Grimby-Ekman Anna, Kim Malin, Stankovic Nenad, Mannheimer Clas
Chronic Pain, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden.
Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden.
Pain Rep. 2021 Jun 16;6(2):e938. doi: 10.1097/PR9.0000000000000938. eCollection 2021 Jul-Aug.
Chronic pain is treated with multimodal rehabilitation programs, targeting improvement in several health aspects. These treatments must be evaluated multidimensionally, which is a methodological challenge.
This study investigated factors (demographic, pain-related, and individual- vs group-based treatment) predicting successful outcomes after multimodal pain rehabilitation programs.
Data from 3 outpatient clinics were retrieved from the Swedish Quality Registry for Pain Rehabilitation, for 314 patients (218 women). Outcome variables were dichotomized as binary change (improved or not improved) based on clinical thresholds. Total improvement grouped outcomes into 0 to 2, 3 to 4, and 5 to 6 improved variables. Binary logistic regression analyses investigated the association between the baseline predictors and change variables.
Patients improving after treatment ranged from 34% (pain intensity) to 80% (depression) for women and 34% to 76% for men, respectively. Total improvement outcome was consistent (after treatment and 1 year) with 28% of patients improving on 5 to 6 outcomes. The baseline predictor related to most improved outcomes was pain intensity, with positive correlation to improvement in pain intensity ( < 0.001) and negative correlation with improvements in anxiety ( = 0.075) and depression ( = 0.002). Individual-based treatment, compared with group-based treatment, was associated with improvement in pain intensity ( = 0.008).
About a third of patients improved in several outcomes by the end of a multimodal program, with most improvement for depression and least for pain intensity. Generally, patients with more severe health status at baseline improve most directly after treatment, but these findings could not suggest treatment adjustments that would improve overall success rates.
慢性疼痛采用多模式康复计划进行治疗，目标是在多个健康方面取得改善。这些治疗必须进行多维度评估，这是一个方法学上的挑战。
本研究调查了预测多模式疼痛康复计划后成功结果的因素（人口统计学因素、疼痛相关因素以及基于个体与基于团体的治疗）。
从瑞典疼痛康复质量登记处检索了3家门诊诊所的314例患者（218名女性）的数据。基于临床阈值，将结局变量二分法化为二元变化（改善或未改善）。总体改善将结局分为0至2个、3至4个和5至6个改善变量。二元逻辑回归分析研究了基线预测因素与变化变量之间的关联。
治疗后改善的女性患者比例从34%（疼痛强度）到80%（抑郁）不等，男性患者比例从34%到76%不等。总体改善结果在治疗后和1年后保持一致，28%的患者在5至6个结局上得到改善。与大多数改善结局相关的基线预测因素是疼痛强度，与疼痛强度改善呈正相关（<0.001），与焦虑（=0.075）和抑郁（=0.002）改善呈负相关。与基于团体的治疗相比，基于个体的治疗与疼痛强度改善相关（=0.008）。
在多模式计划结束时，约三分之一的患者在多个结局上得到改善，抑郁改善最多，疼痛强度改善最少。一般来说，基线健康状况较差的患者在治疗后改善最直接，但这些发现无法提出能提高总体成功率的治疗调整建议。
