Predictors for deterioration after an integrated and blended primary care treatment in patients with moderate MUPS

Abstract

Aim In order to prevent chronic MUPS, an integrated and blended intervention (the PARASOL-intervention) for people with moderate MUPS is developed. Earlier research in chronic MUPS, has shown that deterioration after treatment is a major problem. The expectation is that a proportion of patients with moderate MUPS also have a deterioration in functioning post treatment. The aim of this study is to identify relevant prognostic factors that are associated with deterioration in physical functioning or mental health between post treatment and long-term follow-up (12 months) in patients with moderate MUPS after the PARASOL-intervention. Method This prospective cohort study included patients (≥ 18 years) with moderate MUPS in primary care who received the PARASOL-intervention. Deterioration in physical functioning or mental health was measured with the Physical Components Summary (PCS) and the Mental Components Summary (MCS) of the RAND-36. The following variables were included in univariate logistic regressions as possible predictors: age, gender, education level, psychiatric comorbidity, duration of complaints, pain level and self-management skills. Results A total of 79 participants were assigned to the intervention group. The amount of participants who had a significant clinically relevant deterioration was 29.6% for physical functioning and 38.5% for mental health. None of the possible predictors appears to be a significant predictor for deterioration after the treatment period. Conclusion About 30% of the patients with moderate MUPS deteriorate in physical functioning and about 40% of the patients deteriorate in mental health between post treatment and long-term follow-up (12 months) after the PARASOL-intervention. No baseline factors associated with this deterioration were identified. Clinical Relevance The results in this study cannot explain why some patients with moderate MUPS are deteriorating post treatment. This study does, however, provide insight into the risk of deterioration, namely 29.6% for physical functioning and 38.5% for mental health. Further research is needed to explore if factors, measured during- or post treatment, might be more relevant predictors for deterioration in patients with moderate MUPS. In addition, it is also necessary to investigate how deterioration can be reduced in this patient population.