Health social workers’ assessments as part of a specialized pain rehabilitation: a clinical data-mining study

ABSTRACT

This study examines how health social workers (HSWs) assess the rehabilitation needs of patients with long-term pain. Data were extracted from 66 patient assessments through a retrieval form based on the International Classification of Functioning, Disability, and Health. The assessments included information about relations, work, and recreation. Stress management, problem solving, self-care, participation in community life, and providing personal care were missing in parts of or all assessments. Differences in assessments suggest that information was registered based on traditional gender roles and age. Therefore, HSWs need standardized assessment tools to ensure that assessments are relevant for all patients with long-term pain irrespective of gender or age.

KEYWORDS:

• Chronic pain
• ICF
• social work
• health care
• assessment

Introduction

Patients with long-term pain referred to specialized pain rehabilitation regularly show interconnected and multifaceted medical, psychological and social difficulties that are difficult to treat by a single professional or by professionals working independently. Evidence has shown that well-trained multi-professional teams with an interdisciplinary working approach produce better rehabilitation outcomes (Kamper et al., 2015; Scascighini, Toma, Dober-Spielman, & Sprott, 2008). To obtain a comprehensive understanding of the patient, the different health care professionals perform individual assessments of the patient which are evaluated jointly. This mutual evaluation is crucial for the subsequent formation of rehabilitation goals and choice of rehabilitation strategies.

In clinical work, health social workers (HSWs) contribute to the multi-professional evaluation of the patients’ rehabilitation needs by assessing social and psychosocial factors that may be significant for the rehabilitation process (Fugl-Meyer, 2016). The assessment is part of the clinical evaluation of patients with long-term pain and complex problems, particularly those indicating work-related and financial difficulties as well as maladaptive coping strategies in family life and partner relationships.

The importance of social and psychosocial factors as significant predictors of functioning in patients with pain and physical disabilities is well known and has recently been demonstrated in a review (Jensen, Moore, Bockow, Ehde, & Engel, 2011). For example, patients with stressful jobs are more likely to report pain (Bongers, Kremer, & Ter Laak, 2002; Hoogendoorn, van Poppel, Bongers, Koes, & Bouter, 2000). Low education level, belonging to lower socio-economic groups, being an immigrant, and experiencing low social support are all associated with long-term pain and fibromyalgia (Bergman, 2005). Factors related to family and social network are also important. For example, patients with non-supportive families or close relatives tend to experience increased pain (Kerns, Rosenberg, & Otis, 2002; Romano et al., 1995; Schwartz, Jensen, & Romano, 2005) whereas patients with supportive families tend to report less pain and pain interference (Jamison & Virts, 1990; Kerns et al., 2002). Satisfaction with family life has been found to be significantly correlated to satisfaction with life as a whole, which is more important than several other life domains and even experienced pain intensity (Silvemark, Källmén, Portala, & Molander, 2008). Furthermore, lack of social support, substance abuse, and a variety of psychological factors such as fear and harm avoidance, pain-related anxiety, and self-efficacy are important factors in women and men with long-term pain (Turk & Okifuji, 2002). These findings support that stressors in work areas and family life as well as sociodemographic and personality factors are important to include in pain rehabilitation.

The HSWs apply a bio-psycho-social approach in their clinical work when assessing a patient (Hruschak & Cochran, 2017). Generally, HSWs have a broad clinical perspective that includes factors such as supportive resources, living conditions including housing, work, economy and insurances, addictive behavior, and access to health care resources. To our knowledge, the role of HSWs in the pain rehabilitation team has not been investigated in a research context. Furthermore, the assessments of patients with pain may need to take social stratifiers such as gender and age in consideration because of both differences in the expression of pain and the occurrence of stereotypes related to gender and age in health care. A review of Pieretti et al. (2016) reports differences in how women and men experience pain and pain relief, and that the differences was found in both clinical settings and in mice. Gender stereotypic views regarding willingness to report pain has also been found (Wesolowicz, Clark, Boissoneault, & Robinson, 2018). Agism, i.e., stereotypies, prejudice, and discriminatory behavior among physicians are reported in a review by Meisner (2012) and also among physicians, nurses and social workers (Ben-Harush et al., 2017). To address social stratifiers such as gender and age is thus recommended in health care planning and health systems research (Morgan et al., 2018; Theobald et al., 2017). The overall aim of this investigation was, therefore, to explore the content of HSWs’ social and psychosocial assessments of the rehabilitation needs of patients with long-term pain. Furthermore, on the base of gender and age stereotypes, the study also aims to highlight possible differences in the assessments due to these social stratifiers.

