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Original article

Vol. 153 No. 5 (2023)

Change over time in functional capacity and self-perceived health status for patients with chronic musculoskeletal pain: a registry-based longitudinal study

  • Franziska Schütz
  • Eva Haffter
  • André Meichtry
  • Balz Winteler
  • Brigitte E. Gantschnig
Cite this as:
Swiss Med Wkly. 2023;153:40083


BACKGROUND AND AIMS: Chronic musculoskeletal pain is a major public health problem worldwide. Both self-reported functional capacity and self-perceived health status are reduced in patients with chronic musculoskeletal pain. Previous studies mostly assessed functional capacity through self-reported questionnaires instead of objective measurements. The aim of this study, therefore, is to assess the amount of change over time and its clinical meaningfulness in functional capacity and self-perceived health status of patients with chronic musculoskeletal pain undergoing Bern Ambulatory Interprofessional Rehabilitation (BAI-Reha).

METHODS: The registry-based longitudinal cohort study with prospectively collected data from a rehabilitation programme took place in a real-life setting. Patients (n = 81) with chronic musculoskeletal pain took part in the BAI-Reha. The main outcomes were the six-minute-walk test (6MWT), the safe maximum floor-to-waist lift (SML) and the European Quality of Life and Health measure visual analogue scale (EQ VAS). Timepoints of measurement were at baseline and post-BAI-Reha (i.e., at 4 months). The quantity of interest was the adjusted time effect (point estimate, 95% confidence interval, and p-value for testing the null hypothesis of no change over time). Statistical significance (α = 0.05) and clinical meaningfulness of the mean value change over time were assessed using predefined thresholds (six-minute-walk test 50 m, SML 7 kg, and EQ VAS 10 points).

RESULTS: The linear mixed model analysis showed a statistically significant change over time for the six-minute-walk test (mean value change 56.08 m, 95% CI [36.13, 76.03]; p <0.001), SML (mean value change 3.92 kg, 95% CI [2.66, 5.19]; p <0.001), and EQ VAS (mean value change 9.58 points, 95% CI [4.87, 14.28]; p <0.001). Moreover, the improvement in the six-minute-walk test is clinically meaningful (mean value change 56.08 m) and almost clinically meaningful (mean value change 9.58 points) in the EQ VAS.

CONCLUSION: Patients walk further, lift more weight, and feel healthier after interprofessional rehabilitation when compared to baseline measurement. These findings confirm and add to previous results.

IMPLICATIONS: We encourage other providers of rehabilitation for patients with chronic musculoskeletal pain to measure functional capacity with objective outcome variables and to use self-reported outcome measures in addition to self-perceived health status. The well-established assessments used in this study are suitable for this purpose.


