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Service Line: Rapid Response Service
Version: 1.0
Publication Date: August 4, 2017
Report Length: 19 Pages
CADTH RAPID RESPONSE REPORT: SUMMARY WITH CRITICAL APPRAISAL
Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach: A Review of the Clinical and Cost-Effectiveness and Guidelines
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 2
Authors: Chuong Ho, Charlene Argez
Cite As: Occupational therapy for chronic pain management using the biopsychosocial approach: a review of the clinical and cost-effectiveness and guidelines.
Ottawa: CADTH; 2017 Jul. (CADTH rapid response report: summary with critical appraisal).
ISSN: 1922-8147 (online)
Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders,
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the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular
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While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date
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Funding: CADTH receives funding from Canadas federal, provincial, and territorial governments, with the exception of Quebec.
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 3
Context and Policy Issues
The International Association for the Study of Pain (IASP) defines pain as an unpleasant
sensory and emotional experience associated with actual or potential tissue damage and
chronic pain as pain persisting beyond the normal expected time of healing,1 which is
typically considered pain that lasts for three to six months or more.2 It has recently been
reported that one in five Canadians struggle with chronic pain,3-5
with chronic low back pain
being the most common chronic pain condition.6,7
The annual costs of treating chronic pain
in the United States were greater than the costs of treating heart disease, cancer, and
diabetes combined, with up to $635 billion annually attributed to medical costs and lost
productivity in the United States in 2010 dollars.8
Treatment options for chronic pain can be pharmacologic (i.e., pain medication which can
include opioids or non-opioid analgesics), and/or non-pharmacologic, including physical
treatment, surgery, and occupational or multimodal therapy using the biopsychosocial
approach which addresses the biological, psychological and social aspects of the
condition.9-20
Because of the harmful, dose-dependent deleterious effects of opioid
treatment, including addiction, increased risk of injuries, respiratory depression,
hyperalgesia, and death,21-23
there is a need for non-opioid, multi-disciplinary approaches
such as biopsychosocial therapy for diverse chronic pains, from low back pain, to
headache, musculoskeletal pain, and cancer-related pain.24-35
This Rapid Response report aims to review the clinical and cost-effectiveness of
occupational therapy using a biopsychosocial approach to manage chronic pain compared
to opioids, no treatment, placebo, or waiting list. Evidence-based guidelines regarding
occupational therapy using a biopsychosocial approach to manage chronic pain will also be
examined.
Research Questions
1. What is the clinical effectiveness of occupational therapy using a biopsychosocial
approach to manage chronic pain?
2. What is the cost-effectiveness of occupational therapy using a biopsychosocial
approach to manage chronic pain?
3. What are the evidence-based guidelines regarding occupational therapy using a
biopsychosocial approach to manage chronic pain?
Key Findings
The findings of a systematic review of patients with chronic low back pain show that
multidisciplinary biopsychosocial rehabilitation interventions seem to be more effective than
usual care (which generally involved pain medication and physical treatment) or physical
treatments in decreasing pain and disability; multidisciplinary rehabilitation seems to be
more effective than physical treatment in work absenteeism but not more effective than
usual care. Based on evidence from two prospective non-randomized studies in patients
with chronic pain and chronic musculoskeletal pain, a multimodal psychosocial approach
may have a better effect on pain, disability, depression and different domains of life
satisfaction compared with usual care or no treatment. There was no evidence found on
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 4
the cost effectiveness of, and the evidence-based guidelines for, occupational therapy
using a biopsychosocial approach to manage chronic pain.
Methods
A limited literature search was conducted on key resources including PubMed, The
Cochrane Library, University of York Centre for Reviews and Dissemination (CRD)
databases, Canadian and major international health technology agencies, as well as a
focused Internet search. No filters were applied to limit the retrieval by study type. Where
possible, retrieval was limited to the human population. The search was also limited to
English language documents published between January 1, 2012 and July 10, 2017. Rapid
Response reports are organized so that the evidence for each research question is
presented separately.
