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  • 1.
    Söderlund, Anne
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Löfgren, Monika
    Danderyd Hosp AB, Dept Clin Sci, Karolinska Inst, SE-18288 Stockholm, Sweden.;Danderyd Hosp AB, Dept Rehabil Med, SE-18288 Stockholm, Sweden..
    Stålnacke, Britt-Marie
    Danderyd Hosp AB, Dept Clin Sci, Karolinska Inst, SE-18288 Stockholm, Sweden.;Danderyd Hosp AB, Dept Rehabil Med, SE-18288 Stockholm, Sweden.;Umea Univ, Dept Community Med & Rehabil, Rehabil Med, SE-90187 Umea, Sweden..
    Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP)2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1475-1482Article in journal (Refereed)
    Abstract [en]

    BACKGROUND CONTEXT: Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD). PURPOSE: The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement. perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR). STUDY DESIGN: The design of this investigation was a cohort study with 1-year postrehabilitation follow-up. STUDY SETTING: The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015. PATIENT SAMPLE: The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR. OUTCOME MEASURES: Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up. METHODS: The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR). RESULTS: Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up. CONCLUSION: For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor. but patients' perceived reactions from their spouses need to be considered in planning the management of WAD. 

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