Chronic pain and vocational rehabilitation: A multifactorial analysis of symptoms, signs, and psycho-socio-demographics.
In this prospective investigation, 80 vocational rehabilitation clients with locomotor pain ("algias") were investigated. Symptoms (23 items; yes/no alternatives), signs (24 items; sign present/not present), and a series of demographic and psycho-social variables (11 items) were recorded. Symptoms and signs generally characterized the clients as "dorsalgic" rather than suffering from low back or neck pain. In spite of this fact, factor analyses formed seven symptom and eight sign factors, which in a subsequent factor analysis pairwise formed statistical, yet meaningful, entities (meta-factors) suggesting five regional, two postural, and one relational "syndrome." These syndromes may not necessarily be generalizable but they may be of clinical descriptory value. At the 2-year follow-up, the vocational outcome (success/failure) for 73% of the subjects could be correctly classified. The most powerful overall predictors, particularly for the failures, were sex and belief in vocational return, whereas only one of the syndromes had predictive impact. Hence, psycho-socio-demographic variables appear to be of greater importance in predicting the outcome of vocational rehabilitation for chronic pain patients than the symptoms and signs recorded by the physician.
Department of Physical Medicine and Rehabilitation, University of Umeå, S-901 85, Umeå, Sweden.
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