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SAT0645-HPR Which Problems in Functioning Are Identified Before and Improve After a Multidisciplinary Rehabilitation Program for Chronic Musculoskeletal Pain?
  1. J. Meesters1,
  2. R. Koele2,
  3. M. van Gestel2,
  4. R. Smeets3,
  5. T. Vliet Vlieland1
  1. 1Orthopaedics & Rehabilitation, Leiden University Medical Center
  2. 2Rijnlands Rehabilitation Centre, Leiden
  3. 3Research School CAPHRI, Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands

Abstract

Background Chronic musculoskeletal pain (CMP) is a common condition for which multidisciplinary rehabilitation is effective. Persson et al. (1) identified a wide variety of everyday problems in functioning by means of the COPM in patients with musculoskeletal pain. Little is known about the extent to which improvements in various problem areas are attained after multidisciplinary rehabilitation program in patients with chronic musculoskeletal pain (CMP).

Objectives To describe the contents of problems in occupational performance derived from the Canadian Occupational Performance Measure (COPM) in patients with CMP before and after a 15-week multidisciplinary rehabilitation program in terms of the International Classification of Functioning, disability and health (ICF). Moreover, we aim to assess the improvement in these problems following a multidisciplinary rehabilitation program.

Methods All eligible patients took part in the same outpatient, multidisciplinary program provided by a multidisciplinary team in one Dutch rehabilitation center. The largely standardized program involved the following treatment modalities: Cognitive Behavioural Therapy (CBT), education, individual and group exercise, relaxation and hydrotherapy. In all patients admitted to the rehabilitation program the COPM was administered at admission and discharge. The problems identified at admission were linked to ICF chapters by using an established linking procedure.

Changes of COPM performance and satisfaction scores (1-10; low-high) with 95%>confidence intervals (CI) were calculated and tested for significance (Wilcoxon signed rank test), and subsequently Effect Sizes (ES) were computed. The same statistical comparisons for performance and satisfaction change scores were also done per ICF chapter.

Results 165 patients were included. Their mean age was 44.1 (SD 12.9) years, 143 (87%) were women. At admission 801 problems were identified and linked to 706 unique ICF categories: 83 (12%) were related to the ICF component “B-Body Functions” and 621 (88%) to “D-Activities and Participation”). ICF categories from the chapters “d4 Mobility” (124, 18%) and “d9 Community social and civic life” (143, 20%) were most frequently identified.

The median changes of the COPM total scores for performance and satisfaction were 2.1 (95% CI 1.9 to 2.3; p<0.001, ES: 1.75) and 3.2 (95% CI 2.9 to 3.4, p<0.001, ES: 2.38). Within all 9 ICF chapters in “D-Activities and Participation” significant changes and large effect sizes were found for performance (ES: 1.0–1.5) and Satisfaction (ES: 1.1–1.5). Similar results were found for the ICF component “B-Body Functions”.

Conclusions A 15-week multidisciplinary treatment program showed that most problems were seen within chapters Mobility and Community life of the ICF. The program led to significant improvements of patient reported problems, the magnitude of improvement was similar for all different problem areas.

References

  1. Persson E, et al. Scand J Occup Ther 2013 Jul;20(4):306-14.

Disclosure of Interest None declared

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