Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Abstract

Björn Gerdle,1 Elena Dragioti,1 Marcelo Rivano Fischer,2,3 Åsa Ringqvist2 1Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 2Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden; 3Department of Health Sciences, Faculty of Medicine, Lund University, Lund, SwedenCorrespondence: Björn Gerdle, Email [email protected]: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies.Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator.Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008– 2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims.Results: Changes in acceptance (β:0.424– 0.553; all P< 0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177– 0.233; all P< 0.001) and changes in fear-avoidance (β: − 0.152– − 0.186; all P< 0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator.Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.Keywords: anxiety, chronic pain, coping strategies, depression, health, pain management

Keywords

• anxiety
• chronic pain
• coping strategies
• depression
• health
• pain management