Interdisciplinary pain rehabilitation for culturally and linguistically diverse patients

Background and aim: Chronic pain constitutes a major health problem. Associated symptoms such as depression, anxiety and fear of movement, and reduction in activity and function, make it a complex condition, often affecting the individual's entire life situation. Interdisciplinary pain rehabilitation (IPR) is an evidence-based and recommended intervention for patients with complex chronic pain. Patients from culturally and linguistically diverse (CALD) backgrounds constitute 20% of those referred to IPR in Sweden, but they are seldom selected for this intervention due to various challenges caused by, among other things, language barriers. This has led to a lack of knowledge regarding IPR regarding the specific patient group. The overall aim of this thesis was to explore if IPR has positive effects for CALD patients with chronic pain with limited profiency in the Swedish language.

Methods and results: Three studies (I, II and III) were performed at two specialised pain clinics, and one study (IV) at just one of the clinics. In these clinics, IPR with language interpreter (IPR-LI) was offered, which was the intervention studied. Study I and study II are prospective multi-center cohort studies where descriptive and comparative statistics are used. Sociodemografic data and data from instruments in the Swedish Registry of Pain Rehabilitation (SQRP) were analysed before and after (study I) for 95 patients; and before, after and one-year after (study II) for 74 patients (from the same group as in study I). The baseline data (sociodemographic and SQRP) showed a poor state for the studied patients in both study I and II. Significant improvements were seen after the programme in pain intensity, fear of movement and depression (study I), and at one-year follow-up in pain intensity, fear of movement, depression and visits to the doctor (study II). When subgrouping for gender, it was shown that the women followed the result for the whole group, while the men did not improve in any of the instruments measured. Study III and study IV are qualitative studies based on data from semi-structured interviews with healthcare professionals (study III) and patients (study IV). In study III the interviews with 12 informants were analysed according to Grounded theory, and the theory developed about the experience of working in the programme is described in the core category "The Demanding and Meaningful Work", consisting of the categories "Challenges", "Frustration" and "Solutions". In study IV the interviews with ten informants were analysed using content analysis. The core theme "Pain rehabilitation makes a difference", which describes the informants' experiences of managing chronic pain, their life situations after the IPR-LI, and their experiences of participating in the IPR-LI, consisted of the themes "A shrunken life", "Respectful learning together", and "A more active life".

Conclusions: The IPR-LI showed positive results, even in the long term, for patients with chronic pain and low profiency in the Swedish language. The result could be of value for the further development of rehabilitation programmes with language interpreters. The men participating should be offered extra attention during rehabilitation.

List of scientific papers

I. Uhlin K, Persson E, Bäärnhielm S, Borg K, Löfgren M, Stålnacke BM. Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation. J Rehabil Med. 2024 Feb 26;56:jrm13466. PMID: 38407432; PMCID: PMC10910276. doi: https://doi.org/10.2340/jrm.v56.13466

II. Uhlin K, Löfgren M, Bäärnhielm S, Borg K, Stålnacke BM. Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation - a one-year follow-up. [Manuscript]

III. Uhlin K, Persson E, Stålnacke BM, Löfgren M. Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study. Disabil Rehabil. 2023 Jul;45(15):2434-2445. Epub 2022 Aug 23. PMID: 35996890. doi: https://doi.org/10.1080/09638288.2022.2111608.

IV. Uhlin K, Bani-Shoraka H, Bäärnhielm S, Stålnacke BM, Löfgren M. Interdisciplinary pain rehabilitation makes a difference - A qualitative interview study with culturally and linguistically diverse patients. [Manuscript]