Method

Study setting

The study took place at the Pain Rehabilitation Center, Uppsala University Hospital, Sweden. The clinic is well established and specializes in multi-disciplinary pain examinations for people with long-term, complex, and intractable pain using a multidisciplinary team approach. Patients are referred from general practitioners, occupational health care physicians and specialist clinics in the region as well as from other parts of Sweden and other countries. The examinations are carried out over one full week. During this period, the patient meets the professionals in the multidisciplinary team: a specialist in rehabilitation medicine (PM&R, physiatrist), an anesthetist, a psychiatrist with expertise in chronic pain, physiotherapists, occupational therapists, a psychologist, and a health social worker. Each health care professional performs a profession-specific examination and assessment of the patient’s situation, including diagnostic evaluation and pain analysis, functional evaluation, strength evaluation, and actual and future needs. After these assessments, a concluding report is formulated. This report is presented in a meeting with the patient where the results of the assessments and suggestions for pain treatment and/or rehabilitation are discussed. In the multi-disciplinary team, the health social worker is responsible for assessing the patient’s social and psychosocial situation (present and lifelong), and for suggesting psychosocial components of a treatment and rehabilitation plan developed by the multi-disciplinary team.

Study design and data collection

This study is an exploratory clinical data-mining (CDM) study that follows the procedures and concepts suggested by Epstein (Epstein, 2001). A CDM, a strategy for the collection of available medical information (i.e., medical records), is widely used for the study of client characteristics, HSWs’ interventions, and client outcomes in practice-based research (Epstein, 2001).

The International Classification of Functioning, Disability, and Health (ICF) (World Health Organization [WHO], 2001) offers a useful tool for systematic mapping of various functional and environmental factors and was used as a tool for the analysis.

The ICF (WHO, 2001) uses a bio-psycho-social perspective that divides different aspects of functionality into components: Body functions and structure (b), Activities and participation (d), Environmental factors (e) and Personal factors. In this text, all components are written in italics. Figure 1 shows an overview of the interaction of these components. As these components may be important in the investigation of patients with long-term pain, they were used as references to identify and quantify the content of the HSWs’ social and psychosocial assessments. This study uses the categories from the components Activities and participation (d) (41 categories) and Environmental factors (e) (22 categories) that were included in the comprehensive ICF Core Sets of the following diagnoses: osteoporosis (Cieza et al., 2004a), low back pain (Cieza et al., 2004b), chronic widespread pain (Cieza et al., 2004c), osteoarthritis (Dreinhöfer et al., 2004), and rheumatoid arthritis (Stucki et al., 2004). These diagnoses were found in the records of the patients referred to the Pain Rehabilitation Center, Uppsala University Hospital, Sweden. Thus, a data retrieval form that consisted of these 63 categories was developed. The component Activities and participation (d), which includes the execution of a task or action by an individual and involvement in a life situation, concerns limitations and restrictions that an individual may have in executing activities and involvement in different life situations. The component Environmental factors (e) concerns the physical, social, and attitudinal environment in which people live and conduct their lives. These components may be either barriers or facilitators to the person’s functioning (WHO, 2001). The component Personal factors, was not applied in this study as it was not coded in the ICF at the time of the data retrieval. However, sociodemographic data such as gender, age, marrital status, education, employment and sick-leave status were collected in all patients’ medical records.