  1. Andrews P, Steultjens M, Riskowski J. Chronic widespread pain prevalence in the general population: A systematic review. Eur J Pain. 2018 Jan;():5–18. 10.1002/ejp.1090 DOI:
  2. Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016 Jan;():55–64. 10.1097/j.pain.0000000000000314 DOI:
  3. van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013 Jul;():13–8. 10.1093/bja/aet123 DOI:
  4. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May;():287–333. 10.1016/j.ejpain.2005.06.009 DOI:
  5. Cimas M, Ayala A, Sanz B, Agulló-Tomás MS, Escobar A, Forjaz MJ. Chronic musculoskeletal pain in European older adults: cross-national and gender differences. Eur J Pain. 2018 Feb;():333–45. 10.1002/ejp.1123 DOI:
  6. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019 Jan;():19–27. 10.1097/j.pain.0000000000001384 DOI:
  7. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007 Jul;():581–624. 10.1037/0033-2909.133.4.581 DOI:
  8. Björnsdóttir SV, Jónsson SH, Valdimarsdóttir UA. Functional limitations and physical symptoms of individuals with chronic pain. Scand J Rheumatol. 2013;():59–70. 10.3109/03009742.2012.697916 DOI:
  9. Bernfort L, Gerdle B, Rahmqvist M, Husberg M, Levin LÅ. Severity of chronic pain in an elderly population in Sweden—impact on costs and quality of life. Pain. 2015 Mar;():521–7. 10.1097/01.j.pain.0000460336.31600.01 DOI:
  10. Molander P, Dong HJ, Äng B, Enthoven P, Gerdle B. The role of pain in chronic pain patients’ perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients. Scand J Pain. 2018 Jul;():417–29. 10.1515/sjpain-2018-0003 DOI:
  11. Mäntyselkä PT, Turunen JH, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003 Nov;():2435–42. 10.1001/jama.290.18.2435 DOI:
  12. Pérez C, Margarit C, Sánchez-Magro I, de Antonio A, Villoria J. Chronic Pain Features Relate to Quality of Life More than Physiopathology: A Cross-Sectional Evaluation in Pain Clinics. Pain Pract. 2017 Sep;():866–78. 10.1111/papr.12533 DOI:
  13. Bui KL, Nyberg A, Maltais F, Saey D. Functional Tests in Chronic Obstructive Pulmonary Disease, Part 1: Clinical Relevance and Links to the International Classification of Functioning, Disability, and Health. Ann Am Thorac Soc. 2017 May;():778–84. 10.1513/AnnalsATS.201609-733AS DOI:
  14. Gross DP. Are functional capacity evaluations affected by the patient’s pain? Curr Pain Headache Rep. 2006 Apr;():107–13. 10.1007/s11916-006-0021-3 DOI:
  15. Tseli E, Boersma K, Stålnacke BM, Enthoven P, Gerdle B, Äng BO, et al. Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Clin J Pain. 2019 Feb;():148–73. 10.1097/AJP.0000000000000669 DOI:
  16. Maniscalco L, Miceli S, Bono F, Matranga D. Self-Perceived Health, Objective Health, and Quality of Life among People Aged 50 and Over: Interrelationship among Health Indicators in Italy, Spain, and Greece. Int J Environ Res Public Health. 2020 Apr;():2414. 10.3390/ijerph17072414 DOI:
  17. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: cochrane systematic review and meta-analysis. BMJ. 2015 Feb; feb18 5:h444–444. 10.1136/bmj.h444 DOI:
  18. Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology (Oxford). 2008 May;():670–8. 10.1093/rheumatology/ken021 DOI:
  19. Hållstam A, Löfgren M, Benson L, Svensén C, Stålnacke BM. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain. Scand J Pain. 2017 Oct;():233–42. 10.1016/j.sjpain.2016.08.004 DOI:
  20. Kurklinsky S, Perez RB, Lacayo ER, Sletten CD. The Efficacy of Interdisciplinary Rehabilitation for Improving Function in People with Chronic Pain. Pain Res Treat. 2016;:7217684. 10.1155/2016/7217684 DOI:
  21. Banerjee S, Argáez C. Multidisciplinary Treatment Programs for Patients with Chronic Non-Malignant Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019.
  22. Cheng JO, Cheng ST. Effectiveness of physical and cognitive-behavioural intervention programmes for chronic musculoskeletal pain in adults: A systematic review and meta-analysis of randomised controlled trials. PLoS One. 2019 Oct;():e0223367. 10.1371/journal.pone.0223367 DOI:
