Longitudinal outcome evaluations of interdisciplinary multimodal pain treatment programs for patients with chronic primary musculoskeletal pain: a systematic review and meta-analysis.

Abstract

BACKGROUND AND OBJECTIVES\nAlthough Interdisciplinary Multimodal Pain Treatment (IMPT) programs share a biopsychosocial approach to increase the wellbeing of patients with chronic pain, substantial variation in content and duration have been reported. In addition, it is unclear to what extent any favorable health outcomes are maintained over time. Therefore, our first aim was to identify and analyze the change over time of patient related outcome measures in cohorts of patients who participated in IMPT programs. Our second aim was to acquire insight into the heterogeneity of IMPT programs.\n\n\nDATABASES AND DATA TREATMENT\nThe study protocol was registered in Prospero under CRD42018076093. We searched Medline, Embase, PsycInfo and Cinahl from inception to May 2020. All study selection, data extraction and risk of bias assessments were independently performed by two researchers. Study cohorts were eligible if they included adult patients with chronic primary musculoskeletal pain for at least 3 months. We assessed the change over time, by calculating pre-post, post-follow-up and pre-follow-up contrasts for seven different patient-reported outcome domains. To explore the variability between the IMPT programs, we summarized the patient characteristics and treatment programs using the intervention description and replication checklist.\n\n\nRESULTS\nThe majority of the 72 included patient cohorts significantly improved during treatment. Importantly, this improvement was generally maintained at follow-up. In line with our expectations and with previous studies, we observed substantial methodological and statistical heterogeneity.\n\n\nCONCLUSIONS\nThis study shows that participation in an IMPT program is associated with considerable improvements in wellbeing that are generally maintained at follow-up. The current study also found substantial heterogeneity in dose and treatment content, which suggests different viewpoints on how to optimally design an IMPT program.