Figure 1. Interactions between the components of the ICF and the components used in this study’s mapping tool: Environmental factors (e) and Activities and participation (d).

Using clinical data mining, we extracted data from the patients’ medical records and the HSWs’ social and psychosocial assessments of the patients (Epstein, 2001). The data mining procedure was performed in five steps. First, the hospital’s database for medical records was searched for patients receiving care at the Pain Rehabilitation Center. Second, a data retrieval form was developed from the ICF categories of the components Activities and participation (d) and Environmental factors (e). Third, meaning units (i.e., words and sentences) in the HSWs’ assessments that fit the ICF categories were registered in the data retrieval form. Fourth, the retrieval form was pilot tested in ten HSWs’ records (i.e., the part of the medical records that consists of the HSWs’ assessments). Thus, the retrieval form was considered appropriate for extracting data from the assessments and no changes were made to it. Fifth, the extracted data were sorted in ICF categories and analyzed.

Participants

The study includes assessments performed by HSWs working at the Pain Rehabilitation Center during the time of data collection. These HSWs were all women, had the same education and, as revealed through consensus had similar views on the purpose and content of the assessment. The HSWs had performed assessments of 520 patients (aged 18–65 years) with long-term pain who had undergone the multidisciplinary pain rehabilitation assessment program between 2004 (when the clinic introduced multidisciplinary pain assessments) and 2009. Of these, 180 patient assessments were chosen as a reasonable number for completing the study within the time-frame. The assessments were randomly selected using the randomization function in Microsoft Office Excel (2003). The 180 patients were sent a letter informing them about the purpose of the study and asking them for permission to search their medical records. One reminder letter was sent to non-responders. A total of 56 patients did not respond to the letters and 58 patients declined the search, leaving 66 patients (42 women and 24 men) included in the social and psychosocial assessments (response rate 37%). The mean age of the participants was 43 (range 18–65 years). No significant gender or age differences were found between the eligible patients, the selected sample, the non-responders, and the study patients.

Data analysis

Clinical data mining following the steps presented above was performed by the second author, a health social worker with clinical experience in social and psychosocial assessments of pain patients and rehabilitation team work. A consistency check of the meaning units retrieved from the psychosocial assessments was performed by the first author and discussed within the research group until consensus was reached. The analysis was made in 2009 immediately following the data collection. The content of the social and psychosocial assessments according to ICF categories were counted and listed in descending order for the total sample of pain patients, gender, and the three age groups – young (18–30 years), middle (31–54 years), and older (55–65 years). Chi² tests were performed to analyze possible differences in the assessments between groups (i.e., between women and men and between age-groups).

Ethical considerations

The study was conducted in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) and approved by the Regional Ethical Review Board in Uppsala, Sweden (Dnr 2009/250). Data from the medical records were retrieved after written informed consent was obtained from the patients.

Results activities and participation – categories found in HSWs’ assessments

About half (51%) of the categories of the component Activities and participation (d) were found in the reviewed HSWs’ assessments. The categories “Family relationship” (d760), “Intimate relationships” (d770), and “Recreation and leisure” (d920) were included in more than 90% of the medical records. The least prevalent categories were “Lifting and carrying objects” (d430), “Moving around” (d455), and “Preparing meals” (d630) which were all found in only 2% of the assessments (Table 1).

Table 1. Content of HSWs’ social/psychosocial assessments of pain patients according to categories in the International Classification of Functioning, Disability and Health (ICF), component Activities and participation (d), women, men and total.