  23. Taylor AM, Phillips K, Patel KV, Turk DC, Dworkin RH, Beaton D, et al. Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations. Pain. 2016 Sep;():1836–50. 10.1097/j.pain.0000000000000577
  24. Wittink H. Functional capacity testing in patients with chronic pain. Clin J Pain. 2005;():197–9. 10.1097/00002508-200505000-00001 DOI:
  25. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al.; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006 Mar;( Suppl 2):S192–300. 10.1007/s00586-006-1072-1 DOI:
  26. Körner M, Bengel J. [Teamwork and team success in multi- and interdisciplinary teams in medical rehabilitation]. Rehabilitation (Stuttg). 2004 Dec;():348–57. 10.1055/s-2004-828533 DOI:
  27. Henchoz Y, de Goumoëns P, So AK, Paillex R. Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial. Swiss Med Wkly. 2010 Dec;:w13133. 10.4414/smw.2010.13133 DOI:
  28. Kjeken I, Bø I, Rønningen A, Spada C, Mowinckel P, Hagen KB, et al. A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. J Rehabil Med. 2013 Mar;():260–7. 10.2340/16501977-1078 DOI:
  29. Monticone M, Ferrante S, Rocca B, Baiardi P, Dal Farra F, Foti C. Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial. Clin J Pain. 2013 Nov;():929–38. 10.1097/AJP.0b013e31827fef7e DOI:
  30. Nazzal ME, Saadah MA, Saadah LM, Al-Omari MA, Al-Oudat ZA, Nazzal MS, et al. Management options of chronic low back pain. A randomized blinded clinical trial. Neurosciences (Riyadh). 2013 Apr;():152–9.
  31. Schwarz B, Neuderth S, Gutenbrunner C, Bethge M. Multiprofessional teamwork in work-related medical rehabilitation for patients with chronic musculoskeletal disorders. J Rehabil Med. 2015 Jan;():58–65. 10.2340/16501977-1893 DOI:
  32. Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil. 2020 May;():571–83. 10.1177/0269215520905112 DOI:
  33. Gantschnig BE, Heigl F, Widmer Leu C, Bütikofer L, Reichenbach S, Villiger PM. Effectiveness of the Bern Ambulatory Interprofessional Rehabilitation (BAI-Reha) programme for patients with chronic musculoskeletal pain: a cohort study. Swiss Med Wkly. 2017 May;():w14433. Available from: 10.4414/smw.2017.14433
  34. Pasanen T, Tolvanen S, Heinonen A, Kujala UM. Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials. Br J Sports Med. 2017 Oct;():1459–65. 10.1136/bjsports-2016-097132 DOI:
  35. Dürr S, Zogg S, Miedinger D, Steveling EH, Maier S, Leuppi JD. Daily physical activity, functional capacity and quality of life in patients with COPD. COPD. 2014 Dec;():689–96. 10.3109/15412555.2014.898050 DOI:
  36. José A, Dal Corso S. Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. J Physiother. 2016 Apr;():96–102. 10.1016/j.jphys.2016.02.014 DOI:
  37. Gerdle B, Molander P, Stenberg G, Stålnacke BM, Enthoven P. Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres. BMC Musculoskelet Disord. 2016 Nov;():490. 10.1186/s12891-016-1346-7 DOI:
  38. Hållstam A, Löfgren M, Svensén C, Stålnacke BM. Patients with chronic pain: one-year follow-up of a multimodal rehabilitation programme at a pain clinic. Scand J Pain. 2016 Jan;():36–42. 10.1016/j.sjpain.2015.08.008 DOI:
  39. Isernhagen SJ. Functional capacity evaluation: Rationale, procedure, utility of the kinesiophysical approach. J Occup Rehabil. 1992 Sep;():157–68. Available from: 10.1007/BF01077187 DOI:
  40. Oesch P, Meyer K, Jansen B, Kool J. Functional Capacity Evaluation: Performance of Patients with Chronic Non-specific Low Back Pain Without Waddell Signs. J Occup Rehabil. 2015 Jun;():257–66. 10.1007/s10926-014-9533-6 DOI:
  41. Benaim C, Blaser S, Léger B, Vuistiner P, Luthi F. “Minimal clinically important difference” estimates of 6 commonly-used performance tests in patients with chronic musculoskeletal pain completing a work-related multidisciplinary rehabilitation program. BMC Musculoskelet Disord. 2019 Jan;():16. 10.1186/s12891-018-2382-2 DOI:
  42. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017 Apr;():377–81. 10.1111/jep.12629 DOI:
  43. Grochtdreis T, Dams J, König HH, Konnopka A. Health-related quality of life measured with the EQ-5D-5L: estimation of normative index values based on a representative German population sample and value set. Eur J Health Econ. 2019 Aug;():933–44. 10.1007/s10198-019-01054-1 DOI:
