School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden.
Department of Clinical Sciences Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital AB, Mörbygårdsvägen, SE 182 88 Stockholm, Sweden.
Spine J. 2018 Aug;18(8):1475-1482. doi: 10.1016/j.spinee.2017.11.014. Epub 2017 Nov 16.
Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD).
The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR).
The design of this investigation was a cohort study with 1-year postrehabilitation follow-up.
The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015.
The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR.
Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up.
The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR).
Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up.
For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD.
研究表明，与心理灵活性相关的疼痛接受策略在慢性肌肉骨骼疼痛中很重要。然而，在与挥鞭样损伤相关的疾病（WAD）患者中，这些策略的预测因素尚未得到广泛研究。
本研究的目的是在接受多模式康复（MMR）前后，通过疼痛强度、运动恐惧、重要他人感知反应、结果预期和人口统计学变量，预测 WAD 患者在 1 年随访时的慢性疼痛接受和活动参与情况。
本研究设计为队列研究，有 1 年的康复后随访。
该研究的参与者在瑞典一家康复诊所接受 MMR，时间为 2009 年至 2015 年。
患者经历过挥鞭样损伤（WAD Ⅰ-Ⅱ级），患有疼痛和功能障碍。共有 386 名参与者入组：297 名完成了康复后评估，177 名在 MMR 后 1 年进行了随访。
康复前的结果预期、重要他人的支持和干扰反应、对（再）受伤和运动的恐惧，以及 MMR 后的疼痛强度和对（再）受伤和运动的恐惧，是随访时活动参与的显著预测因素。康复前重要他人的支持反应和对（再）受伤和运动的恐惧，以及 MMR 后的疼痛强度和对（再）受伤和运动的恐惧，是随访时活动参与的显著预测因素。康复前重要他人的支持反应和对（再）受伤和运动的恐惧，是 1 年随访时疼痛接受的显著预测因素。康复后重要他人的关心反应和对（再）受伤和运动的恐惧是随访时疼痛接受的显著预测因素。
对于活动参与和疼痛接受，运动恐惧似乎是最强的预测因素，但在管理 WAD 时需要考虑患者对配偶的感知反应。
