Depression and age as predictors of patient-reported outcome in a multidisciplinary rehabilitation programme for chronic musculoskeletal pain.

BACKGROUND

The recommended treatment for chronic musculoskeletal pain is multidisciplinary, with a cognitive approach. The aim of this study was to investigate health-related quality of life (HRQoL) outcome after a multidisciplinary treatment with a cognitive approach.

METHODS

A total of 131 subjects who participated in a multidisciplinary rehabilitation programme (2005-2008) were studied at baseline and after six months, using the Short Form Short Form 36-item Health Survey questionnaire (SF-36) as primary outcome (HRQoL), and the Hospital Anxiety and Depression Scale (HAD) and pain as secondary outcomes and possible baseline predictors for HRQoL.

RESULTS

Complete data were available for 97 subjects (85 women, mean age [SD] 44.6 [9.7] years). The SF-36 subscales physical function (PF), general health (GH), vitality (VT), social function (SF) and mental health (MH), the visual analogue scale for pain and the HAD improved significantly (p < 0.05) at follow-up compared with baseline. A pre-treatment probable depression (HAD score ≥11) was associated with a favourable outcome of the SF-36 subscales PF (odds ratio [OR] 5.6; p = 0.01), VT (OR 4.3; p = 0.02) and MH (OR 3.6; p = 0.02). A probable anxiety (HAD score ≥11) was associated with a favourable outcome of PF (OR 2.6; p = 0.05). There was an even stronger association for younger subjects (20-45 years), with probable depression scores at baseline and a favourable HRQoL outcome at follow up.

CONCLUSION

This multidisciplinary rehabilitation programme, using a non-pharmacological cognitive approach, seemed to yield a better outcome concerning HRQoL measures in younger subjects with higher depression scores at baseline. This information is important for clinics when tailoring a multidisciplinary rehabilitation programme for patients with musculoskeletal chronic pain.