SQRP SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION

SQRP SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION

SQRP SWEDISH QUALITY REGISTRY FOR PAIN

REHABILITATION

Marcelo Rivano Fischer, PhD

Head of Dept. Rehabilitation Medicine, University HospitalPresident, Swedish Pain Society

Chairman, Swedish Quality Registry for Pain Rehabilitation


Organisation from 1 januari 2011ChairmanMarcelo Rivano Fischer, Head of Department, Psych PhD, Lund CoordinatorElisabeth Persson, Leg Arbetsterapeut MSc, PhD student, LundBoardBjörn Gerdle, Professor, MD, LinköpingBritt-Marie Stålnacke, Ass Prof, MD, Umeå Margareta Fridén, Occup T, Jönköping Marie-Louise Schult, Occup T, PhD, Stockholm Harriet Brännström, Phys T, UmeåStatistician/Coordinator to UCR Annelie Inghilesi Larsson, PolMag Statistics, Umeå Center of excellenceUppsala Clinical Research Center UCR


Goals:1.Support member units in their quality improvement activities2.Serve as base for developing evidence-based methods3.Establish adequate comparisons with other units for improvement in national standards of pain rehabilitation

NRS uses the ICF framework and groups its instruments into the categories of function, activity/participation, and personal factors

NRS uses mainly patient related outcome measurement, PROM

Several scientific works are produced from register data

Since 2007 are results from the units open to public scrutiny


Instruments in NRS

Questionnaire, socio-demographic data, work, sick-leave, pain duration and attitudes towards the future. Numeric Rating Scale (skala 0-10) (Turk m fl, 1993). The Hospital and Anxiety Depression Scale (HAD) (Zigmond & Snaith, 1983). Multidimensional Pain Inventory (MPI) (Kerns m fl. 1985; Rudy & Turk, 1987).

SF- 36 Health Related Life Quality (Ware, 1992; Sullivan m fl., 1998).

EQ-5D Experienced Health (the EuroQol Group) (Brooks R, 1996; van Agt m fl., 1994)


Patients referred to multimodal/interdisciplinary pain rehabilitation due to complex persisting pain (non-cancer, > 3 months)

During 2010, twenty units delivered data

18 out of 20 Swedish provinces/regions are represented in NRS

Most of Swedish rehabilitation units departments are NRS members

Seven new units joined NRS during 2011 and two units left the register as they lost their local procurements.


Data from 3651 patients entered 2010 at first contact (initial)

67% of referrals from GPs 1863 patients were offered pain rehab program after pain team screening

Pain team screening only, for 1788 patients

During 2010, 1394 patients completed their pain rehab programs

Pain rehab patients were mainly women ( 74%), with average pain duration of 72 months and out of work for 22 months (median)

Worst pain was described by patients going through pain rehab programs as varying in localisation (36%), followed by low back pain (19%) and by pain in the neck region (14%).


One year follow up

2010, 842 patients out of 1272 that went through pain rehab programs 2009 answered their one year follow up forms

It means that follow up coverage for patients in rehab 2009 was around 65%.

Out of the 842 follow up patients, 189 had incomplete set of answers (admission, discharge, follow up) and therefore excluded from analyses.

Attrition of patients answering at follow up is therefore 23%


Average waiting time for patients undergoing pain team screening only during 2010 was 68 days (median)

Fourteen out of 20 units make first contact with patients within the health care mandatory timeframe (less than 90 days)Seven units make first contact in less than 60 days

Average waiting time for patients undergoing pain rehab programs during 2010 was 55 days (median)

Fifteen out of 20 units initiate pain rehab within the health care mandatory timeframe (less than 90 days)Eight units in less than 60 days.









Do you feel you were responded to in a respectful and considerate way?

Were you satisfied with the unit’s equipment?

How was the information you received about practical matters?

Do you feel you were participating in the planning of your own rehabilitation?

How did the rehab team worked together in your case?

Did your relatives participate in your rehabilitation?

Did the rehabilitation period change your pain experinces?

Did the rehabilitation period change your ability to cope with your life situation?


NRS självskattningsprofil

Country of birth

Age

Days with persisting painImportance of work

Days with full absence from work

Days since pain onset

How possible return to workWhen possible return to workConvinced about being restored

Pain last week (NRS)MPI: pain intensityPain spreadMPI: affective distressHAD: depressionHAD: anxiety

Main pain localisation

Vitality (SF-36)

Physical function, PF (SF-36)MPI: activity indexRole function, RP (SF-36)Social Function, SF (SF-36)MPI: Life disturbanceMPI: Life control

Level of education


Since 2010, improvements are defined, for all measures besides SF-36 and EQ-5D, in terms of clinically meaningful improvements, that is, differences that had been found significant by research for the health of patients, rather than statistically significant positive differences.

Patients improved in most measures: 40-60% at discharge and 30-70% at follow up.

Variation in improvements between the units is large for some measures and quite small for others.Comparison between units demands an analysis about differences and similarities in the rehab programs offered at the different places. This analysis is planned to be published in next year rapport.

Specific analyses show that age, pain intensity at admission, and ethnicity are related to improvements as captured by several instruments


2010, number of patients by unit


2010, number of days that patients are within the responsability of the unit, screening team


2010, number of days that patients are within the responsability of the unit, pain rehab team


2010, Pain onset, screening teams


2010, Pain onset, pain rehab teams


2010, patients born in Sweden, pain rehab teams


Reduced pain, follow up


Better ability to cope with life situation, follow up


Improvement, all instruments, admission-follow up



Persisting pain patients experience their health poorer than, for instance, spinal cord injured people

They experience their pain as invisible and themselves under suspicion (pain in the head)

They report being systematically de-legitimized

They experience their encounters with health care and other authorities as frustrating and negative

Research shows ways for improvement

Registries help us to improve our strategies

Disclosure Statement of Financial Interest

I, I, Marcelo Rivano Fischer, Marcelo Rivano Fischer, DO NOT have a DO NOT have a financial interest/arrangement or affiliation with financial interest/arrangement or affiliation with one or more organizations that could be one or more organizations that could be perceived as a real or apparent conflict of perceived as a real or apparent conflict of interest in the context of the subject of this interest in the context of the subject of this presentation.presentation.

Documents

SQRP SWEDISH QUALITY REGISTRY FOR PAIN REHABILITATION