1. Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
- Author
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Gerdle B, Dragioti E, Rivano Fischer M, and Ringqvist Å
- Subjects
anxiety ,chronic pain ,coping strategies ,depression ,health ,pain management ,Medicine (General) ,R5-920 - Abstract
Björn Gerdle,1 Elena Dragioti,1 Marcelo Rivano Fischer,2,3 Åsa Ringqvist2 1Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 2Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden; 3Department of Health Sciences, Faculty of Medicine, Lund University, Lund, SwedenCorrespondence: Björn Gerdle, Email bjorn.gerdle@liu.seBackground: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies.Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator.Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008– 2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims.Results: Changes in acceptance (β:0.424– 0.553; all P< 0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177– 0.233; all P< 0.001) and changes in fear-avoidance (β: − 0.152– − 0.186; all P< 0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator.Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.Keywords: anxiety, chronic pain, coping strategies, depression, health, pain management
- Published
- 2024