Koele Robin, Volker Gerard, van Vree Félicie, van Gestel Marc, Köke Albère, Vliet Vlieland Theodora
Rijnlands Rehabilitation Centre, Leiden, the Netherlands.
Musculoskeletal Care. 2014 Dec;12(4):210-20. doi: 10.1002/msc.1076. Epub 2014 Jun 11.
Evidence for the efficacy of a multi-component approach for chronic widespread musculoskeletal pain (CWP) has been reported, although the effects are overall moderate and this approach has rarely been investigated in real life.
The aim of the study was to describe the effects of a 15-week multidisciplinary pain rehabilitation programme on pain, activities and participation in patients with CWP.
The current retrospective study used data which were routinely gathered on all consecutive patients with CWP referred to a rehabilitation programme over a 21-month period. The 15-week multidisciplinary rehabilitation programme consisted of cognitive behavioural therapy and exercise, as well as individual and group sessions with additional treatment modalities. Assessments included the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Multidimensional Pain Inventory (MPI), numerical scales for pain and fatigue, the Canadian Occupational Performance Measure (COPM), the one-minute stair-climb test and the RAND-36. Paired t-tests and Wilcoxon signed-rank tests were carried out to analyse changes over time.
A total of 165 patients were included [mean age 44.1 (standard deviation 12.9) years], 143 (87%) women). Discharge data were available for 154 patients (93%). All outcomes showed statistically significant improvements between admission and discharge (p<0.05), with the largest effect sizes (>1.0) observed for the COPM. A longer duration of complaints was associated with less improvement in the PDI.
In daily rehabilitation practice, a 15-week multidisciplinary treatment programme for patients with CWP showed statistically significant improvements in pain, activities and participation over time. Future studies are needed further to substantiate the long-term cost-effectiveness, and to identify the patients who benefit the most.
尽管多成分疗法对慢性广泛性肌肉骨骼疼痛（CWP）疗效的证据已有报道，但其效果总体中等，且该疗法在现实生活中很少得到研究。
本研究旨在描述一项为期15周的多学科疼痛康复计划对CWP患者疼痛、活动及参与度的影响。
本项回顾性研究使用了在21个月期间转诊至康复计划的所有连续性CWP患者的常规收集数据。为期15周的多学科康复计划包括认知行为疗法和运动，以及包含其他治疗方式的个体和团体治疗。评估指标包括疼痛残疾指数（PDI）、疼痛灾难化量表（PCS）、多维疼痛量表（MPI）、疼痛和疲劳数字评分量表、加拿大职业表现测量量表（COPM）、一分钟爬楼梯试验和兰德36项健康调查量表。采用配对t检验和Wilcoxon符号秩检验分析随时间的变化情况。
共纳入165例患者[平均年龄44.1（标准差12.9）岁]，其中143例（87%）为女性。154例患者（93%）有出院数据。所有结局指标在入院和出院之间均有统计学显著改善（p<0.05），COPM的效应量最大（>1.0）。疼痛持续时间越长，PDI改善越小。
在日常康复实践中，针对CWP患者的为期15周的多学科治疗计划随时间推移在疼痛、活动及参与度方面显示出统计学显著改善。未来需要进一步研究以证实其长期成本效益，并确定受益最大的患者。