Selection Criteria and Methods
One reviewer screened citations and selected studies. In the first level of screening, titles
and abstracts were reviewed and potentially relevant articles were retrieved and assessed
for inclusion. The final selection of full-text articles was based on the inclusion criteria
presented in Table 1.
Table 1: Selection Criteria
Population Any patient with chronic pain (pediatric and adult)
Intervention Occupational therapy using the biopsychosocial approach
Comparator Q1 and Q2: Opioids, no treatment/placebo/wait list
Q3: No comparator required
Outcomes Q1: Clinical benefits and harms
Q2: Cost-effectiveness outcomes
Q3: Evidence-based guidelines and recommendations
Study Designs Heath technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non-
randomized studies, economic evaluations, evidence-based guidelines
Exclusion Criteria
Articles were excluded if they did not meet the selection criteria outlined in Table 1, they
were duplicate publications were already reported in the included SRs, or were published
prior to 2012. Guidelines with unclear methodology were also excluded.
Critical Appraisal of Individual Studies
The included systematic review and clinical studies were assessed using the AMSTAR36
and Downs and Black37
checklists, respectively. Summary scores were not calculated for
the included studies; rather, a review of the strengths and limitations of each included study
were described narratively.
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 5
Summary of Evidence
Quantity of Research Available
A total of 423 citations were identified in the literature search. Following screening of titles
and abstracts, 411 citations were excluded and 12 potentially relevant reports from the
electronic search were retrieved for full-text review. Three potentially relevant publications
were retrieved from the grey literature search. Of these potentially relevant articles, 12
publications were excluded for various reasons, while three publications met the inclusion
criteria and were included in this report. Appendix 1 describes the PRISMA flowchart of the
study selection. References of potential interest (studies without a comparator group) are
provided in Appendix 5.
Summary of Study Characteristics
The included review38
is a systematic review and meta-analysis of randomized controlled
trials on patients with chronic low back pain undergoing multimodal biopsychosocial
treatment. It included 41 trials with 6858 participants with a mean age of 40 to 45 years (16
trials vs. usual care; 19 trials vs. physical treatment; 2 trials vs. surgery; 4 trials vs. waiting
list). Usual care was not clearly defined; however, the review indicated that it implies pain
medication and physical treatment. Outcomes reported were pain intensity (using a 10-
point Visual Analogue Scale), disability level (using the 24-point Roland-Morris Index), and
work absenteeism. The review was conducted in Australia, the Netherlands, and Canada.
The included clinical trials were prospective longitudinal studies.39,40
One study39
included
296 patients with chronic musculoskeletal pain with the intervention as a multimodal
rehabilitation program (using a biopsychosocial approach) and the comparator as usual
unimodal rehabilitation program. Outcomes reported were pain intensity (using a 100-mm
horizontal Visual Analogue Scale, with 0 representing no pain and 100 representing
worst imaginable pain), disability level (using the 100-point Disability Rating Index, with 0
representing manage without difficulty and 100 indicating cannot manage at all),
depression (using the 14 item, 21-point Hospital Anxiety and Depression Scale, with the
categories of normal, mild, and moderate/severe), and life satisfaction (using the 11-
domain LiSat questionnaire, with higher scores indicating higher levels of life satisfaction).
Assessments were made after one-year follow-up. The study was conducted in Sweden.
One study40
included 527 patients with chronic pain with intervention as physiotherapy, or
psycho-education, or physiotherapy combined with psycho-education, or self-hypnosis and
self-care learning, and comparator as waiting list/no intervention. Outcomes reported were
pain intensity (using a 10-point Visual Analogue Scale, with increasing scores indicating
more intense pain), disability level (using the 100-point Disability Rating Index), depression
(using 21-point Hospital Anxiety and Depression Scale), and general health (using the 100-
point Short Form-36 measure of eight dimensions of health, including a Physical
Component Summary and Mental Component Summary; higher scores indicate better
health). Mean duration between pre- and post-intervention health assessment was 9 3
months. The study was conducted in Belgium.
