Journal of Occupational Rehabilitation

, Volume 24, Issue 3, pp 446–457 | Cite as

Early Psychologically Informed Interventions for Workers at Risk for Pain-Related Disability: Does Matching Treatment to Profile Improve Outcome?

  • Sofia Bergbom
  • Ida K. L. Flink
  • Katja Boersma
  • Steven J. Linton
Article

Abstract

Purpose This randomized controlled trial had two main aims. The first aim was to investigate the effect of early preventive, psychologically informed, interventions for pain-related disability. The second aim was explore whether people who are matched to an intervention specifically targeting their psychological risk profile had better outcomes than people who were not matched to interventions. Methods A total of 105 participants were recruited from their workplace, screened for psychological risk factors and classified as being at risk for long-term pain-related disability. They were subgrouped into one of three groups based on their psychological profile. Three behaviorally oriented psychological interventions were developed to target each of the three risk profiles. Half of the participants were assigned a matched intervention developed to target their specific profile, and half were assigned an unmatched intervention. After treatment, repeated measure ANOVAs and χ2 tests were used to determine if treatments had an effect on primary and secondary outcomes including perceived disability, sick leave, fear and avoidance, pain catastrophizing and distress, and if matched participants had better outcomes than did unmatched. Results Treatments had effects on all outcome variables (effect sizes d ranging between 0.23 and 0.66), but matched participants did not have better outcomes than unmatched. Conclusions Early, preventive interventions have an impact on a number of outcome variables but it is difficult to realize a matching procedure. More in-depth research of the process of matching is needed.

Keywords

Musculoskeletal pain Occupational health services Disability leave Return-to-work Pain management Randomized controlled trial 

Notes

Acknowledgments

This research was supported by Grants from the Swedish Council for Working Life and Social Research.

