Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses.

Details

Serval ID
serval:BIB_CBB273F97E8B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses.
Journal
PloS one
Author(s)
Luthi F., Vuistiner P., Favre C., Hilfiker R., Léger B.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
13
Number
9
Pages
e0203329
Language
english
Notes
Publication types: Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
Three main activity patterns have been distinguished in describing chronic pain (avoidance, pacing and persistence). However, their influence on patient outcomes remains a question of debate. This observational study aimed to measure the associations between the avoidance, pacing, and persistence (labelled overdoing) scales of the Patterns of Activity Measure-Pain (POAM-P), self-reported outcomes (pain-interference, depression, functional ability), and observational outcomes (walking, lifting test, physical fitness).
We conducted an observational study with cross-sectional and longitudinal analyses. The data were collected prospectively before and after treatment, which was a 5-week functional rehabilitation including vocational aspects. In addition to self-reported and observational outcomes, patients were asked if they thought they would be able to return to work at 6 months. Analyses were conducted with treatment effect sizes, correlations, and multiple regression models.
In this sample (891 patients), we found on average small to moderate improvements for pain-interference and observational outcomes (Cohen's d: 0.37 to 0.64). According to the multivariable models, overdoing was associated with most of the beneficial psychosocial and observational outcomes (β -0.13 to 0.17; all p<0.01). Avoidance was related to negative psychosocial outcomes before treatment (β -0.09 to 0.17; all p<0.015). Pacing, which had moderate correlation with avoidance (r = 0.46), was not associated with most of the outcomes. The feeling that the goal of returning to work was attainable was associated with lower avoidance scores (adjusted OR 0.97; p = 0.024).
The overdoing POAM-P scale probably measures a task-contingent persistence, which appears appropriate in the setting of this study. Persistent behavior was indeed related to small or moderate positive biopsychosocial outcomes, before and after treatment. Moreover feeling able to return to work was related to lower avoidance. Further studies should test the efficacy of motivational strategies that may promote functional task-contingent persistence and reduce avoidance of painful tasks.
Keywords
Activities of Daily Living/psychology, Adult, Avoidance Learning, Chronic Pain/physiopathology, Chronic Pain/psychology, Chronic Pain/rehabilitation, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Musculoskeletal Pain/physiopathology, Musculoskeletal Pain/psychology, Musculoskeletal Pain/rehabilitation, Pain Management/methods, Pain Management/psychology, Psychology, Rehabilitation, Vocational/methods, Rehabilitation, Vocational/psychology, Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
11/09/2018 7:25
Last modification date
20/08/2019 15:46
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