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Skattning av prognostiska faktorer för gradering av smärtans komplexitet hos patienter i behov av multimodal smärtrehabilitering inom två vårdnivåer.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
2011 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Abstract

PURPOSE: The aim of this study was to describe and compare possible differences regarding selected prognostic factors for disability between patients with non-specific chronic pain who were about to start a multidisciplinary treatment program (MMR), either within primary care (MMR1) or hospital care (MMR2).

METHODS: The study had a descriptive and comparative cross sectional design. Eighty-nine patients were recruited consecutively when they were about to start their team treatment (50 in MMR1,39 in MMR2). The measurements were; Evaluation of self-reported self-efficacy for eight daily activities (STIVA-8), The Pain Belief Screening Instrument (PBSI) and Hospital Anxiety and Depression Scale (HADS).

RESULTS: The study found some significant differences between the answers from patients in MMR1 and those from patients in MMR2. For instance, patients in MMR2 estimated lower self-efficacy according to STIVA-8 than patients in MMR1. Also, there were fewer low risk patients and more high risk patients in MMR2 than in MMR1 regarding pain intensity according to PBSI. In addition to this, there were fewer patients without depression and more with moderate depression in MMR2 than in MMR1 according to HADS.

No significant differences could be shown for either anxiety according to HADS or for low- and high risk regarding activity disability according to PBSI. No significant differences could be found when pain intensity was measured with mean values on a scale from 0-10.

CONCLUSIONS: Patients in MMR2 experienced more negative consequences from their pain disease than patients in MMR1. Systematic use of standardized self-reported instruments for selected prognostic factors could be helpful when screening for complexity and make it easier to decide whether the rehabilitation should be within MMR1 or MMR2 for patients in need of MMR.

Abstract [sv]

Sammanfattning

SYFTE: Syftet med denna studie var att beskriva och jämföra om patienter med långvarig smärtproblematik inom primärvård (MMR1) respektive specialiserad sjukhusvård (MMR2), som stod i begrepp att påbörja multimodal smärtrehabilitering (MMR), skattade olika avseende ett antal prognostiska faktorer för funktionsförmåga.

METOD: Studien hade en deskriptiv och komparativ tvärsnittsdesign. Åttionio konsekutivt tillfrågade patienter deltog (50 i MMR1, 39 i MMR2). Datainsamlingen gjordes vid start av MMR med tre självskattningsformulär; Skattning av tilltro till sin förmåga att utföra åtta specificerade vardagsaktiviteter (STIVA-8), The Pain Belief Screening Instrument (PBSI) och Hospital Anxiety and Depression Scale (HADS).

RESULTAT: Studien visade statistiskt signifikanta skillnader avseende att patienterna i MMR2 skattade lägre tilltro till sin förmåga enligt STIVA-8, det var färre andel lågriskpatienter och större andel högriskpatienter i MMR2 avseende smärtintensitet enligt PBSI samt färre andel patienter utan depression i MMR2 och fler med måttliga depressionsbesvär i MMR2 enligt HADS. Inga signifikanta skillnader kunde visas avseende låg- och högrisk för aktivitetsbegränsning enligt PBSI och inte heller för ångest enligt HADS. När smärtintensitet beräknades med medelvärde på skalan 0-10 fanns inga signifikanta skillnader.

KONKLUSION: Patienterna i MMR2 skattade mer negativa konsekvenser av sin smärtsjukdom än i MMR1. Systematisk användning av skattningsformulär som ringar in olika prognostiska faktorer bör kunna underlätta selektion och sortering vid val av vårdnivå för patienter i behov av MMR.

Place, publisher, year, edition, pages
2011. , 25 p.
Keyword [en]
Chronic pain, multidisciplinary treatment, prognostic factors, treatment allocation
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-161968OAI: oai:DiVA.org:uu-161968DiVA: diva2:457984
Uppsok
Medicine
Supervisors
Examiners
Available from: 2011-11-29 Created: 2011-11-21 Last updated: 2011-11-29Bibliographically approved

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