Patients' pretreatment beliefs about recovery influence outcome of a pain rehabilitation program.
OBJECTIVE
The aim of this study was to monitor the outcome of a five-week cognitive-behavioral interdisciplinary rehabilitation program for patients disabled by chronic pain, utilizing data collected for a national quality registry.


METHODS
The study included 255 consecutive patients from a university hospital setting. Demographic data and patient beliefs about recovery recorded on a five-category scale were collected before the program. Pain intensity (VAS), Disability Rating Index (DRI) and life satisfaction (LiSat-11) were collected before, immediately after and one year after the program. Partial respondents and non-respondents were excluded;168 patients remained.


RESULTS
Pain intensity decreased (''pain now''; Friedman's test, P<0.0001) by 13 mm (median) after the program, (Dunn's test; P<0.001) and by 5 mm after one year (P<0.05). Only one of twelve DRI items (activity), ''participating in exercise/sports'' improved significantly after rehabilitation (Wilcoxon's test; P=0.0009), and remained improved one year later (P=0.0144). Life satisfaction in the physical and psychological domains increased after the program. A clinically meaningful reduction in pain intensity (10 mm) was reported by 43% of patients at the one-year follow-up. This group had significant increases in life satisfaction. Only patients with positive beliefs about recovery before rehabilitation showed a decrease in pain intensity at the one-year follow-up (P<0.028).


CONCLUSIONS
The program influenced the pain, life satisfaction and, to a small extent, activity. A clinically relevant pain reduction and an increase in life satisfaction were related. Patients' pretreatment beliefs about recovery influenced the long-term decrease of pain intensity, indicating that more attention should be focused on patients' pretreatment beliefs.
Merrick
D
D
Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark. daniel.merrick@rehabmed.umu.se
Sjölund
B H
BH
D000203:Activities of Daily Living; D000328:Adult; D001294:Attitude to Health; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology* / Q000534:rehabilitation*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000379:methods; D011788:Quality of Life / Q000523:psychology; D018434:Sickness Impact Profile; D016896:Treatment Outcome