Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain : an observational study with cross-sectional and longitudinal analyses

Luthi, François (Clinique Romande de Réadaptation suva, Sion, Switzerland ; Orthopedic Hospital, Lausanne, University Hospital, Lausanne, Switzerland) ; Vuistiner, Philippe (Clinique Romande de Réadaptation suva, Sion, Switzerland) ; Favre, Christine (Clinique Romande de Réadaptation suva, Sion, Switzerland) ; Hilfiker, Roger (Clinique Romande de Réadaptation suva, Sion, Switzerland ; School of Health Science, HES-SO Valais-Wallis, Sion, Switzerland) ; Léger, Bertrand (Clinique Romande de Réadaptation suva, Sion, Switzerland)

Background: Three main activity patterns have been distinguished in describing chronic pain (avoidance, pacing and persistence). However, their influence on patient outcomes remains a question of debate. This observational study aimed to measure the associations between the avoidance, pacing, and persistence (labelled overdoing) scales of the Patterns of Activity Measure–Pain (POAM-P), self-reported outcomes (pain-interference, depression, functional ability), and observational outcomes (walking, lifting test, physical fitness). Methods: We conducted an observational study with cross-sectional and longitudinal analyses. The data were collected prospectively before and after treatment, which was a 5-week functional rehabilitation including vocational aspects. In addition to self-reported and observational outcomes, patients were asked if they thought they would be able to return to work at 6 months. Analyses were conducted with treatment effect sizes, correlations, and multiple regression models. Results: In this sample (891 patients), we found on average small to moderate improvements for pain-interference and observational outcomes (Cohen’s d: 0.37 to 0.64). According to the multivariable models, overdoing was associated with most of the beneficial psychosocial and observational outcomes (β -0.13 to 0.17; all p<0.01). Avoidance was related to negative psychosocial outcomes before treatment (β -0.09 to 0.17; all p<0.015). Pacing, which had moderate correlation with avoidance (r = 0.46), was not associated with most of the outcomes. The feeling that the goal of returning to work was attainable was associated with lower avoidance scores (adjusted OR 0.97; p = 0.024). Conclusions: The overdoing POAM-P scale probably measures a task-contingent persistence, which appears appropriate in the setting of this study. Persistent behavior was indeed related to small or moderate positive biopsychosocial outcomes, before and after treatment. Moreover feeling able to return to work was related to lower avoidance. Further studies should test the efficacy of motivational strategies that may promote functional task-contingent persistence and reduce avoidance of painful tasks.


Article Type:
scientifique
Faculty:
Santé
School:
HEdS-VS
Institute:
Institut Santé
Subject(s):
Santé
Date:
2018-09
Pagination:
22 p.
Published in:
PLoS ONE
Numeration (vol. no.):
2018, vol. 13, no. 9, e0203329
DOI:
ISSN:
1932-6203
Appears in Collection:



 Record created 2019-02-25, last modified 2019-08-07

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