Effectiveness of different interventions using a psychosocial subgroup assignment in chronic neck and back pain patients: a 10-year follow-up

Abstract

Purpose: The aim of this study was to evaluate the potential interaction between treatment content and subgroups according to the Swedish version of the Multidimensional Pain Inventory (MPI-S) on the effect on sickness absence during a 10-year follow-up in a population with chronic neck pain (NP) and/or low back pain (LBP). Methods: This study is based on a randomized controlled multicentre trial with a 10-year follow-up using the MPI-S and included 214 participants. The interventions consisted of Behavioural-oriented Physiotherapy (PT), Cognitive Behavioural Therapy (CBT), Behavioural Medicine Rehabilitation (BM), and a “treatment-as-usual” control group (CG). Results: There appears to be a difference in the development of sickness absence after rehabilitation for the adaptive coper (AC) group even though the result did not reach statistical significance. AC seems to respond most favourably to the multidisciplinary programme compared to the CG. The development of sickness absence after intervention among interpersonally distressed (ID) and dysfunctional (DYS) patients were similar across all three treatment alternatives as well as CG. Conclusion: In terms of long-term follow-up of sickness absence, the multidisciplinary programme appears to be most beneficial for DYS and AC patients. In contrast, the CBT and PT interventions failed to benefit any patient group.

Implications for Rehabilitation

• There may be subgroups of patients with neck/back pain that benefit differently from different treatments.

• This study indicates that patients with less psychosocial problems (adaptive copers) benefit most from behavioural medicine rehabilitation with regard to sick leave 10 year after rehabilitation.

• Additional studies with larger study groups are needed to further investigate these findings.

Keywords::

• musculoskeletal pain
• neck
• pain
• psychosocial
• sickness absence
• the multidimensional pain inventory (MPI)

Acknowledgements

The authors wish to thank all the patients and personnel at the rehabilitation clinics involved. A special thanks to Eva Nilsson and Anders Hägg for their painstaking and professional assistance in database management.

Declaration of Interest: AFA Insurance has financially supported this study.