Comparison of short- and mid-term outcomes of Italian- and German-speaking patients after an interdisciplinary pain management programme in Switzerland: A prospective cohort study.

OBJECTIVE: To quantify and compare the course of health-related quality of life of immigrant native Italian-speaking and German-speaking patients before and after an interdisciplinary pain programme. DESIGN: Prospective cohort study with 1-12 month follow-up. SUBJECTS: Fibromyalgia, generalized widespread pain, and chronic non-specific back pain patients (Italian-speaking n = 96, German-speaking n = 199). METHODS: Score changes measured with the Short Form 36 (SF-36) were compared with multivariate analysis using standardized mean differences (SMD), adjusted for sex, education and the baseline score. RESULTS: At baseline, health of the Italian-speaking patients was worse than for the German-speaking patients. Adjusted SMDs showed significantly better improvements in the German group compared with the Italian group: SF-36 Physical functioning SMD = 0.54 (at discharge) and 0.49 (at 12 months), General health SMD = 0.71 and 0.44, Vitality SMD = 0.43 and 0.48 in one sample. In the other sample, the corresponding SMDs were 0.06 (discharge), 0.50 (3 months) and 0.47 (6 months) for Bodily pain. CONCLUSION: State of health was better and health improvements were greater in German-speaking patients compared with Italian-speaking patients. Patients with a migration background may have special needs in therapeutic management, and addressing these might enhance the positive outcome in the short- and mid-term.

Effectiveness of subgroup-specific pain rehabilitation: a randomized controlled trial in patients with chronic back pain.

BACKGROUND: Prospective classification of patients with nonspecific chronic back pain into homogeneous subgroups might be an important objective in order to tailor interventions and improve treatment outcomes. AIM: This study investigated the effect of a subgroup-specific pain rehabilitation program based on the Multidimensional Pain Inventory (MPI) Classification System compared to standard care. DESIGN: Single blinded, parallel group, pragmatic randomized controlled trial. SETTING: Inpatient subjects of a rehabilitation clinic. POPULATION: A total of 139 patients with chronic back pain. METHODS: Patients in both the experimental group and control group received during their 4-week in-house stay at the rehabilitation clinic on average four daily sessions of therapy. The patients in the experimental group received specific interventions, which were tailored to their subgroup classification profile. The patients in the control group participated in state-of-the-art care. The primary outcome was self-reported disability measured at 1, 3 and 12 months after randomization with the Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, examiner-reported disability, anxiety and depression, catastrophizing, self-efficacy and global perceived effect. RESULTS: Groups were comparable under demographic and clinical characteristics. No significant differences between the experimental group and the control group for any of the outcomes and follow-up times were found in the intention-to-treat analysis. Compared to the 8-10 points considered as minimal clinically important difference for the ODI, effects within groups were small, e.g. the experimental group improved by 2.2 points at 1-month follow-up, 3.7 points at 3 months and 5.3 points at 12 months. CONCLUSIONS: This study failed to demonstrate that a subgroup-specific program was more effective than standard care. CLINICAL REHABILITATION IMPACT: Since the subgroup-specific interventions were equally effective as standard pain rehabilitation, subgroup classification and tailoring interventions may be an alternative in clinical care.

Reliability of the Multidimensional Pain Inventory and stability of the MPI classification system in chronic back pain.

