The impact of psychologically different patient groups on outcome after a vocational rehabilitation program for long-term spinal pain patients

A better knowledge of differential treatment outcomes for subgroups of chro nic spinal pain patients may, for instance, help clinicians in treatment pl anning or pain researchers in treatment outcome research. The purpose of th is prospective study was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the (West Haven Yale) Multid imensional Pain Inventory, the MPI-S. Patients referred to a vocational reh abilitation program were classified into one of three groups, labeled 'adap tive copers', 'dysfunctional' patients, and 'interpersonally distressed' pa tients, and followed over an 18-month follow-up period. The outcome variabl es were absence from work (defined as sick listing plus early retirement), general health status, and utilization of health care resources. To our kno wledge, the predictive validity of the MPI subgroups has not been evaluated regarding sick listing and early retirement after rehabilitation. As hypot hesized, the results showed that the 'dysfunctional' patient group had sign ificantly more registered absences from work and reported higher utilizatio n of health care, over the follow-up period compared to the 'adaptive coper s'. Furthermore, as hypothesized, the 'interpersonally distressed' and 'dys functional' patient groups report a poorer general health status than the ' adaptive copers' over the whole follow-up period. However, contrary to our hypothesis, the proportion of improved patients did not differ significantl y between the subgroups. Altogether, the predictive validity of the MPI-S s ubgroup classification was mainly confirmed. The clinical implications of t his study suggest that the matching of treatment to patient needs may enhan ce treatment outcome, reduce pain and suffering among chronic spinal pain p atients and facilitate a better health economic allocation of treatment res ources. (C) 2001 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.