Center for Pain Management, Rehabilitation Institute of Chicago, Chicago 60611, USA.
Pain Pract. 2013 Apr;13(4):282-8. doi: 10.1111/j.1533-2500.2012.00586.x. Epub 2012 Aug 3.
Assess the efficacy of an outpatient-based interdisciplinary pain rehabilitation program for patients with active workers compensation claims.
Data were available for 101 patients, primarily with chronic low back pain (75%), who participated in the program.
Treatment included a 4-week (Monday to Friday), 8-hours/day graded progressive program that included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, pool therapy, vocational counseling, patient education and medical management). Outcome measures included program completion status, release-to-work status, return-to-work status, total scores on the Beck depression inventory, state-trait anxiety inventory, pain catastrophizing scale, and the McGill pain questionnaire visual analogue scale (MPQ VAS). The majority of the patients (65%) graduated from the program. Pre-postoutcome data were available for those who graduated from the program. For noncompleters, last obtained MPQ VAS was compared with their initial MPQ VAS scores.
Of those completing the program, most patients (91%)were released to return to work; with 80% released to full-time status and 11% released to gradual return. Approximately half (49%) of the program completers returned to work. Paired-samples t-tests showed that program completers had significant reductions in depression (P = 0.000), pain-related catastrophizing (P = 0.033), and pain intensity (P = 0.000), but not in anxiety (P = 0.098). Interestingly, the last obtained (at early discharge/withdrawal) pain intensity scores (M = 70.33) were higher than at baseline (M = 61.20) in the noncompleters. This difference was not statistically significant (P = 0.127) but may be clinically meaningful.
Our results support the efficacy of an outpatient-based 4-week interdisciplinary pain rehabilitation program in decreasing emotional distress, reducing pain intensity, and improving return-to-work status in the majority of completers in this challenging population. Patients reporting increased pain at discharge or those discharged early may have been due to operant factors.
评估基于门诊的多学科疼痛康复计划对有活跃工人赔偿要求的患者的疗效。
数据可用于 101 名患者，主要患有慢性下腰痛（75％），他们参加了该计划。
治疗包括为期 4 周（星期一至星期五），每天 8 小时的分级渐进式计划，包括个体和小组治疗（疼痛心理学、物理治疗、职业治疗、放松训练/生物反馈、有氧运动、游泳池治疗、职业咨询、患者教育和医疗管理）。结果测量包括计划完成状态、工作释放状态、工作返回状态、贝克抑郁量表、状态特质焦虑量表、疼痛灾难化量表和麦吉尔疼痛问卷视觉模拟量表（MPQ VAS）的总评分。大多数患者（65％）从该计划毕业。对于从该计划毕业的患者，提供了预后结果数据。对于未完成者，将最后获得的 MPQ VAS 与他们的初始 MPQ VAS 评分进行比较。
在完成该计划的患者中，大多数（91％）患者被释放以返回工作；80％被释放为全职，11％被释放为逐步返回。大约一半（49％）的计划完成者返回工作。配对样本 t 检验显示，计划完成者的抑郁（P = 0.000）、与疼痛相关的灾难化（P = 0.033）和疼痛强度（P = 0.000）显著降低，但焦虑（P = 0.098）没有。有趣的是，未完成者的最后一次获得的疼痛强度评分（M = 70.33）高于基线（M = 61.20），但差异无统计学意义（P = 0.127），但可能具有临床意义。
我们的结果支持基于门诊的 4 周多学科疼痛康复计划的疗效，该计划可减少情绪困扰，降低疼痛强度，并改善大多数复杂人群中的康复状态。在出院或提前出院时报告疼痛增加的患者可能是由于操作性因素。