ICF-Code	ICF-Category	Women(n = 42)		Men(n = 24)		Total(n = 66)
		n	(%)	n	(%)	n	(%)
d760	Family relationships	42	(100)	23	(96)	65	(98)
d770	Intimate relationships	40	(95)	21	(88)	61	(92)
d920	Recreation and leisure	39	(93)	21	(88)	60	(91)
d850	Remunerative employment	32	(76)	19	(79)	51	(77)
d845	Acquiring, keeping and terminating a job	27	(64)	12	(50)	37	(56)
d240	Handling stress and other psychological demands	15	(36)	6	(25)	21	(32)
d640	Doing housework	12	(29)	5	(21)	17	(26)
d660	Assisting others	11	(26)	3	(12)	14	(21)
d160	Focusing attention	6	(14)	4	(17)	10	(15)
d475	Driving	5	(12)			5	(12)
d360	Using communication devices and techniques	4	(10)	1	(4)	5	(8)
d470	Using transportation	2	(5)	1	(4)	3	(5)
d170	Writing			3	(13)	3	(3)
d720	Complex interpersonal interactions	2	(5)			2	(5)
d230	Carrying out daily routine	2	(5)			2	(5)
d859	Work and employment, other specified and unspecified	1	(2)	1	(4)	2	(5)
d855	Non-remunerative employment	2	(5)			2	(5)
d650	Caring for household objects	1	(2)	1	(5)	2	(3)
d430	Lifting and carrying objects	1	(2)			1	(2)
d455	Moving around	1	(2)			1	(2)
d630	Preparing meals	1	(2)			1	(2)

Environmental factors – categories found in HSWs’ assessments

Thirteen categories (60%) of the component Environmental factors (e) from the retrieval form were noted in the HSWs’ assessments. The categories “Immediate family” (e310) and “Friends” (e320) were found in 88% of the assessments. The least found categories, only 4 to 5%, were “Individual attitudes of health professionals” (e450) and “Individual attitudes to other professionals” (e455) (Table 2).

Table 2. Content of HSWs’ social/psychosocial assessments of pain patients according to categories in the International Classification of Functioning, Disability and Health (ICF), component Environmental factors (e), women, men and total.

ICF-Code	ICF-Category	Women(n = 42)		Men (n = 24)		Total(n = 66)
		n	(%)	n	(%)	n	(%)
e310	Immediate family	39	(93)	19	(79)	58	(88)
e320	Friends	38	(90)	20	(83)	58	(88)
e330	People in position of authority	23	(55)	12	(50)	35	(53)
e325	Acquaintances, peers, colleagues, neighbors and community members	14	(33)	10	(42)	24	(36)
e410	Individual attitudes of immediate family members	12	(29)	5	(21)	17	(26)
e355	Health professionals	7	(17)	4	(17)	11	(17)
e110	Products or substances for personal consumption	2	(5)	7	(29)	9	(14)
e430	Individual attitudes of people in positions of authority	4	(10)	2	(8)	6	(9)
e425	Individual attitudes of acquaintances, peers, colleagues, neighbors and community members	3	(7)	2	(8)	5	(8)
e360	Other professionals	2	(5)	2	(8)	4	(6)
e420	Individual attitudes of friends	3	(7)			3	(7)
e450	Individual attitudes of health professionals	2	(5)			2	(5)
e455	Individual attitudes of other professionals			1	(4)	1	(4)

Categories missing in HSWs’ assessments

Almost half (49%) the categories of the component Activities and participation (d) included in the retrieval form were not found in the reviewed assessments (Table 3). These were mainly various categories that deal with physical functioning such as “Walking” (d450) and personal hygiene such as “Dressing” (d540). However, missing in the reviewed assessments were also categories such as “Solving problems” (d175), “Looking after one’s health” (d570), and “Community life” (d910).

Table 3. Missing content of HSWs’ social/psychosocial assessments of pain patients according to categories in the International Classification of Functioning, Disability and Health (ICF), component Activities and participation (d) and Environmental factors (e).

