08-27Bibliographically approved
Stenberg, G., Stålnacke, B.-M. & Enthoven, P. (2017). Implementing multimodal pain rehabilitation in primary care - a health care professional perspective.. Disability and Rehabilitation, 39(21), 2173-2181
Open this publication in new window or tab >>Implementing multimodal pain rehabilitation in primary care - a health care professional perspective.
2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 21, p. 2173-2181Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To explore professional perspectives on how to start and work with multimodal pain rehabilitation within primary healthcare.

METHODS: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their experiences of starting and working with multimodal pain. Interviews were transcribed and analyzed by qualitative content analysis. This study was part of a larger project, which aimed at evaluating multimodal pain rehabilitation in primary care.

RESULTS: The analysis resulted in six categories. Two categories were about management engagement: putting the focus on rehabilitation and creating appropriate conditions. Three were about professional engagement: importance of driving spirits, creating a program - a process, and good teamwork - not a coincidence. The last category was about professional gain from multimodal rehabilitation (MMR): team work is enriching.

CONCLUSIONS: To enable implementation of MMR in primary care, managers on all organizational levels must take responsibility for allowing rehabilitation to be a priority. A driving spirit among the professionals facilitates the start, but the entire team is important when processing a program. Creating good teamwork requires hard work, e.g., negotiations for consensus about rehabilitation, and assumption of responsibility by each team member. Collaboration between professionals was perceived to strengthen and enhance knowledge about the patients. Implications for rehabilitation Much can be gained from conducting multimodal pain rehabilitation in primary care. Front line managers and those at other organizational levels must prioritize and create appropriate conditions to facilitate multimodal pain rehabilitation in primary care. Creation of an effective multimodal rehabilitation team requires that each team member takes responsibility, drops the focus on individual rehabilitation, seek member consensus about the content of the rehabilitation, and confer equal worth to each team member. The process of creating a program can be facilitated, especially at the beginning, if the team is supported by speciality pain clinics or more experienced teams.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
Keywords
Pain; primary care, guidelines, implementation, multimodal rehabilitation, qualitative
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-135798 (URN)10.1080/09638288.2016.1224936 (DOI)000406714100006 ()27645584 (PubMedID)
Note

Funding agencies: Swedish Social Insurance Agency, REHSAM

Available from: 2017-03-22 Created: 2017-03-22 Last updated: 2017-08-22
Tseli, E., Grooten, W. J., Stålnacke, B.-M., Boersma, K., Enthoven, P., Gerdle, B. & Äng, B. O. (2017). Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis. Systematic Reviews, 6(1), Article ID 199.
Open this publication in new window or tab >>Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis
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2017 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, no 1, article id 199Article in journal (Refereed) Published
Abstract [en]

Background

Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain.

Methods

We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographicsymptoms-relatedphysicalpsychosocialwork-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation.

Discussion

The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Chronic musculoskeletal pain; Literature review; Meta-analysis; Multidisciplinary rehabilitation; Prognostic factors; Treatment outcome
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-146339 (URN)10.1186/s13643-017-0598-0 (DOI)29020989 (PubMedID)2-s2.0-85030844165 (Scopus ID)
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3707-5869

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