References

  1. 1.
    Bergman S, Herrström P, Högström K, Petersson IF, Svensson B, Jacobsson LT. Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study. J Rheumatol. 2001;28(6):1369–77.PubMedGoogle Scholar
  2. 2.
    Picavet H, Schouten J. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC < sub > 3 </sub > -study. Pain. 2003;102(1):167–78.PubMedCrossRefGoogle Scholar
  3. 3.
    Linton SJ, Boersma K, Jansson M, Svärd L, Botvalde M. The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: a randomized controlled trial. Clin J Pain. 2005;21(2):109–19.PubMedCrossRefGoogle Scholar
  4. 4.
    Linton SJ, Halldén K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain. 1998;14(3):209.PubMedCrossRefGoogle Scholar
  5. 5.
    Nicholas MK, Linton SJ, Watson PJ, Main CJ. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Phys Ther. 2011;91(5):737.PubMedCrossRefGoogle Scholar
  6. 6.
    Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, et al. Psychosocial risk factors for chronic low back pain in primary care—a systematic review. Fam Pract. 2011;28(1):12–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Boersma K, Linton SJ. Screening to identify patients at risk: profiles of psychological risk factors for early intervention. Clin J Pain. 2005;21(1):38–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatment-and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil. 2003;13(1):1–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Linton SJ. Early identification and intervention in the prevention of musculoskeletal pain. Am J Ind Med. 2002;41(5):433–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Guck TP, Meilman PW, Skultety FM, Poloni LD. Pain-patient Minnesota multiphasic personality inventory (MMPI) subgroups: evaluation of long-term treatment outcome. J Behav Med. 1988;11(2):159–69.PubMedCrossRefGoogle Scholar
  11. 11.
    McGill JC, Lawlis GF, Selby D, Mooney V, McCoy C. The relationship of Minnesota Multiphasic Personality Inventory (MMPI) profile clusters to pain behaviors. J Behav Med. 1983;6(1):77–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Moore JE, Armentrout DP, Parker JC, Kivlahan DR. Empirically derived pain-patient MMPI subgroups: Prediction of treatment outcome. J Behav Med. 1986;9(1):51–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Swimmer GI, Robinson ME, Geisser ME. Relationship of MMPI cluster type, pain coping strategy, and treatment outcome. Clin J Pain. 1992;8(2):131–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Boersma K, Linton SJ. Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear–avoidance model and disability. Clin J Pain. 2006;22(2):160–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Bergbom S, Boersma K, Overmeer T, Linton SJ. Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. Phys Ther. 2011;91(5):754–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Reme SE, Shaw WS, Steenstra IA, Woiszwillo MJ, Pransky G, Linton SJ. Distressed, immobilized, or lacking employer support? A sub-classification of acute work-related low back pain. J Occup Rehabil. 2012;22:1–12.CrossRefGoogle Scholar
  17. 17.
    Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Care Res. 2008;59(5):632–41.CrossRefGoogle Scholar
  18. 18.
    Turk DC, Rudy TE. Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data. J Consult Clin Psychol. 1988;56(2):233–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Westman A, Boersma K, Leppert J, Linton SJ. Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain. Clin J Pain. 2011;27(7):567–77.PubMedCrossRefGoogle Scholar
  20. 20.
    Turk DC. The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting. Clin J Pain. 2005;21(1):44–55.PubMedCrossRefGoogle Scholar
  21. 21.
    Turk DC, Okifuji A, Sinclair JD, Starz TW. Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Rheum. 2005;11(5):397–404.CrossRefGoogle Scholar
  22. 22.
    Walen HR, Cronan TA, Serber ER, Groessl E, Oliver K. Subgroups of fibromyalgia patients: evidence for heterogeneity and an examination of differential effects following a community-based intervention. J Musculoskelet Pain. 2002;10(3):9–32.CrossRefGoogle Scholar
  23. 23.
    Gatchel RJ, Noe CE, Pulliam C, Robbins H, Deschner M, Gajraj NM, et al. A preliminary study of multidimensional pain inventory profile differences in predicting treatment outcome in a heterogeneous cohort of patients with chronic pain. Clin J Pain. 2002;18(3):139–43.PubMedCrossRefGoogle Scholar
  24. 24.
    George SZ, Fritz JM, Bialosky JE, Donald DA. The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial. Spine. 2003;28(23):2551.PubMedCrossRefGoogle Scholar
  25. 25.
    George SZ, Zeppieri G Jr, Cere AL, Cere MR, Borut MS, Hodges MJ, et al. A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867). Pain. 2008;140(1):145–57.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Hill JC, Whitehurst DGT, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378(9802):1560–71.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Nachemson AL, Jonsson E, editors. Neck and back pain. Philadelphia: Lippincott Williams & Wilkins; 2000.Google Scholar
  28. 28.
    Linton SJ, Halldén K, Hellsing A-L. The reliability of self-reported sick absenteeism: a pilot study. Scand J Behav Ther. 1995;24(4):145–50.CrossRefGoogle Scholar
  29. 29.
    Ferrie JE, Kivimäki M, Head J, Shipley MJ, Vahtera J, Marmot MG. A comparison of self-reported sickness absence with absences recorded in employers’ registers: evidence from the Whitehall II study. Occup Environ Med. 2005;62(2):74–9.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Group EuroQol. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRefGoogle Scholar
  31. 31.
    van Agt HME, Essink-Bot M-L, Krabbe PFM, Bonsel GJ. Test-retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med. 1994;39(11):1537–44.PubMedCrossRefGoogle Scholar
  32. 32.
    Deyo RA, Battie M, Beurskens A, Bombardier C, Croft P, Koes B, et al. Outcome measures for low back pain research: a proposal for standardized use. Spine. 1998;23(18):2003.PubMedCrossRefGoogle Scholar
  33. 33.
    Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, et al. The Quebec back pain disability scale: measurement properties. Spine. 1995;20(3):341.PubMedCrossRefGoogle Scholar
  34. 34.
    Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, et al. The Quebec back pain disability scale: conceptualization and development. J Clin Epidemiol. 1996;49(2):151–61.PubMedCrossRefGoogle Scholar
  35. 35.
    Kori SH, Miller RP, Todd DD. Kinisophobia: a new view of chronic pain behavior. Pain Manage. 1990;3:35–43.Google Scholar
  36. 36.
    Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.PubMedCrossRefGoogle Scholar
  37. 37.
    Swinkels-Meewisse EJCM, Swinkels RAHM, Verbeek ALM, Vlaeyen JWS, Oostendorp RAB. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther. 2003;8(1):29–36.PubMedCrossRefGoogle Scholar
  38. 38.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361.PubMedCrossRefGoogle Scholar
  39. 39.
    Lisspers J, Nygren A, Söderman E. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand. 1997;96(4):281–94.PubMedCrossRefGoogle Scholar
  40. 40.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69–77.PubMedCrossRefGoogle Scholar
  41. 41.
    Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524–32.CrossRefGoogle Scholar
  42. 42.
    Von Korff M, Moore JE, Lorig K, Cherkin DC, Saunders K, González VM, et al. A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care. Spine. 1998;23(23):2608.CrossRefGoogle Scholar
  43. 43.
    IBM Corp. IBM SPSS Statistics for Windows, version 20.0. Armonk, NY: IBM Corp; 2011.Google Scholar
  44. 44.
    Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods. 2002;7(1):105.PubMedCrossRefGoogle Scholar
  45. 45.
    Leeuw M, Goossens MEJB, van Breukelen GJP, de Jong JR, Heuts PHTG, Smeets RJEM, et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain. 2008;138(1):192–207.PubMedCrossRefGoogle Scholar
  46. 46.
    Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.PubMedCrossRefGoogle Scholar
  47. 47.
    Einarsson C, Karlsson B. Allians i psykologisk behandling för smärta [Alliance in psychological treatment for pain] [Master’s thesis]. Örebro: Örebro University; 2010.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sofia Bergbom
    • 1
    • 2
  • Ida K. L. Flink
    • 1
  • Katja Boersma
    • 1
  • Steven J. Linton
    • 1
  1. 1.Center for Health and Medical Psychology (CHAMP)Örebro UniversityÖrebroSweden
  2. 2.Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social WorkÖrebro UniversityÖrebroSweden

Personalised recommendations