Characteristics of the included studies are detailed in Appendix 2.
Summary of Critical Appraisal
The included systematic review38
provided an a priori design and performed a
comprehensive literature search. Procedures for the independent duplicate selection and
data extraction of the study were in place, a list of included studies and characteristics were
provided, and quality assessment of the included studies was used in formulating
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 6
conclusions. Some degrees of clinical heterogeneity across trials such as variation in
biopsychosocial treatments and usual care, as well as differences between included trials
in terms of quality (ranging from low to moderate quality) lead to possible heterogeneity
issues when data were pooled. The review assessed publication bias and did not include a
list of excluded studies.
The included clinical studies39,40
were observational in nature with no randomization
leading to potential selection bias. The hypotheses, method of selection from source
population and representation of the study population, main outcomes, interventions,
patient characteristics, and main findings were clearly described, and estimates of random
variability and actual probability values were provided. It was unclear whether the study
had sufficient power to detect a clinically important effect, as no power calculation was
reported.
Details of the critical appraisal of the included studies are presented in Appendix 3.
Summary of Findings
The main findings of the included studies are presented in Appendix 4.
What is the clinical effectiveness of occupational therapy using a biopsychosocial
approach to manage chronic pain?
The included systematic review38
on patients with chronic low back pain found that after
one year of treatment, multidisciplinary biopsychosocial therapy was more effective in
reducing pain intensity and disability level compared with usual care, but the two
approaches had a similar effect on work absenteeism. Compared with physical treatment,
biopsychosocial therapy reduced disability and work absenteeism, but the comparison did
not reach statistical significance for pain. Compared with surgery, a biopsychosocial
therapy approach had a similar effect on pain, disability and work absenteeism, but more
adverse events (details not provided) occurred with surgery. Compared with waiting list, a
biopsychosocial therapy approach reduced pain and disability; there were no data on work
absenteeism for this comparison. The authors concluded that multidisciplinary
biopsychosocial rehabilitation interventions were more effective than usual care (moderate
quality evidence) and physical treatments (low quality evidence) in decreasing pain and
disability in people with chronic low back pain. Multidisciplinary rehabilitation seems to be
more effective than physical treatment in work outcomes but not more effective than usual
care.
One included clinical trial39
found that, compared to baseline after one-year follow-up, the
biopsychosocial approach significantly reduced current pain intensity as well as pain
intensity of last week, disability level, depression, and life satisfaction in all three measured
outcomes (leisure, somatic health and psychological health) in patients with chronic
musculoskeletal pain. Usual rehabilitation care statistically improved measurements of pain
last week and somatic health from measurements of those outcomes at baseline;
comparison to baseline was not conclusive for the other outcomes. The authors concluded
that multimodal rehabilitation may have long-term positive effects on pain, disability,
depression and domains of life satisfaction.
The second included trial40
found that, in patients with chronic pain, compared to baseline
after a mean of nine months follow-up, there was a statistically significant decrease in
anxiety with physiotherapy or psycho-education treatment and with self-hypnosis and self-
care treatment, a significant decrease in depression in self-hypnosis and self-care
treatment, a significant improvement in the mental component of the Short-Form-36
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 7
questionnaire in both psycho-education and self-hypnosis and self-care treatments, a
significant decrease in disability with both physiotherapy or psycho-education treatment
and self-hypnosis and self-care treatment, and a significant diminution of pain intensity in
self-hypnosis and self-care treatment. There was no statistically significant difference
compared to baseline values in all measured outcomes in the no-treatment group. The
authors concluded that the study has shown the relevance of biopsychosocial approaches,
in particular the self-hypnosis/self-care treatment, in the improvement of pain and
psychological factors in chronic pain patients.
A list of trials of potential interest on the clinical effectiveness of the biopsychosocial
approach which do not have a comparator group is listed in Appendix 5.
What is the cost-effectiveness of occupational therapy using a biopsychosocial approach to
manage chronic pain?
