Journal of Rehabilitation Medicine 51-2 | Page 52

J Rehabil Med 2019; 51: 127–135 ORIGINAL REPORT COMPARISON OF SHORT- AND MID-TERM OUTCOMES OF ITALIAN- AND GERMAN-SPEAKING PATIENTS AFTER AN INTERDISCIPLINARY PAIN MANAGEMENT PROGRAMME IN SWITZERLAND: A PROSPECTIVE COHORT STUDY Thomas BENZ, MSc 1,2 *, Susanne LEHMANN, RN 1 , Roberto BRIOSCHI, MSc 1 , Achim ELFERING, PhD 2 , André AESCHLIMANN, MD 1 and Felix ANGST, MD, MPH 1 From the 1 Research Department, Rehabilitation Clinic “RehaClinic”, Bad Zurzach, and 2 Institute of Psychology, University of Bern, Bern, Switzerland Objective: To quantify and compare the course of health-related quality of life of immigrant native Ita- lian-speaking and German-speaking patients before and after an interdisciplinary pain programme. Design: Prospective cohort study with 1–12 month follow-up. Subjects: Fibromyalgia, generalized widespread pain, and chronic non-specific back pain patients (Italian-speaking n  = 96, German-speaking n  = 199). Methods: Score changes measured with the Short Form 36 (SF-36) were compared with multivariate analysis using standardized mean differences (SMD), adjusted for sex, education and the baseline score. Results: At baseline, health of the Italian-speaking patients was worse than for the German-speaking patients. Adjusted SMDs showed significantly bet- ter improvements in the German group compared with the Italian group: SF-36 Physical functioning SMD = 0.54 (at discharge) and 0.49 (at 12 months), General health SMD  =  0.71 and 0.44, Vitality SMD = 0.43 and 0.48 in one sample. In the other sam- ple, the corresponding SMDs were 0.06 (discharge), 0.50 (3 months) and 0.47 (6 months) for Bodily pain. Conclusion: State of health was better and health improvements were greater in German-speaking pa- tients compared with Italian-speaking patients. Pa- tients with a migration background may have special needs in therapeutic management, and addressing these might enhance the positive outcome in the short- and mid-term. Key words: rehabilitation; interdisciplinary pain management programme; fibromyalgia; back pain; language; socio-cultural factors. Accepted Dec 7, 2018; Epub ahead of print Jan 22, 2019 J Rehabil Med 2019; 51: 127–135 Correspondence address: Thomas Benz, Research Department, Reha- bilitation Clinic “RehaClinic”, Quellenstrasse 34, CH-5330 Bad Zurzach, Switzerland. E-mail: [email protected] C hronic pain occurs in countries with different ethnic, racial, and cultural backgrounds, and has an adult prevalence of 19% in Europe (1). “Ethnic and racial differences” have been described for response to experimental pain, as well as for the perception, expe- LAY ABSTRACT This study examined the health of patients with chronic pain who participated in a specific rehabilita- tion programme for chronic pain. Patients’ health was measured before participating in the programme, at the end of the programme, and after the programme. German-speaking patients were compared with Italian- speaking patients. Both groups participated in the same pain management programme with the same therapies, held either in German or in Italian. Italian-speaking and German-speaking patients improved immediately after the programme, but Italian-speaking patient reported lower improvements. The measurements after the pro- gramme showed that German-speaking patients could maintain the improvements, whereas the Italian-speak­ ing patients lost the positive effects of the programme over time. In conclusion, Italian-speaking patients may have special needs in pain management and the level of acculturation may influence the results. rience and treatment of pain (2, 3). Reasons proposed for ethnic differences in the prevalence of widespread pain include psychosocial or cultural differences, ge- netic predisposition, and the influence of physical or social environment (4, 5). Interdisciplinary biopsychosocial rehabilitation for chronic low back and fibromyalgia reduces pain intensity, symptom impact, disability and improves functional capacity and work status (6–9). Based on a biopsychosocial treatment approach for chronic pain, interdisciplinary pain management programmes (IPMP) consider that pain, disability, and participation are not only the consequence of a biomedical cause (10, 11). Biological, psychological and social factors influence the development, course and maintenance of chronic pain (12, 13). These dimensions, as well as their interactions, are therefore, recommended to be an integral part of the treatment of low back pain and fibromyalgia (14, 15). Social factors can be defined as “external facts and circumstances that influence and control an individual’s behaviour or attitudes related to pain”, e.g. language (16). Language difficulties may lead to misunderstandings relating to treatment intentions and This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2514