Explaining functioning outcomes across musculoskeletal conditions: a multilevel modelling approach

Abstract

Purpose. To determine whether changes in health outcomes result from changes in domains of functioning and relevant environmental factors in musculoskeletal conditions.

Method. Longitudinal observational study on a convenience sample of 291 patients with low back pain, osteoarthritis, osteoporosis, rheumatoid arthritis and chronic widespread pain. The study was part of the MHADIE project. Data collection was performed at baseline, after 4 and 8 weeks using the ICF Core Sets for the corresponding musculoskeletal conditions. Multilevel models for change were used to determine which ICF categories explain the variability and change over time of the general, physical and mental health according to the SF-36.

Results. There are only small fluctuations in the health outcomes. These are related to functions of the locomotor apparatus, such as muscle power, and to activities and participation domains related to them, such as lifting and carrying objects. A large amount of baseline variance is explained with a relatively small number of ICF categories of functioning.

Conclusions. This study presents a list of functioning problems and environmental factors relevant to map out both the patterns and the variations in the experience of living with a chronic and painful condition. These are intervention targets common across MSC conditions.

Keywords:

• MHADIE
• functioning
• disability
• ICF
• musculoskeletal

Acknowledgements

We would like thank Johana Jonsdottir, Giovanni Rainero and Vittorio Racca from the Rehabilitative Neurology Department, IRCCS ‘Santa Maria Nascente’ Fondazione Don Gnocchi, Milan, Italy and Andrea Gläßel from the Institute for Health and Rehabilitation Sciences at the Ludwig-Maximilians-University for performing the data collection of this study. We also want to thank Susanne Schwarzkopf and Andreas Winkelmann and the whole team of the Clinic for Physical Medicine and Rehabilitation at the Ludwig-Maximilians-University, Munich, for their support during the data collection. Finally, our most special thank goes to all the patients participating in the study.

Declaration of interest

MHADIE project was funded by the European Commission, Sixth Framework Programme. Contract Number: SP-24-CT-2004-513708, thematic priority ‘Scientific Support to Policies’. Cristina Bostan is supported by a Marie Curie Fellowship from the EU funded project MURINET.