Background and objectives: Although Interdisciplinary Multimodal Pain Treatment (IMPT) programmes share a biopsychosocial approach to increase the wellbeing of patients with chronic pain, substantial variation in content and duration have been reported. In addition, it is unclear to what extent any favourable health outcomes are maintained over time. Therefore, our first aim was to identify and analyse the change over time of patient-related outcome measures in cohorts of patients who participated in IMPT programmes. Our second aim was to acquire insight into the heterogeneity of IMPT programmes. Databases and data treatment: The study protocol was registered in Prospero under CRD42018076093. We searched Medline, Embase, PsycInfo and Cinahl from inception to May 2020. All study selection, data extraction and risk of bias assessments were independently performed by two researchers. Study cohorts were eligible if they included adult patients with chronic primary musculoskeletal pain for at least 3 months. We assessed the change over time, by calculating pre-post, post-follow-up and pre-follow-up contrasts for seven different patient-reported outcome domains. To explore the variability between the IMPT programmes, we summarized the patient characteristics and treatment programmes using the intervention description and replication checklist. Results: The majority of the 72 included patient cohorts significantly improved during treatment. Importantly, this improvement was generally maintained at follow-up. In line with our expectations and with previous studies, we observed substantial methodological and statistical heterogeneity. Conclusions: This study shows that participation in an IMPT programme is associated with considerable improvements in wellbeing that are generally maintained at follow-up. The current study also found substantial heterogeneity in dose and treatment content, which suggests different viewpoints on how to optimally design an IMPT programme. Significance: The current study provides insight into the different existing approaches regarding the dose and content of IMPT programs. This analysis contributes to an increased understanding of the various approaches by which a biopsychosocial perspective on chronic pain can be translated to treatment programs. Furthermore, despite theoretical and empirical assertions regarding the difficulty to maintain newly learned health behaviors over time, the longitudinal analysis of health outcomes did not find a relapse pattern for patients who participated in IMPT programs.
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A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism. In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
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Objective: To explore predictors of dropout of patients with chronic musculoskeletal pain from an interdisciplinary chronic pain management programme, and to develop and validate a multivariable prediction model, based on the Extended Common- Sense Model of Self-Regulation (E-CSM). Methods: In this prospective cohort study consecutive patients with chronic pain were recruited and followed up (July 2013 to May 2015). Possible associations between predictors and dropout were explored by univariate logistic regression analyses. Subsequently, multiple logistic regression analyses were executed to determine the model that best predicted dropout. Results: Of 188 patients who initiated treatment, 35 (19%) were classified as dropouts. The mean age of the dropout group was 47.9 years (standard deviation 9.9). Based on the univariate logistic regression analyses 7 predictors of the 18 potential predictors for dropout were eligible for entry into the multiple logistic regression analyses. Finally, only pain catastrophizing was identified as a significant predictor. Conclusion: Patients with chronic pain who catastrophize were more prone to dropout from this chronic pain management programme. However, due to the exploratory nature of this study no firm conclusions can be drawn about the predictive value of the E-CSM of Self-Regulation for dropout.
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Aanleiding Hoe effectief zijn de chronische pijnprogramma's, vooral op de lage termijn? Die vraag leeft bij een aantal revalidatiecentra in Nederland. De revalidatiecentra behandelen patiënten met chronische musculoskeletale pijn. Veel van de patiënten hebben of krijgen te maken met persoonlijk en maatschappelijk disfunctioneren. Programma's zijn met name gericht op het beïnvloeden en veranderen van het gedrag van patiënten, zodat ze in hun dagelijks leven beter met de pijn om kunnen gaan. Zelfmanagement speelt daarbij een belangrijke rol. Echter, patiënten met chronische pijnklachten zijn lang niet altijd trouw aan hun therapie en gaan ook niet altijd goed om met een terugval. Hulpverleners in chronische-pijnbehandelteams van revalidatiecentra en ziekenhuizen constateren dat een deel van hun patiënten zelfmanagement niet volledig kunnen bestendigen in het dagelijks leven. Doelstellingen Vanuit de beroepspraktijk is de volgende vraag geformuleerd: wat is het langetermijneffect van een chronische-pijnprogramma en zijn er strategieën te ontwikkelen om een eventuele terugval te voorkomen? Deze vraag is leidend in het RAAK-project SOLACE. Het start met een onderzoek naar het langetermijneffect van een revalidatieprogramma en meet de terugval van patiënten die een programma hebben gevolgd. Daarna worden strategieën ontwikkeld die gericht zijn op gedragsbehoud. Professionals, onderzoekers, studenten en docenten werken hierbij nauw samen. Om de effectiviteit van de strategieën in de praktijk te testen, wordt een pilot uitgevoerd. Boogde resultaten Het SOLACE-project verbindt het onderwijs- en onderzoeksveld met de beroepspraktijk door het samen ontwikkelen van strategieën die het vermogen tot zelfmanagement van patiënten met chronische pijn vergroten. Verspreiding van de opgedane kennis en ervaring vindt plaats via de verschillende projectpartners en hun netwerken. Denk aan intercollegiaal overleg, stages en fysiotherapeutische en pijngenootschappen. Daarnaast zullen de resultaten geïmplementeerd worden in het onderwijs van het Instituut voor Bewegingsstudies van de Hogeschool Utrecht.
