Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
Department of Health Sciences, Rehabilitation Medicine, Lund University, Lund, Sweden.
Eur J Pain. 2019 Nov;23(10):1839-1849. doi: 10.1002/ejp.1457. Epub 2019 Aug 8.
Throughout the world many people have both obesity and chronic pain, comorbidities that decrease Health-Related Quality of Life (HRQoL). It is uncertain whether patients with comorbid obesity can maintain improved HRQoL after Interdisciplinary Multimodal Pain Rehabilitation (IMMPR).
Data from 2016, 2017, and 2018 were obtained from a national pain database for Swedish specialized pain clinics and collected at three time points: Pre-IMMPR; Post- IMMPR; and 12-month follow-up (FU-IMMPR). Participants (N = 872) reported body weight, height, pain aspects, and HRQoL (RAND 36-Item Health Survey). Severe obesity (Body Mass Index, BMI ≥35 kg/m ) was defined according to WHO classifications. We used linear mixed regression models to examine BMI group differences in HRQoL over time.
More than 25% of patients (224/872) were obese and nearly 30% (63/224) of these were severely obese. All BMI groups improved significantly in both physical and mental composites of HRQoL after IMMPR (Pre- vs. Post-IMMPR, p < .001). The improvements were maintained at a 12-month follow-up (Post- vs. FU-IMMPR, p > .05). The severe obesity group had the lowest physical health score and least improvement (pre- vs. FU-IMMPR, Cohen's d = o.422, small effect size). Severe obesity had negative impact on physical health (β = -4.39, p < .05) after controlling for sociodemographic factors and pain aspects.
Improvements in HRQoL after IMMPR were achieved and maintained across all weights, including patients with comorbid obesity. Only severe obesity was negatively associated with physical health aspects of HRQoL.
Patients with chronic pain and comorbid obesity achieve sustained Health-Related Quality of Life (HRQoL) improvements from Interdisciplinary Multimodal Pain Rehabilitation (IMMPR). This finding suggests that rehabilitation professionals should consider using IMMPR for patients with comorbid obesity even though their improvement may not reach the same level as for non-obese patients.
在世界范围内，许多人同时患有肥胖症和慢性疼痛，这两种疾病都会降低健康相关生活质量（HRQoL）。目前尚不确定患有肥胖合并症的患者在接受跨学科多模式疼痛康复（IMMPR）后是否能够保持 HRQoL 的改善。
从瑞典专门的疼痛诊所的国家疼痛数据库中获取了 2016 年、2017 年和 2018 年的数据，并在三个时间点收集数据：IMMPR 前；IMMPR 后；和 12 个月随访（FU-IMMPR）。参与者（N=872）报告了体重、身高、疼痛方面和 HRQoL（RAND 36-Item Health Survey）。根据世界卫生组织的分类，严重肥胖（BMI≥35kg/m）定义为 BMI≥35kg/m。我们使用线性混合回归模型来检查 BMI 组在不同时间点 HRQoL 的差异。
超过 25%的患者（224/872）肥胖，其中近 30%（63/224）为严重肥胖。所有 BMI 组在接受 IMMPR 后，在身体和心理 HRQoL 综合方面都有显著改善（Pre- vs. Post-IMMPR，p<.001）。在 12 个月的随访中，这种改善仍然存在（Post- vs. FU-IMMPR，p>.05）。严重肥胖组的身体健康评分最低，改善最小（pre- vs. FU-IMMPR，Cohen's d=0.422，小效应量）。在控制社会人口因素和疼痛方面后，严重肥胖对身体健康（β=-4.39，p<.05）有负面影响。
IMMPR 后 HRQoL 的改善在所有体重范围内都得到了实现和维持，包括患有肥胖合并症的患者。只有严重肥胖与 HRQoL 的身体健康方面呈负相关。
患有慢性疼痛和肥胖合并症的患者通过跨学科多模式疼痛康复（IMMPR）获得持续的健康相关生活质量（HRQoL）改善。这一发现表明，康复专业人员应该考虑为患有肥胖合并症的患者使用 IMMPR，即使他们的改善可能达不到非肥胖患者的水平。
