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Case complexity in patients with chronic nonspecific musculoskeletal pain

a Delphi and feasibility study

Waterschoot, Franka P.C.; Bennen, Elseline; van der Woude, Lucas H.V.; Schiphorst Preuper, Henrica R.; Reneman, Michiel F.

International Journal of Rehabilitation Research: March 2016 - Volume 39 - Issue 1 - p 48–56
doi: 10.1097/MRR.0000000000000144
Original articles
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Assessment of case complexity in patients with chronic nonspecific musculoskeletal pain (CMP) is currently clinician based, not transparent, and with low reliability. The objective of this study was to explore case complexity and to initiate the development of a case complexity index (CCI). A three-round Delphi study among clinicians involved in multidisciplinary Pain Rehabilitation Programs was performed to identify important factors that are assumed to influence functioning in patients with CMP. The 10 most important factors were used to initiate the development of a CCI, with mean ratings of importance per factor as weights. The feasibility of the CCI was tested in a pilot study on 16 patients with CMP. In the first round, 166 factors were identified; in the second round, the 10 most important factors were selected; in the third round, relative weights of each factor were calculated, ranging from 1.75 (features of complaints) to 3.56 (psychiatric disorders) on a scale from 0 (no weight) to 4 (very heavy weight). The assessments for the factors were mainly based on clinical examination and reasoning. Clinicians could rate all patients using the CCI, which confirmed feasibility of the CCI. Ten, mainly psychosocial, factors were identified, which were assumed to be most important for the assessment of case complexity in a patient with CMP. With these factors, a CCI was created, for which feasibility was established. This CCI is transparent, easy to use, and might provide a basis for further development of a structured assessment of case complexity, which may have scientific and clinical relevance.

aDepartment of Rehabilitation Medicine, Center for Rehabilitation

bCenter for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Haren, The Netherlands

Correspondence to Franka P.C. Waterschoot, Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30.002, 9750 RA Haren, The Netherlands Tel: +31 501 7423; e-mail: f.p.c.waterschoot@umcg.nl

Received July 1, 2015

Accepted October 9, 2015

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