Does classification of chronic musculoskeletal disorder patients into psychosocial subgroups predict differential treatment responsiveness and 1-year outcomes after a functional restoration program?

Sali Asih, Tom G. Mayer, Mark Williams, Yun Hee Choi, Robert J. Gatchel

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objectives: The objectives of this study: (1) to assess whether Multidimensional Pain Inventory (MPI) profiles predicted differential responses to a functional restoration program (FRP) in chronic disabling occupational musculoskeletal disorder (CDOMD) patients; (2) to examine whether coping style improves following FRP; and (3) to determine whether discharge MPI pro-files predict discharge psychosocial and 1-year socioeconomic outcomes. Methods: Consecutive CDOMD patients (N=716) were classified into Adaptive Coper (AC, n=209), Interpersonally Distressed (ID, n=154), Dysfunctional (DYS, n=310), and Anomalous (n=43) using the MPI, and reclassified at discharge. Profiles were compared on psychosocial measures and 1-year socioeconomic outcomes. An intent-to-treat sample analyzed the effect of dropouts on treatment responsiveness. Results: The MPI classification significantly predicted program completion (P=0.001), although the intent-to-treat analyses found no significant effects of drop-out on treatment responsiveness. There was a significant increase in the number of patients who became AC or Anomalous at FRP discharge and a decrease in those who were ID or DYS. Patients who changed or remained as DYS at FRP discharge reported the highest levels of pain, disability, and depression. No significant interaction effect was found between MPI group and time for pain intensity or disability. All groups improved on psychosocial measures at discharge. DYS patients had decreased work retention and a greater health care utilization at 1 year. Conclusions: An FRP was clinically effective for CDOMD patients regardless of initial MPI profiles. The FRP modified profiles, with patients changing from negative to positive profiles. Discharge DYS were more likely o have poor 1-year outcomes. Those classified as Anomalous had a good prognosis for functional recovery similar to ACs.

Original languageEnglish
Pages (from-to)1036-1045
Number of pages10
JournalClinical Journal of Pain
Volume31
Issue number12
DOIs
StatePublished - 1 Jan 2015

Keywords

  • Chronic disabling occupational musculoskeletal disorders
  • Interdisciplinary treatment
  • Multidimensional Pain Inventory
  • functional restoration program
  • socioeconomic outcomes
  • treatment responsiveness

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