BACKGROUND: This cross validation study examined the reliability of the Multidimensional Pain Inventory (MPI) and the stability of the Multidimensional Pain Inventory Classification System of the empirically derived subgroup classification obtained by cluster analysis in chronic musculoskeletal pain. Reliability of the German Multidimensional Pain Inventory was only examined once in the past in a small sample. Previous international studies mainly involving fibromyalgia patients showed that retest resulted in 33-38% of patients being assigned to a different Multidimensional Pain Inventory subgroup classification. METHODS: Participants were 204 persons with chronic musculoskeletal pain (82% chronic non-specific back pain). Subgroup classification was conducted by cluster analysis at 4 weeks before entry (=test) and at entry into the pain management program (=retest) using Multidimensional Pain Inventory scale scores. No therapeutic interventions in this period were conducted. Reliability was quantified by intraclass correlation coefficients (ICC) and stability by kappa coefficients (κ). RESULTS: Reliability of the Multidimensional Pain Inventory scales was least with ICC = 0.57 for the scale life control and further ranged from ICC = 0.72 (negative mood) to 0.87 (solicitous responses) in the other scales. At retest, 82% of the patients in the Multidimensional Pain Inventory cluster interpersonally distressed (κ = 0.69), 80% of the adaptive copers (κ = 0.58), and 75% of the dysfunctional patients (κ = 0.70) did not change classification. In total, 22% of the patients changed Multidimensional Pain Inventory cluster group, mainly into the adaptive copers subgroup. CONCLUSION: Test-retest reliability of the German Multidimensional Pain Inventory was moderate to good and comparable to other language versions. Multidimensional Pain Inventory subgroup classification is substantially stable in chronic back pain patients when compared to other diagnostic groups and other examiner-based subgroup Classification Systems. The MPI Classification System can be recommended for reliable and stable specification of subgroups in observational and interventional studies in patients with chronic musculoskeletal pain.

Horticultural therapy for patients with chronic musculoskeletal pain: results of a pilot study.

CONTEXT: Therapists can use horticultural therapy as an adjuvant therapy in a non threatening context, with the intent of bringing about positive effects in physical health, mental health, and social interaction. Very few experimental studies exist that test its clinical effectiveness. OBJECTIVE: To determine whether the addition of horticultural therapy to a pain-management program improved physical function, mental health, and ability to cope with pain. DESIGN: The research team designed a prospective, nonrandomized, controlled cohort study, enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program (ZISP) who met the studys criteria. The team divided them into two cohorts based on when medical professionals referred them: before (control group) or after (intervention group) introduction of a horticultural therapy program. SETTING: The setting was the rehabilitation clinic (RehaClinic) in Bad Zurzach, Switzerland. PARTICIPANTS: Seventy-nine patients with chronic musculoskeletal pain (fibromyalgia or chronic, nonspecific back pain) participated in the study. INTERVENTIONS: The research team compared a 4-week, inpatient, interdisciplinary pain-management program with horticultural therapy (intervention, n = 37) with a pain-management program without horticultural therapy (control, n = 42). The horticultural therapy program consisted of seven sessions of group therapy, each of 1-hour duration. OUTCOME MEASURES: The research team assessed the outcome using the Medical Outcome Study Short Form-36 (SF-36), the West Haven-Yale Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), the Coping Strategies Questionnaire (CSQ ), and two functional performance tests. The team tested participants on entry to and discharge from the 4-week pain-management program. RESULTS: Between-group differences in sociodemographic and outcome variables were not significant on participants entry to the pain-management program. On discharge, the research team measured small to moderate outcome effects (effect size [ES] up to 0.71) within both groups. The study found significantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical (ES = 0.71 vs 0.22; P = .018); SF-36 mental health (ES = 0.46 vs 0.16; P = .027); HADS anxiety (ES = 0.26 vs 0.03; P = .043); and CSQ pain behavior (ES = 0.30 vs -0.05; P = .032). CONCLUSION: The addition of horticultural therapy to a pain management program improved participants' physical and mental health and their coping ability with respect to chronic musculoskeletal pain.

[Multidisciplinary rehabilitation programs]. / Multimodale Rehabilitationsprogramme.

This is an overview of development, aspects of content, importance and evidence of multidisciplinary rehabilitation programs. In subacute and chronic pain, bio-psycho-social factors act together in a complex manner. The importance of multi-modal treatment programs will, thus, be focused. However, present study data show only few positive effects in this field.

Differences in pain, function and coping in Multidimensional Pain Inventory subgroups of chronic back pain: a one-group pretest-posttest study.

