title: Does Classification of Chronic Musculoskeletal Disorder Patients Into Psychosocial Subgroups Predict Differential Treatment Responsiveness and 1-Year Outcomes After a Functional Restoration Program?
abstract: OBJECTIVE
  The objectives of this study: (1) to assess whether Multidimensional Pain Inventory (MPI) profiles predicted differential responses to a functional restoration program (FRP) in chronic disabling occupational musculoskeletal disorder (CDOMD) patients; (2) to examine whether coping style improves following FRP; and (3) to determine whether discharge MPI profiles predict discharge psychosocial and 1-year socioeconomic outcomes.
  
  
  METHODS
  Consecutive CDOMD patients (N=716) were classified into Adaptive Coper (AC, n=209), Interpersonally Distressed (ID, n=154), Dysfunctional (DYS, n=310), and Anomalous (n=43) using the MPI, and reclassified at discharge. Profiles were compared on psychosocial measures and 1-year socioeconomic outcomes. An intent-to-treat sample analyzed the effect of drop-outs on treatment responsiveness.
  
  
  RESULTS
  The MPI classification significantly predicted program completion (P=0.001), although the intent-to-treat analyses found no significant effects of drop-out on treatment responsiveness. There was a significant increase in the number of patients who became AC or Anomalous at FRP discharge and a decrease in those who were ID or DYS. Patients who changed or remained as DYS at FRP discharge reported the highest levels of pain, disability, and depression. No significant interaction effect was found between MPI group and time for pain intensity or disability. All groups improved on psychosocial measures at discharge. DYS patients had decreased work retention and a greater health care utilization at 1 year.
  
  
  CONCLUSIONS
  An FRP was clinically effective for CDOMD patients regardless of initial MPI profiles. The FRP modified profiles, with patients changing from negative to positive profiles. Discharge DYS were more likely to have poor 1-year outcomes. Those classified as Anomalous had a good prognosis for functional recovery similar to ACs.
authors.affiliation: *PRIDE Research Foundation †Department of Orthopedic Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas ‡Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, TX.
authors.forename: Sali
authors.initials: S
authors.lastname: Asih
authors.forename: Tom G
authors.initials: TG
authors.lastname: Mayer
authors.forename: Mark
authors.initials: M
authors.lastname: Williams
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Choi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gatchel
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D000704:Analysis of Variance; D002908:Chronic Disease; D003863:Depression / Q000209:etiology*; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D010147:Pain Measurement; D010554:Personality Disorders / Q000209:etiology*; D010555:Personality Inventory; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012923:Social Class