There was no evidence found regarding the cost-effectiveness of occupational therapy using a biopsychosocial approach to manage chronic pain.
What are the evidence-based guidelines regarding occupational therapy using a biopsychosocial approach to manage chronic pain?
There was no evidence found in evidence-based guidelines regarding occupational therapy
using a biopsychosocial approach to manage chronic pain
Limitations
Evidence from the included systematic review and meta-analysis should be interpreted with
caution due to clinical heterogeneity across trials which may have affected the pooled
estimates when data were pooled. Blinding in the included trials was not possible for
patients, clinicians and assessors due to the nature of the interventions which may have
introduced ascertainment bias.
Conclusions and Implications for Decision or Policy Making
In patients with chronic low back pain, multidisciplinary biopsychosocial rehabilitation
interventions seem to be more effective than usual care and physical treatments in
decreasing pain and disability; multidisciplinary rehabilitation seems to be more effective
than physical treatment at reducing work absenteeism but not more effective than usual
care. In patients with chronic pain and chronic musculoskeletal pain, multimodal
psychosocial therapy may have a better effect on pain, disability, depression and different
domains of life satisfaction compared with usual care or no treatment. There was no
evidence found on the cost effectiveness of, and the evidence-based guidelines for,
occupational therapy using a biopsychosocial approach to manage chronic pain.
Openness to patients psychosocial concerns is important as reflected by patients reporting
lowest satisfaction with the attention of their practitioners to the existential domain
(meaning and purpose of life) and social domain; this dissatisfaction in turn may affect their
health-related behaviour, depression, and treatment success.41
However, promoting non-
pharmacological multimodal treatment approaches may not be easy once opioid therapy is
started, and patients may be skeptical about the efficacy of this approach.42
Stakeholder
dialogues have been conducted in Canada to summarize the evidence and elicit policy
makers and stakeholders knowledge and views to improve chronic pain management.
Development of a national network and a national pain strategy are important initiatives to
improve chronic pain management in Canada.43
A 2014 cost study of chronic pain in
adolescents in the US found that the primary driver of costs was direct medical costs
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 8
followed by productivity losses,44
which emphasizes the need for effective treatments for
chronic pain. Legislative efforts to reform workers compensation law using the
biopsychosocial model seemed to provide good care while controlling costs in the
treatment of injured workers.45
The clinical benefits of the intervention should be weighed
against the monetary costs and time commitments associated with multidisciplinary
rehabilitation programmes.
Randomized controlled trials to compare biopsychosocial approach to opioids are needed
to confirm the comparative effectiveness of the multimodal approach to opioid analgesics in
the treatment of patients with chronic pain. Cost-effectiveness studies on the use of
biopsychological therapy are needed to formulate guidelines on the use of the approach.
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 9
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SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 11
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SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 12
Appendix 1: Selection of Included Studies
411 citations excluded
12 potentially relevant articles retrieved for scrutiny (full text, if available)
3 potentially relevant reports retrieved from other sources (grey
literature, hand search)
15 potentially relevant reports
12 reports excluded: - irrelevant intervention (3) - no comparator (3) - irrelevant outcome (1) - reviews (5)
3 reports included in review
423 citations identified from electronic literature search and screened
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 13
Appendix 2: Characteristics of Included Publications Table A1: Characteristics of Included Systematic Review
First Author, Year, Country
Objectives Literature Search
Strategy
Inclusion Criteria Exclusion Criteria Number of studies included
Main Outcomes
