Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up : A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
(2024) In Journal of Pain Research 17. p.83-105- Abstract
Background: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods: This study uses Patient-Reported Outcome Measures (PROMs)... (More)
Background: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008–2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results: Changes in acceptance (β:0.424–0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177–0.233; all P<0.001) and changes in fear-avoidance (β: −0.152– −0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
(Less)
- author
- Gerdle, Björn ; Dragioti, Elena ; Fischer, Marcelo Rivano LU and Ringqvist, Åsa
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- anxiety, chronic pain, coping strategies, depression, health, pain management
- in
- Journal of Pain Research
- volume
- 17
- pages
- 23 pages
- publisher
- Dove Medical Press Ltd.
- external identifiers
-
- pmid:38196970
- scopus:85182498370
- ISSN
- 1178-7090
- DOI
- 10.2147/JPR.S438260
- language
- English
- LU publication?
- yes
- id
- 43867aab-b641-45e9-af63-4a39bfe010c2
- date added to LUP
- 2024-02-16 11:15:06
- date last changed
- 2024-04-17 04:58:19
@article{43867aab-b641-45e9-af63-4a39bfe010c2,
abstract = {{<p>Background: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008–2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results: Changes in acceptance (β:0.424–0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177–0.233; all P<0.001) and changes in fear-avoidance (β: −0.152– −0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.</p>}},
author = {{Gerdle, Björn and Dragioti, Elena and Fischer, Marcelo Rivano and Ringqvist, Åsa}},
issn = {{1178-7090}},
keywords = {{anxiety; chronic pain; coping strategies; depression; health; pain management}},
language = {{eng}},
pages = {{83--105}},
publisher = {{Dove Medical Press Ltd.}},
series = {{Journal of Pain Research}},
title = {{Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up : A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)}},
url = {{http://dx.doi.org/10.2147/JPR.S438260}},
doi = {{10.2147/JPR.S438260}},
volume = {{17}},
year = {{2024}},
}