Gerdle Björn, Boersma Katja, Åsenlöf Pernilla, Stålnacke Britt-Marie, Larsson Britt, Ringqvist Åsa
Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden.
School of Law, Psychology and Social Work, Örebro University, SE-701 82 Örebro, Sweden.
J Clin Med. 2020 Jul 25;9(8):2374. doi: 10.3390/jcm9082374.
This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.
本研究调查了性别、教育程度和出生国家对跨学科多模式疼痛康复项目（IMMRPs）临床表现及治疗效果的影响。多变量改善评分（MIS）以及对疼痛变化和应对生活状况能力的两项回顾性评估被用作IMMRPs的三项总体治疗效果指标。研究对象包括2008年至2016年期间瑞典疼痛康复质量登记处（SQRP）专科护理中的慢性疼痛患者，基线时共有39916例，其中参与IMMRPs的亚组有14666例。基于性别、教育程度和原籍国的聚类分析显示，在以下方面存在显著差异：基线临床状况最佳的是受过大学教育的欧洲女性，而基线临床状况最差的是所有出生在欧洲以外、具有不同教育程度的男女患者（即中等至较大效应量）。此外，受过大学教育的欧洲女性对IMMRPs的总体治疗效果也最为有利（效应量较小）。这些结果引发了有关公平和平等的重要问题，在优化针对慢性疼痛患者的IMMRPs评估、内容和实施时需要加以考虑。
