Article

PURPOSE: To evaluate changes in pain intensity and activity limitation, at group
and individual levels, and their associations with the global impression of
change after multimodal rehabilitation in patients with back pain. METHOD:
Patients with long-term back pain (n = 282) participated in a 4-week programme
with a follow-up after 6 months. Visual analogue scales (VAS) were used to rate
pain intensity and activity limitation. Global impression of change (GIC) was
rated on a 7-category scale.
The sign test, the Svensson method and the Spearman
rank correlation were used for analyses. RESULTS: Significantly lower ratings in
pain and activity limitation at follow-up were found at group level. However, a
large individual variability was found by the Svensson method. The correlations
between GIC and changes in pain and activity limitation were rs = 0.49 and rs =
0.50, respectively. A rated GIC of at least "much better" on group level showed
changes of >/=20 mm on the VAS. CONCLUSIONS: At group level, lower VAS ratings
were found in patients with back pain. However, a large individual variability in
pain and activity limitation was also found resulting in low to moderate
associations between GIC and the change in VAS ratings. The large individual
variability might be due to the impreciseness in the ratings on the VAS. We have
presented a critical discussion of statistical methods in connection with the
VAS. Implications for Rehabilitation The use of VAS as a rating instrument may be
questioned, especially for perceived pain intensity which is a too complex
experience to be rated on a line without any visible categories. Single ratings
of pain intensity should preferably be complemented with the ratings of activity
limitation in patients with long-term back pain. Global impression of change is a
suggested inclusive rating after rehabilitation. The improvement desired by the
patient should preferably be determined before rehabilitation.

Langue : ANGLAIS