title: The Effectiveness of Multidisciplinary Rehabilitation in the Treatment of Fibromyalgia: A Randomized Controlled Trial Can It Be Predicted Which Patients With Chronic Low Back Pain Should Be Offered Tertiary Rehabilitation in a Functional Restoration Program?: A Search for Demographic, Socioeconomic, and Physical Predictors Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study The value of physical performance tests for predicting therapy outcome in patients with subacute low back pain: a prospective cohort study Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain The impact of psychologically different patient groups on outcome after a vocational rehabilitation program for long-term spinal pain patients Change in kinesiophobia and its relation to activity limitation after multidisciplinary rehabilitation in patients with chronic back pain
abstract: Objectives : To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to st and ard medical care . Methods : Seventy-nine men and women were r and omly assigned to one of two groups . The intervention group consisted of a rheumatologist and physical therapist intake and discharge , 18 group supervised exercise therapy sessions , 2 group pain and stress management lectures , 1 group education lecture , 1 group dietary lecture , and 2 massage therapy sessions . The control group consisted of st and ard medical care with the patients ' family physician . Outcome measures included self-perceived health status , pain-related disability , average pain intensity , depressed mood , days in pain , hours in pain , prescription and nonprescription medication usage , and work status . Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up . Results : Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study . There were no statistically significant differences between the 2 groups prior to intervention . Intention-to-treat analysis revealed that the intervention group , in comparison to the control group , experienced statistically significant changes at intervention completion in self-perceived health status , average pain intensity , pain related disability , depressed mood , days in pain , and hours in pain , but no significant differences in nonprescription drug use , prescription drug use , or work status . At 15 months , all health outcomes retained their significance except health status . Nonprescription and prescription drug use demonstrated significant reductions at 15 months . Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status . Conclusions : Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost , group multidisciplinary intervention in a community-based , non clinical setting Study Design . A prospect i ve clinical trial was conducted that involved six groups of patients with chronic low back pain selected from a large cohort ( N = 816 ) . Objectives . To correlate pretreatment baseline variables with outcome parameters after treatment in a functional restoration program or in control programs , to identify possible factors predictive of the need for functional restoration . Summary of Background Data . Since the functional restoration program was first described , research has focused on identifying patients who will or will not benefit from such a program . The value of previous studies is limited , however , because predictive factors from a control group were not " subtracted . " Methods . Eight hundred sixteen patients with chronic low back disability were included . All had a structured medical examination , including various physical tests before participation in either a functional restoration program ( n = 621 ) or shorter " control " outpatient programs ( n = 144 ) . A smaller group of the cohort ( n = 51 ) had no treatment and served as a pure control group . Six groups were selected from the cohort : Three underwent an identical functional restoration program and three underwent different outpatient control programs . Several baseline demographic , physical , and socioeconomic variables were correlated to 1‐year outcome parameters . Results . Age , days of sick leave , connection to the work force , and back pain intensity , were significantly correlated to success 1 year after entry into the study in all groups , no matter what kind of treatment was administered . Back muscle endurance , sports activity , activity of daily living scores , and vibrations were of importance in some outcome parameters for success after functional restoration . Smoking was positively correlated to disability pension . Days of sick leave and , in functional restoration , ability to work were the only factors that were correlative with statistics for people who withdrew . Conclusions . Different factors can be identified as predictive of outcome in a functional restoration program , but most of these factors were also shown to predict success for shorter control outpatient programs or of no treatment Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain ( CNSLBP ) . Objective The purpose of this study was to describe the course of disability and identify clinical ly important prognostic factors of low-back-pain – specific disability in patients with CNSLBP receiving multidisciplinary therapy .  Design A prospect i ve cohort study was conducted . Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy  were evaluated for their course of disability and prognostic factors at baseline and at 2- , 5- , and 12-month follow-ups . Recovery was defined as 30 % reduction in low back pain – specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale ( QBPDS ) was ≤20 points at follow-up . Potential prognostic factors were identified using multivariable logistic regression analysis . Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 ( SD=15.6 ) at baseline to 31.7 ( SD=15.2 ) , 31.1 ( SD=18.2 ) , and 29.1 ( SD=20.0 ) at 2 , 5 , and 12 months , respectively . The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey ( SF-36 ) ( Physical and Mental Component Summaries ) at baseline . In addition , at 5-month follow-up , a shorter duration of complaints was a positive predictor , and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up . Limitations Missing values at 5- and 12-month follow-ups were 11.1 % and 45.2 % , respectively . Conclusion After multidisciplinary treatment , the course of disability in patients with CNSLBP continued to decline over a 12-month period . At 5- and 12-month follow-ups , prognostic factors were identified for a clinical ly relevant decrease in disability scores on the QBPDS Considering the enormous costs of intensive multidisciplinary treatment , predictive tests for therapy outcome are needed to evaluate patients ’ performance potential and increase cost effectiveness . Somatic parameters are commonly used to evaluate health status and serve as an additional means of forecasting the prognosis , yet little is known of their validity . In this study , we investigated the prognostic value of somatic parameters regarding the outcome of multidisciplinary treatment in patients with subacute low back pain . The study was design ed as a prospect i ve cohort study of 162 patients .  