Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
J Rehabil Med. 2020 Feb 27;52(2):jrm00023. doi: 10.2340/16501977-2649.
To investigate the outcomes 1 year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after 1 year.
A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and 1 year after multimodal rehabilitation programmes.
Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, confidence interval (CI) 1.21-1.06, p = 0.005).
This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.
调查初级保健中多模式康复方案对慢性疼痛患者的 1 年治疗效果，包括整体效果以及对男性和女性的分别效果。第二个目的是确定 1 年后随访时无病假的预测因素。
对来自瑞典两个郡的 234 名年龄在 18-65 岁的患者（34 名男性和 200 名女性）进行前瞻性纵向队列研究，他们参加了初级保健中的多模式康复方案。在多模式康复方案之前和 1 年后评估疼痛、身体和情绪功能、应对方式、健康相关生活质量、与工作相关的因素、病假（病假、病假补偿/残疾抚恤金）。
患者在所有指标上（所有 p 值均≤0.004），除对职业满意度（p=0.060）外，在 1 年随访时均有显著改善。随访时，病假患者的比例显著下降（p=0.027），而病假补偿/残疾抚恤金患者的比例无显著差异（p=0.087）。自我评估的工作能力越高，1 年随访时无病假的可能性就越大（比值比（OR）为 1.19，置信区间（CI）为 1.21-1.06，p=0.005）。
本研究表明，初级保健中的多模式康复方案可能对慢性疼痛患者有益，因为疼痛、身体和情绪功能、应对方式以及健康相关生活质量的 1 年随访结果是积极的。然而，效果大小较小，因此需要进一步开发多模式康复方案，以提高治疗效果。
