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

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  • François Luthi
  • Philippe Vuistiner
  • Christine Favre
  • Roger Hilfiker
  • Bertrand Léger

Abstract

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

Suggested Citation

  • François Luthi & Philippe Vuistiner & Christine Favre & Roger Hilfiker & Bertrand Léger, 2018. "Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-22, September.
    • Handle: RePEc:plo:pone00:0203329
    DOI: 10.1371/journal.pone.0203329
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