title: Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy?
abstract: To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients.
  
  
  
  In-depth analyses of secondary outcomes of a randomized-controlled trial.
  
  
  
  Women (N = 187) with fibromyalgia.
  
  
  
  Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain catastrophizing. Individual and group associations between outcomes were examined.
  
  
  
  Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (rs= 0.08, p = 0.27) and process (rs= 0.12, p = 0.11), not even in those patients with a clinically relevant improvement in observed functioning (38.5%), and only weakly or moderatly with changes in SF-36-PF; (rs= 0.31, p < 0.0001), SF-36-MSC; (rs= 0.41, p < 0.0001), and pain catastrophizing (rs= -0.31, p < 0.0001). No differences in pain self-efficacy were observed between the rehabilitated group and controls (difference: 1.61; 95% CI: -0.84 to 4.06; p = 0.24). However, a subgroup (34%) had a clinically relevant improvement in pain self-efficacy. This group was younger (mean age 41.4 vs. 45.8, p = 0.01), more recently diagnosed (1.8 vs. 2.8 years, p = 0.003), but had an unresolved welfare situation (59% vs. 40%, p = 0.02).
  
  
  
  The main hypothesis was falsified, as there was no association between pain self-efficacy and actual performance of activity. The relation to functioning may be limited to perceived, cognitive-emotional aspects, as indicated by the weak to moderate correlations to the self-reported measures. Implications for Rehabilitation Improvement in observed activity post multi-disciplinary rehabilitation was not associated with change in pain self-efficacy. Patients performed better after rehabilitation, but did not perceive to have improved their capacity. The relationship between pain self-efficacy and functioning may be limited to cognitive-emotional aspects rather than actual activity. Both observational and self-reported measures should be included in evaluating outcomes of rehabilitation for patients with fibromyalgia.
authors.affiliation: a The Parker Institute , Department of Rheumatology , Bispebjerg and Frederiksberg Hospital , Capital Region of Copenhagen , Frederiksberg , Denmark.|b Institute of Public Health, University of Southern Denmark , Odense C , Denmark.
authors.forename: Marianne Uggen
authors.initials: MU
authors.lastname: Rasmussen
authors.affiliation: a The Parker Institute , Department of Rheumatology , Bispebjerg and Frederiksberg Hospital , Capital Region of Copenhagen , Frederiksberg , Denmark.
authors.forename: Kirstine
authors.initials: K
authors.lastname: Amris
authors.affiliation: c Research Unit of Clinical Nursing , Bispebjerg and Frederiksberg Hospital , Capital Region of Copenhagen , København , Denmark.|d Section for Nursing Department of Public Health , Aarhus University , Aarhus , Denmark.
authors.forename: Susan
authors.initials: S
authors.lastname: Rydahl-Hansen
authors.affiliation: a The Parker Institute , Department of Rheumatology , Bispebjerg and Frederiksberg Hospital , Capital Region of Copenhagen , Frederiksberg , Denmark.
authors.forename: Bente
authors.initials: B
authors.lastname: Danneskiold-Samsoe
authors.affiliation: e Department of Public Health and Center for Healthy Aging , University of Copenhagen , København K , Denmark.
authors.forename: Erik Lykke
authors.initials: EL
authors.lastname: Mortensen
authors.affiliation: a The Parker Institute , Department of Rheumatology , Bispebjerg and Frederiksberg Hospital , Capital Region of Copenhagen , Frederiksberg , Denmark.
authors.forename: Robin
authors.initials: R
authors.lastname: Christensen
authors.affiliation: b Institute of Public Health, University of Southern Denmark , Odense C , Denmark.
authors.forename: Bengt
authors.initials: B
authors.lastname: H Sjölund
mesh_terms: D000328:Adult; D003718:Denmark; D005260:Female; D005356:Fibromyalgia / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D020377:Self Efficacy; D057566:Self Report
keywords: Fibromyalgia; multi-disciplinary rehabilitation; observed activity performance; pain self-efficacy; self-reported perceived capacity