The long-term outcome of interdisciplinary treatment in patients with chronic musculoskeletal pain on level of disability

Abstract

Rationale: Chronic musculoskeletal pain (CMP) can lead to increasing level of disability and other limitations in daily functioning and participation. Evidence of the long-term outcome of interdisciplinary treatment on level of disability in patients with CMP is scarce and a responder analyses were not conducted. Aim: The aim of the present study was to measure the long-term outcome of interdisciplinary treatment on level of disability in patients with CMP and to calculate the responder rate. Methods: Data were recorded routinely at admission, discharge, and at three, six and 12 months’ follow up for all consecutive patients referred to a rehabilitation program between July 1st, 2017 and December 31st, 2018. The interdisciplinary treatment program consisted of Pain Neuroscience Education, Cognitive Behavioural Therapy, Graded Activity, individual therapy by a psychologists and physical therapists and goal setting and (mid-term) evaluation with coordinator and physiatrist. Assessments included the Pain Disability Index (PDI), Beck’s Depression Inventory (BDI), Checklist Individual Strength (CIS) and Tampa Scale of Kinesiophobia (TSK). Mixed-model analysis was used to analyze changes over time and responder analysis was used to measure the responder rate. Results: 628 patients were included in this study [mean age 44.2 (standard deviation 12.0) years], 460 (73.2%) of whom were women. Data from 484 (77.1%), 26 (4.1%), and 35 (5.6%) patients was available respectively at discharge, three- and six months follow-up. No data was available at 12 months’ follow-up. The level of disability showed significant improvement between admission and discharge (p=0.000), and three months follow-up (p=0.008). The responder rate for the different patient groups stratified in PDI scores at baseline was respectively 51.5%, 52.8% and 53.7%. Conclusion: Patients with CMP showed a significant improvement on level of disability directly after discharge and was maintained until three months after discharge. Over half of the patients with CMP showed clinically relevant improvement on level of disability at discharge. Clinical relevance: Referring patients with CMP in an earlier disease stage to interdisciplinary treatment can have a beneficial effect on the outcome on level of disability. Further research is recommended of matched-care referral policy in patients with CMP.