Somatic parameters were assessed with three physical performance tests ( Villiger test , Oesch test , Biering – Sørensen test ) before treatment ( T0 ) , after 3 weeks ’ inpatient therapy ( T1 ) and at 6-month follow-up ( T2 ) . Psychometric characteristics of subjective pain perception ( VAS ) , a pain disability index ( PDI ) and a physical capability index ( FFbH-R ) were recorded . Correlation coefficients between the physical performance test scores and psychometric characteristics were calculated . To predict therapy outcome , discriminant analyses were performed . A control group ( n = 30 ) was evaluated at similar time points without receiving any therapy . Our results demonstrate good discrimination between patients and controls by means of the investigated performance tests and exhibit a significant negative correlation with the psychometric data . Lower outcome values at study entry correlated with higher pain intensity and disability after multidisciplinary treatment . However , the statistical magnitude of correlation was relatively low and further discriminant analysis did not reveal any predictive value . Consequently the physical performance tests do not have a prognostic value regarding therapy outcome Background Whiplash associated disorders ( WAD ) have dramatic consequences for individual and public health . Risk factors for better and worse outcomes are important to optimize management . This study aim ed to determine short- and mid-term associative co-factors of neck pain relief , improved physical functioning , and improved working capacity ( dependent variables ) in patients suffering from whiplash associated disorder who participated in a st and ardized , inpatient pain management program .  Methods Naturalistic , observational , prospect i ve cohort study . Outcome was measured by st and ardized assessment instruments . Co-factors covered sociodemographics , comorbidities , social participation , affective health , and coping abilities . Stepwise , multivariate linear regression analysis was performed at discharge and at the 6-month follow-up . Results All regression models explained high proportions of variance ( 53.3 % – 72.1 % ) . The corresponding baseline level was significantly associated with a change in every dependent variable ( explained variances : 11.4%-56.7 % ) . Pain relief significantly depended on improved function and vice-versa ( 3.4%-14.8 % ) . Improved ability to decrease pain was associated with pain relief at discharge ( 9.6 % ) . Functional improvement was associated with decreased catastrophizing ( 19.4 % ) at discharge and decreased depression ( 20.5 % ) at the 6 month follow-up . Conclusions Pain relief , improved physical function and working capacity were associated with each other . Improved coping ( catastrophizing and ability to decrease pain ) and reduced depression may act as important predictors for pain relief and improved function . These findings offer toe-holds for optimized therapy of chronic WAD Background The prevalence of chronic musculoskeletal pain is high , with widespread negative economic , psychological , and social consequences for the individual . It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life . The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function , and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain . Methods A prospect i ve study was conducted among one hundred and forty three ( N = 143 ) musculoskeletal pain patients .  Measures of pain , function , and functional health status were obtained at baseline , after 5 weeks of intensive training , at the end of the 57-week rehabilitation programme , and at a 1 year follow-up , using vali date d self-administrated measures . Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain , individual- , and psychosocial factors in function . Results The participants studied showed a significant increase in function during the 57 weeks rehabilitation period . There was also a significant increase in function from the end of the rehabilitation period ( 57th week ) to the one year follow-up measures . Pain intensity associated significantly with pain experience over all measurement periods . High levels of pain intensity ( β = .42 * * ) and pain experience ( β = .37 * ) , and poor psychological capacity ( β = -.68 * ) at baseline , as well as poor physiological capacity ( β = -.44 * * ) and high levels of anxiety ( β = .48 * * ) and depression ( β = .58 * * * ) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods . Conclusion The data suggest that physical capacity , emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life Background The effectiveness of multidisciplinary treatment in chronic widespread pain ( CWP ) is limited . The considerable heterogeneity among patients is a likely explanation . Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness . The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP . Methods Data were used from baseline and 6 months follow-up measurements of a prospect i ve cohort study of 120 CWP . Regression models were used to assess whether baseline variables predicted treatment outcome . Outcome domains included : pain , pain interference , depression , and global perceived effect ( GPE ) . Potential predictors included : psychological distress , illness and self-efficacy beliefs , fear-avoidance beliefs and behaviour , symptoms , disability , and socio-demographic factors . Results Greater improvement in pain was predicted by more pain at baseline and male gender . Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline , lower levels of anxiety , a stronger belief in personal control , less belief in consequences , male gender , and a higher level of education . Greater improvement in depression was predicted by higher baseline values of depression , stronger beliefs in personal control , and a higher level of education . Better outcome on GPE was predicted by less pain , less fatigue , and a higher level of education . Conclusion Less anxiety , stronger beliefs in personal control , less belief in consequences , less pain , less fatigue , higher level of education , and male gender are predictors of better outcome of multidisciplinary treatment in CWP . Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome Purpose The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological ( CPP ) programme in chronic low back pain ( CLBP ) patients . Methods A prospect i ve cohort of 524 selected consecutive CLBP patients was followed . Potential predictive factors included demographic characteristics , disability , pain and cognitive behavioural factors as measured at pre-treatment assessment . The primary outcome measure was the oswestry disability index ( ODI ) . A successful 1-year follow-up outcome was defined as a functional status equivalent to ‘ normal ’ and healthy population s ( ODI ≤22 ) . The 2-week residential programme fulfills the recommendations in international guidelines . For statistical analysis we divided the data base into two equal sample s. A r and om sample was used to develop a prediction model with multivariate logistic regression . The remaining cases were used to vali date this model . Results The final predictive model suggested being ‘ in employment ’ at pre-treatment [ OR 3.61 ( 95 % CI 1.80–7.26 ) ] and an initial ‘ disability score ’ [ OR 0.94 ( 95 % CI 0.92–0.97 ) ] as significant predictive factors for a successful 1-year outcome ( R2 = 22 % ; 67 % correctly classified ) . There was no predictive value from measures of psychological distress . Conclusion CLBP patients who are in work and mild to moderately disabled at the start of a CPP programme  are most likely to benefit from it and to have a successful treatment outcome . In these patients , the disability score falls to values seen in healthy population s. This small set of factors is easily identified , allowing selection for programme entry and triage to alternative treatment regimes & NA ; A better knowledge of differential treatment outcomes for subgroups of chronic spinal pain patients may , for instance , help clinicians in treatment planning or pain research ers in treatment outcome research . The purpose of this prospect i ve study was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the ( West Haven Yale ) Multidimensional Pain Inventory , the MPI‐S. Patients referred to a vocational rehabilitation program  were classified into one of three groups , labeled ‘ adaptive copers ’ , ‘ dysfunctional ’ patients  , and ‘ interpersonally distressed ’ patients , and followed over an 18‐month follow‐up period . The outcome variables were absence from work ( defined as sick listing plus early retirement ) , general health status , and utilization of health care re sources . To our knowledge , the predictive validity of the MPI subgroups has not been evaluated regarding sick listing and early retirement after rehabilitation . As hypothesized , the results showed that the ‘ dysfunctional ’ patient group had significantly more registered absences from work and reported higher utilization of health care , over the follow‐up period compared to the ‘ adaptive copers ’ . Furthermore , as hypothesized , the ‘ interpersonally distressed ’ and ‘ dysfunctional ’ patient groups report a poorer general health status than the ‘ adaptive copers ’ over the whole follow‐up period . However , contrary to our hypothesis , the proportion of improved patients did not differ significantly between the subgroups . Altogether , the predictive validity of the MPI‐S subgroup classification was mainly confirmed . The clinical implication s of this study suggest that the matching of treatment to patient needs may enhance treatment outcome , reduce pain and suffering among chronic spinal pain patients and facilitate a better health economic allocation of treatment re sources Purpose : To explore the change in kinesiophobia in relation to activity limitation after a multidisciplinary rehabilitation programme in patients with chronic back pain . Method : A prospect i ve cohort study was made including 265 patients . Data were collected at baseline , after rehabilitation , and at 6-months follow-up . Outcome measures were the Tampa Scale for kinesiophobia ( TSK ) and the disability rating index ( DRI ) . The smallest detectable change ( SDC ) in TSK was set to 8 scores . Relationships between kinesiophobia and activity limitation/physical ability were explored with regard to subgroups with high , medium and low baseline TSK scores , and for those patients who did or did not reach the SDC in TSK . Results : Improvements in TSK showed high effect sizes in the groups with high and medium baseline TSK scores . Improvements in DRI showed medium effect sizes in all three TSK subgroups . One third of the patients reached the SDC in TSK , and this group also improved significantly more in DRI . The correlation between change in TSK and change in DRI was low . Half of the patients with high TSK score at baseline remained having high DRI at follow-up . Conclusions : Improvement in physical ability was not related to the initial degree of kinesiophobia but to the SDC in TSK . To prevent patients with high kinesiophobia from preserving high activity limitations , it might be useful to include targeted treatment of kinesiophobia . Implication s for Rehabilitation Intensive multidisciplinary rehabilitation decreases kinesiophobia and activity limitation in patients with chronic back pain . Patients improving > 8 scores on the Tampa Scale for kinesiophobia are likely to increase their physical ability . Patients with an initially high degree of kinesiophobia as well as a high level of activity limitation need targeted treatment of kinesiophobia to increase their physical ability
target: Discussion : While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR , poor pretreatment physical and psychological functioning influenced the prognosis negatively .
  Thus , treatment should further target and optimize these modifiable factors and an increased focus on positive , psychological protective factors may perhaps provide an opening for yet untapped clinical gains
background: Objectives : This systematic review aim ed to identify and evaluate prognostic factors for long-term ( ≥6 mo ) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation ( MDR ) .