ICF-Code	ICF-Category	ICF-Code	ICF-Category
Activities and participation (d)		Environmental factors (e)
d175	Solving problems	e115	Products and technology for personal use in daily living
d220	Undertaking multiple tasks	e120	Products and technology for personal indoor and outdoor mobility and transportation
d410	Changing basic body position	e125	Products and technology for communication
d415	Maintaining a body position	e135	Products and technology for employment
d420	Transferring oneself	e150	Design, construction and building products and technology of buildings for public use
d440	Fine hand use	e155	Design, construction and building products and technology of buildings for private use
d449	Carrying, moving and handling objects, other specified and unspecified	e225	Climate
d450	Walking	e225	Vibration
d460	Moving around in different locations	e340	Personal care providers and personal assistants
d465	Moving around using equipment
d510	Washing oneself
d520	Caring for body parts
d530	Toileting
d540	Dressing
d550	Eating
d560	Drinking
d570	Looking after one’s health
d620	Acquisition of goods and services
d710	Basic interpersonal interactions
d910	Community life

Nine (40%) categories from the component Environmental factors (e) included in the retrieval form were not found in the reviewed assessments (Table 3). These were mostly the categories “Products and technology” (e115 and e120) and the category “Personal care providers and personal assistants” (e340).

Comparisons between assessments of female and male patients

For the component Activities and participation (d), the category “Family relationships” (d760) was found in all assessments except for one male patient. Categories such as “Intimate relationships” (d770), “Recreation and leisure” (d920), and “Doing housework” (d640) were found in more female than in the male patients’ assessments. Other categories, such as “Remunerative employment” (d850) and “Focusing attention” (d160) were more frequently found in the male patients’ assessments (Table 1). However, none of these differences were statistically significant.

For the component Environmental factors (e), the categories “Immediate family” (e310) and “Friends” (e320) were the most common categories for both genders. Although these assessments were more common in the females’ medical records, the differences were not statistically significant (Table 2).

Comparisons of assessments between age groups

Some significant differences in HSWs’ assessments registered in the medical records were found between the age groups. In female patients, the category “Intimate relationships” (d770) was found more often in the two older age groups compared to the younger age group (p = .01) and “Immediate family” (e310) was found more often in the middle age group of women compared to the younger and older age groups (p = .029). Among male patients, the category “Acquiring, keeping and terminating a job” (d845) was found more frequently in the assessments of the middle age group of men compared to the younger and older age groups (p = .040). For an overview of HSWs’ assessments by gender and age groups, see Table 4.

Table 4. Overview of HSWs’ social and psychosocial assessments of pain patients according to categories in the International Classification of Functioning, Disability and Health (ICF), component Activities and participation (d) and Environmental factors (e), for gender and age groups.

ICF-Code* and Category	Women 18–30 years (n = 6)	Women 31–54 years (n = 26)	Women 55–65 years (n = 10)	Women total (n = 42)	Men 18–30 years (n = 2)	Men 31–54 years (n = 16)	Men 55–65 years (n = 6)	Men total (n = 24)	Women and men total (n = 66)
d160 Focusing attention		6		6		3	1	4	10
d170 Writing						3		3	3
d230 Carrying out daily routine		2		2					2
d240 Handling stress and other psychological demands	4	11		15		6		6	21
d360 Using communication devices and techniques		2	2	4		1		1	5
d430 Lifting and carrying objects		1		1					1
d455 Moving around		1		1					1
d470 Using transportation		1	1	2		1		1	3
d475 Driving		3	2	5					5
d630 Preparing meals		1		1					1
d640 Doing housework	1	10	1	12		5		5	17
d650 Caring for household objects		1		1		1		1	2
d660 Assisting others		9	2	11		2	1	3	14
d720 Complex interpersonal interactions		2		2					2
d760 Family relationships	6	26	10	42	1	16	4	21	63
d770 Intimate relationships	3	26	9	40	1	16	4	21	61
d845 Acquiring, keeping and terminating a job	4	17	6	27		12		12	39
d850 Remunerative employment	4	23	5	32	1	14	4	19	51
d855 Non-remunerative employment		2		2					2
d859 Work and employment, other specified and unspecified	1			1		1		1	2
d920 Recreation and leisure	6	25	8	39	1	16	4	21	60
e110 Products or substances for personal consumption	2			2	1	6		7	9
e310 Immediate family	4	26	9	39		15	4	19	58
e320 Friends	6	22	9	37	1	16	3	20	57
e325 Acquaintances, peers, colleagues, neighbors and community members	1	10	3	14		7	3	10	24
e330 People in position of authority	2	15	6	23		10	2	12	35
e355 Health professionals	3	3	1	7		3	1	4	11
e360 Other professionals		2		2		2		2	4
e410 Individual attitudes of immediate family members	2	9	1	12		5		5	17
e420 Individual attitudes of friends		3		3					3
e425 Individual attitudes of acquaintances, peers, colleagues, neighbors and community members		2	1	3		1	1	2	5
e430 Individual attitudes of people in position of authority		3	1	4		1	1	2	6
e450 Individual attitudes of health professionals		2		2					2
e455 Individual attitudes of other professionals						1		1	1