BACKGROUND: Patients with non-specific back pain are not a homogeneous group but heterogeneous with regard to their bio-psycho-social impairments. This study examined a sample of 173 highly disabled patients with chronic back pain to find out how the three subgroups based on the Multidimensional Pain Inventory (MPI) differed in their response to an inpatient pain management program. METHODS: Subgroup classification was conducted by cluster analysis using MPI subscale scores at entry into the program. At program entry and at discharge after four weeks, participants completed the MPI, the MOS Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Coping Strategies Questionnaire (CSQ). Pairwise analyses of the score changes of the mentioned outcomes of the three MPI subgroups were performed using the Mann-Whitney-U-test for significance. RESULTS: Cluster analysis identified three MPI subgroups in this highly disabled sample: a dysfunctional, interpersonally distressed and an adaptive copers subgroup. The dysfunctional subgroup (29% of the sample) showed the highest level of depression in SF-36 mental health (33.4 ± 13.9), the interpersonally distressed subgroup (35% of the sample) a modest level of depression (46.8 ± 20.4), and the adaptive copers subgroup (32% of the sample) the lowest level of depression (57.8 ± 19.1). Significant differences in pain reduction and improvement of mental health and coping were observed across the three MPI subgroups, i.e. the effect sizes for MPI pain reduction were: 0.84 (0.44-1.24) for the dysfunctional subgroup, 1.22 (0.86-1.58) for the adaptive copers subgroup, and 0.53 (0.24-0.81) for the interpersonally distressed subgroup (p = 0.006 for pairwise comparison). Significant score changes between subgroups concerning activities and physical functioning could not be identified. CONCLUSIONS: MPI subgroup classification showed significant differences in score changes for pain, mental health and coping. These findings underscore the importance of assessing individual differences to understand how patients adjust to chronic back pain.

Clinical effectiveness of an interdisciplinary pain management programme compared with standard inpatient rehabilitation in chronic pain: a naturalistic, prospective controlled cohort study.

OBJECTIVE: To compare the effects of an interdisciplinary pain management programme with those of standard in-patient rehabilitation by comprehensive biopsychosocial self--assessment. METHODS: In this naturalistic prospective controlled cohort study, 164 chronic pain patients who participated in the interdisciplinary pain programme and 143 who underwent standard rehabilitation were assessed using standardized instruments. Effect differences were compared bivariately and analysed by multivariate logistic regression to control for baseline differences in the outcome variables and confounders. RESULTS: On entry into the clinic, the interdisciplinary pain programme patients were younger and showed significantly worse mental and psychosocial health than the standard rehabilitation patients. At discharge, the interdisciplinary pain programme patients reported greater improvement on pain (multivariate p = 0.034), social functioning (bivariate p = 0.009), and in trend in catastrophizing and ability to decrease pain. At the 6-month follow-up, the effects experienced by the standard rehabilitation group were higher on physical functioning, social functioning, anxiety, and life control (multivariate p = 0.013-0.050). CONCLUSION: Intensive interdisciplinary rehabilitation with more behavioural therapies was accompanied by a greater improvement in patients who were severely affected by pain, compared with standard rehabilitation by the end of the stay, but not in the mid-term. Highly resource-consuming patients may benefit from subsequent, individually tailored outpatient care.

Interdisciplinary rehabilitation in fibromyalgia and chronic back pain: a prospective outcome study.

UNLABELLED: This study aimed to examine short-term and mid-term course of health, biopsychosocial functional ability, and coping performance of patients with fibromyalgia (FM) or chronic back pain (BP) after participation in a standardized 4-week inpatient, interdisciplinary pain rehabilitation program. In a prospective cohort study, assessments were made by using a set of standardized, well-tested self-rating instruments and other parameters before and after the intervention up to the 6-month follow-up with standardized effect sizes (ES) and comparison to population norms. The effects of improvements in health and coping domains on pain reduction were examined by linear regression modeling. The health of the 65 FM and the 60 BP patients at baseline was far worse than expected from the norms. Improvements included ES up to 1.09 for pain, physical role performance, and mental/affective health dimensions and 0.50 in coping at discharge from the clinic. At the 6-month follow-up, all effects were consistently lower but still up to ES = 0.75. Improvements of FM and BP were equal at discharge but slightly better for the FM's mood scales at the 6-month follow-up. Physical and social function, mood, and coping were significantly associated with pain reduction. PERSPECTIVE: Inpatient, structured interdisciplinary rehabilitation covering elements of cognitive and operant behavioral therapy, graded activity exercise, and adapted drug therapy revealed moderate to large short-term and mid-term improvements in physical and mental health and in the major coping dimensions as captured by comprehensive and specific assessment.