Kamper,38
2015, Canada, Australia, Netherlands
Systematic review and meta-analysis of randomised controlled trials To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain (p 1)
Trials (RCTs) published in full; participants with low back pain for more than three months; multidisciplinary rehabilitation involved a physical component and one or both of a psychological component or a social or work targeted component; multidisciplinary rehabilitation was delivered by health care professionals from at least two different professional backgrounds; multidisciplinary rehabilitation was compared with a non- multidisciplinary intervention (p 1)
Studies not fulfilling the inclusion criteria
Total of 41 trials on multimodal biopsychosocial approach with 6858 participants 16 trials vs. usual care (varied across studies but usually involved pain medication and physical treatment); 19 trials vs. physical treatment (heat and electrotherapeutic modalities; aerobic, stretching, and strengthening exercises); 2 trials vs. surgery; 4 trials vs. waiting list (no treatment). Mean age across studies: 40 - 45 years Mean duration of symptoms > 1 year Outcomes measured: Pain (Visual Analogue Scale) Disability (Roland-Morris Index) Work absenteeism
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 14
Table A2: Characteristics of Included Clinical Studies
First Author, Year, Country
Study Design Study Objectives
Interventions/Comparators
Patients Main Outcomes
Merrick,39
2012, Sweden
Prospective longitudinal study To determine outcomes for 2 rehabilitation strategies for patients with chronic pain: a 2-day interdisciplinary team assessment followed by either: (i) a 4-week outpatient multimodal rehabilitation programme, or (ii) a subsequent rehabilitation plan (p 764)
Multimodal rehabilitation program (biopsychosocial approach) Usual rehabilitation program (details not provided)
296 patients with chronic musculoskeletal pain (76 multimodal; 220 usual rehabilitation plan) Mean age: 39.5 years
Pain (Visual Analogue Scale) Disability (Disability Rating Index) Depression (Hospital Anxiety and Depression Scale) Life satisfaction (LiSat-11) Assessment after 1-year follow -up
Vanhaudenhuyse40
2015, Belgium
Prospective longitudinal study The aim of this study was to explore the effectiveness of pain interventions in reducing disability associated with chronic pain (p 1441)
Physiotherapy Psycho-education Physiotherapy combined with psycho-education Self-hypnosis/self-care learning Control group (waiting list, no intervention)
527 patients with chronic pain (61 physiotherapy; 50 psycho-education; 169 physiotherapy combined with psycho-education; 158 self-hypnosis/self-care learning; 89 control) Mean age: 54 11 years Mean duration of pain: 116 118 months
Pain (Visual Analogue Scale, Pain Disability Index) Depression (Hospital Anxiety and Depression Scale) General health (Short Form-36, including physical and mental component summary scores) Mean duration between pre- and post-health assessment was 9 3 months.
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 15
Appendix 3: Critical Appraisal of Included Publications
Table A3: Strengths and Limitations of Clinical Systematic Reviews using AMSTAR36
Strengths Limitations
Kamper38
a priori design provided
independent studies selection and data extraction procedure in place
comprehensive literature search performed
list of included studies, studies characteristics provided
quality assessment of included studies provided and used in formulating conclusions
assessment of publication bias performed
conflict of interest stated
list of excluded studies not provided
Table A4: Strengths and Limitations of Clinical Studies using Downs and Black37
Strengths Limitations
Merrick39
hypothesis clearly described
method of selection from source population and representation described
loss to follow-up reported
main outcomes, interventions, patient characteristics, and main findings clearly described
estimates of random variability and actual probability values provided
observational study; patients not randomized
unclear whether study had sufficient power to detect a clinically important effect
Vanhaudenhuyse40
hypothesis clearly described
method of selection from source population and representation described
loss to follow-up reported
main outcomes, interventions, patient characteristics, and main findings clearly described
estimates of random variability and actual probability values provided
observational study; patients not randomized