*ICF-Code d = Component Activities and participation, ICF-Code e = Environmental factors

Discussion

Approaches to studying long-term pain conditions have been widened to include more than unidimensional biomedical models; these approaches also now consider psychological and social variables in what has labeled the biopsychosocial approach to chronic pain (Gatchel, Peng, Peters, Fuchs, & Turk, 2007). A better understanding of the psychosocial factors that contribute to the onset and maintenance of long-term pain as well as the implication of such factors on treatment and rehabilitation should assist clinicians in developing more effective treatment for patients with long-term pain. To our knowledge, this study is the first investigation into HSWs’ assessments of patients with long-term pain referred to a specialized pain rehabilitation clinic. The principal findings of this data-mining study reveal that the ICF categories that concern relations with family, friends, work, recreation, and leisure from the components Activities and participation and Environmental factors were found in most of the HSWs’ social and psychosocial assessments (i.e., registered in the medical records). These categories were expected to be found in the assessments as the HSWs represent the social and psychosocial perspective within the multi-disciplinary team and offer individualized patient and family-centered assessments (Hruschak & Cochran, 2017; Mendenhall, 2003).

However, the ICF category “Handling stress and other psychological demands” (d240) only occurred in 33% of the women’s and 25% of the men’s assessments. This category should reasonably be expected to be found in all patients’ assessments since the ability to handle stress may be closely related to various social and psychosocial aspects such as personality, coping skills, and social support (DeLongis & Holtzman, 2005; Moos & Holahan, 2003). Other ICF categories such as “Solving problems” (d175), “Looking after one’s health” (d570), and “Community life” (d910) from the ICF component Activities and participation and “Personal care providers and personal assistants” (e340) from the component Environmental factors could also be considered as parts of the social and psychosocial assessments, but these were not found in any of the reviewed assessments. It is not clear why the HSWs’ assessments had few notes about stress management and no notes about problem solving, self-care, participation in community, and providing personal care. Perhaps, the varying frequency of notes about stress-management in the assessments may be explained by different views among the HSWs on the importance of discussing stress with patients. The absence of categories concerning problem solving, self-care, participation in community, and personal care providers may be due to uncertainties in the role distribution within the multi-disciplinary team and that some other professions, such as occupational therapists, addressed these in their assessments. However, this question is not possible to answer as this study did not consider the roles of the other team members. The rest of the missing ICF categories mainly concerned physical function. Their absence was expected because these factors should primarily be addressed by other professions in the multi-disciplinary team such as physiotherapists and occupational therapists (Lundgren & Molander, 2017).