unclear whether study had sufficient power to detect a clinically important effect
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 16
Appendix 4: Main Study Findings and Authors Conclusions
Table A5: Summary of Findings of Included Clinical Studies
Main Study Findings Authors Conclusion
Kamper38
Multidisciplinary biopsychosocial rehabilitation interventions compared to usual care Pain intensity (data from 16 trials of moderate quality evidence) SMD 0.21, 95% CI 0.04 to 0.37 Disability (data from 16 trials of moderate quality evidence) SMD 0.23, 95% CI 0.06 to 0.40 Work absenteeism (data from 7 trials of moderate quality evidence) Odds ratio1.04, 95% CI 0.73 to 1.47 Statistical heterogeneity was low across trials Multidisciplinary biopsychosocial rehabilitation interventions compared to physical treatment Pain intensity(data from 19 trials of low quality evidence) SMD 0.51,95% CI -0.01 to 1.04 Disability (data from 19 trials of low quality evidence) SMD 0.68, 95% CI 0.16 to 1.19 Significant statistical heterogeneity across trials was present for pain and disability outcomes Work absenteeism (data from 8 trials of low quality evidence) Odds ratio 1.87, 95% CI 1.39 to 2.53 Multidisciplinary biopsychosocial rehabilitation interventions compared to surgery Pain intensity (data from 2 trials of low quality evidence) SMD 0.25, 95% CI -0.04 to 0.53 Disability (data from 2 trials of low quality evidence) SMD 0.25, 95% CI -0.08 to 0.57 Work absenteeism (data from 2 trials of low quality evidence) Odds ratio 0.67, 95% CI 0.31 to 1.45 Adverse events (data from 2 trials of low quality evidence) Odds ratio 28.25, 95% CI 3.77 to 211.93 Multidisciplinary biopsychosocial rehabilitation interventions compared to waiting list Pain intensity (data from 3 trials of low quality evidence) SMD 0.73, 95% CI 0.24 to 1.22
Multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinary rehabilitation seems to be more effective than physical treatment but not more effective than usual care (p 1)
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 17
Table A5: Summary of Findings of Included Clinical Studies
Main Study Findings Authors Conclusion
Disability (data from 3 trials of low quality evidence) SMD 0.49, 95% CI 0.22 to 0.76
Merrick39
For the MMR group Pain intensity (at 1-year follow-up, compared to baseline) From 59 (mean; SD 22) to 46 (SD 27) for VAS current pain (p = 0.002) From 64 (mean; SD 22) to 47 (SD 27) for VAS mean pain last week (p < 0.001) Disability (at 1-year follow-up, compared to baseline) Improved significantly Light work (P< 0.001), Heavy work (P< 0.002) Depression (at 1-year follow-up, compared to baseline) Improved significantly (P < 0.007) Life satisfaction (at 1-year follow-up, compared to baseline)Improved significantly Leisure (P = 0.001) Somatic health (P < 0.001) Psychological health (P< 0.001)
For the usual rehabilitation group
Pain intensity (at 1-year follow-up, compared to baseline) From 67 (mean; SD 19) to 60 (SD 24)for VAS mean pain last week (P< 0.001) Life satisfaction (at 1-year follow-up, compared to baseline) Somatic health improved significantly (P = 0.013) No statistically significant improvements found for other variables
This study indicates that multimodal rehabilitation may have long-term positive effects on pain, disability, depression and domains of life satisfaction (p 764)
Vanhaudenhuyse40
Changes in the pre-treatment to post-treatment (measured by HADS, SF-36, PDI and VAS scores; assessment at mean 9 3 months) Significant decrease in anxiety in physiotherapy/psycho-education treatment (P = 0.04) and in self-hypnosis/self-care treatment (P
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 18
Table A5: Summary of Findings of Included Clinical Studies
Main Study Findings Authors Conclusion
(P
SUMMARY WITH CRITICAL APPRAISAL Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach 19
Appendix 5: Trials of potential interest on the biopsychosocial approach with no comparator group Volker G, van Vree F, Wolterbeek R, van Gestel M, Smeets R, Kke A, et al. Long-term
outcomes of multidisciplinary rehabilitation for chronic musculoskeletal pain.
Musculoskelatal Care. 2017;15(1):59-68.
Hallstam A, Lfgren M, Svensn C, Stalnacke BM, Patients with chronic pain: one-year
follow-up of a multimodal rehabilitation programme at a pain clinic. Scand J Pain.
2016;10:36-42.
Quinlan J, Hughes R, Laird D. Independent validation of the Pain Management Plan in a
multi-disciplinary pain team setting. Br J Pain. 2016;10(4):168-176.