There were a few statistically significant differences detected in the assessments between the age-groups. Information about relations to family and friends was registered to a greater degree in the assessments of the middle-aged and older women compared with the younger women. In addition, work-related information was registered more frequently in assessments of the middle-aged men compared with the younger and older men. There were also differences in the HSWs’ assessments between women and men although these were not statistically significant. These differences concerned relationships and activities such as housework and employment. For example, women’s assessments addressed housework to a greater degree and men’s assessments addressed employment to a greater degree. Furthermore, the results showed that there were no registrations of the ICF factors “Intimate relationships”, “Immediate family”, and “Friends” in about 10–20% of the men’s assessments and no registrations about the factor “Work situation” in about 25% of the women’s assessments. These differences in registrations in the HSWs’ assessments according to gender and age seem to mirror traditional gender roles. However, if the HSWs acknowledge this gender trap and apply a broader perspective on gender roles and activities, this would probably improve the patient’s rehabilitation process. As previous research has shown, factors related to family and social network (Romano et al., 1995; Kerns et al., 2002; Schwartz et al., 2005; Jamison & Virts, 1990) and work situation (Hoogendoorn et al., 2000; Bongers et al., 2002) are important to address in the rehabilitation process, so they should be included as a part of the routine assessments performed by the HSWs.

A newly published review by Duenas, Ojeda, Salazar, Mico, and Failde (2016) emphasizes the importance of addressing these psychosocial aspects in the HSWs’ assessments. This review shows that long-term pain has important consequences on psychosocial aspects such as work as well as social and family life. Factors related to work concerned absenteeism, change of employment, losing jobs or early retirement due to the pain. The rehabilitation of chronic pain patients is influenced by social or family factors such as social interactions and contacts with family and friends and restricted social activities. In addition, HSWs should consider the concerns of family members and the social network of friends, who often need to help taking care of chronic pain patients or take part in treatment or decision making when consulting health care professionals (Duenas et al., 2016). This review (Duenas et al., 2016) and the results of the present study calls for a need to standardize the HSWs’ assessments to ensure that these important aspects of living with long-term pain are addressed for all patients irrespective of gender or age.

Methodological considerations

The study had some methodological limitations and strengths. Among the limitations were that these HSWs’ assessments were collected from one specialized pain rehabilitation clinic in a Swedish University hospital; it is possible that other pain rehabilitation clinics may have adopted other clinical routines and structures for the assessments carried out by HSWs. In addition, the response rate was low even though written reminders were sent to potential study participants. A larger number of patients would possibly have allowed their medical records to be part of the study if the researchers had contacted each patient by telephone. However, due to limited resources in terms of time and finances this was not an option during the time-frame of the study.

A strength of the study is that the methodology of reviewing medical records was followed according to Epstein’s instructions (2001). In addition, the data retrieval form was specifically designed for this study. It was developed to include the 64 categories from the ICF core sets for osteoporosis, low back pain, chronic widespread pain, osteoarthritis, and rheumatoid arthritis, as these diagnoses were the most common diagnoses at this specific Pain Rehabilitation Center.

Conclusions

HSWs’ assessments included aspects related to close relations, work, and recreation, which were expected to be found as HSWs usually have a social and psychosocial treatment perspective. However, some shortcomings in the assessments were found; stress management was only found in 25% to 33% of the assessments, and problem solving, self-care, participation in community life, and providing personal care were not found in any of the assessments. Furthermore, the differences in the assessments according to gender and age may suggest that questions were asked based on preconceived views of traditional gender roles. The findings of the present study suggest a need to develop HSWs’ role in the multi-professional team and to standardize their assessments to ensure that the content is adequate and relevant for all patients with chronic pain irrespective of gender or age.

Declaration of Conflicting Interests

The authors declare no potential conflicts of interest with the research, authorship, and publication of this article.

Acknowledgments

The authors would like to thank the patients for allowing us to include the social and psychosocial assessments from their medical records in this study, Carl Molander for his valuable input in the study, Mia Pless for information about the ICF.

Additional information

Funding

This work was supported by the Uppsala County Council and ALF Grants, County Council of Uppsala.