  44. Whynes DK, McCahon RA, Ravenscroft A, Hodgkinson V, Evley R, Hardman JG. Responsiveness of the EQ-5D health-related quality-of-life instrument in assessing low back pain. Value Health. 2013;():124–32. 10.1016/j.jval.2012.09.003 DOI:
  45. Soer R, de Vries HJ, Brouwer S, Groothoff JW, Geertzen JH, Reneman MF. Do workers with chronic nonspecific musculoskeletal pain, with and without sick leave, have lower functional capacity compared with healthy workers? Arch Phys Med Rehabil. 2012 Dec;():2216–22. 10.1016/j.apmr.2012.06.023 DOI:
  46. Trippolini MA, Reneman MF, Jansen B, Dijkstra PU, Geertzen JH. Reliability and safety of functional capacity evaluation in patients with whiplash associated disorders. J Occup Rehabil. 2013 Sep;():381–90. 10.1007/s10926-012-9403-z DOI:
  47. Hamilton DM, Haennel RG. Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. J Cardiopulm Rehabil. 2000;():156–64. 10.1097/00008483-200005000-00003 DOI:
  48. King MB, Judge JO, Whipple R, Wolfson L. Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Phys Ther. 2000 Jan;():8–16. 10.1093/ptj/80.1.8 DOI:
  49. Gross DP, Battié MC. Factors influencing results of functional capacity evaluations in workers’ compensation claimants with low back pain. Phys Ther. 2005 Apr;():315–22. 10.1093/PTJ/85.4.315 10.1093/ptj/85.4.315 DOI:
  50. N’Goran AA, Déruaz-Luyet A, Haller DM, Zeller A, Rosemann T, Streit S, et al. Comparing the self-perceived quality of life of multimorbid patients and the general population using the EQ-5D-3L. PLoS One. 2017 Dec;():e0188499. 10.1371/journal.pone.0188499 DOI:
  51. Brooks R, Rabin R, de Charro F, editors. The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective: Evidence from the EuroQol BIOMED Research Programme. Springer Netherlands; 2003. 10.1007/978-94-017-0233-1 DOI:
  52. Hinz A, Klaiberg A, Brähler E, König H-H. Der Lebensqualitätsfragebogen EQ-5D: Modelle und Normwerte für die Allgemeinbevölkerung. PPmP - Psychother · Psychosom · Med Psychol 2005;56:42–8. DOI:
  53. R Core Team. R: A Language and Environment for Statistical Computing 2020.
  54. Schindl M, Wassipaul S, Wagner T, Gstaltner K, Bethge M. Impact of Functional Capacity Evaluation on Patient-Reported Functional Ability: An Exploratory Diagnostic Before-After Study. J Occup Rehabil. 2019 Dec;():711–7. 10.1007/s10926-019-09829-2 DOI:
  55. Peppin JF, Marcum S, Kirsh KL. The chronic pain patient and functional assessment: use of the 6-Minute Walk Test in a multidisciplinary pain clinic. Curr Med Res Opin. 2014 Mar;():361–5. 10.1185/03007995.2013.828587 DOI:
  56. Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, van Geel AC, et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]. BMC Musculoskelet Disord. 2006 Jan;():5. 10.1186/1471-2474-7-5 DOI:
  57. Caby I, Olivier N, Janik F, Vanvelcenaher J, Pelayo P. A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France. Healthcare (Basel). 2016 Apr;():23. 10.3390/healthcare4020023 DOI:
  58. Tseli E, LoMartire R, Vixner L, Grooten WJ, Gerdle B, Äng BO. What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study. J Clin Med. 2020 Aug;():2788. 10.3390/jcm9092788 DOI:
  59. Ringqvist Å, Dragioti E, Björk M, Larsson B, Gerdle B. Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation-A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). J Clin Med. 2019 Jun;():905. 10.3390/jcm8060905 DOI:
  60. Müller C, Zimmermann L, Körner M. Förderfaktoren und Barrieren interprofessioneller Kooperation in Rehabilitationskliniken—Eine Befragung von Führungskräften. Rehabilitation (Stuttg). 2014 Dec;():390–5. 10.1055/s-0034-1375639 DOI:
  61. Hutting N, Caneiro JP, Ong’wen OM, Miciak M, Roberts L. Patient-centered care in musculoskeletal practice: key elements to support clinicians to focus on the person. Musculoskelet Sci Pract. 2021;: 10.1016/j.msksp.2021.102434 DOI:
  62. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May;():2082–97. 10.1016/S0140-6736(21)00393-7 DOI:
  63. Liossi C, Johnstone L, Lilley S, Caes L, Williams G, Schoth DE. Effectiveness of interdisciplinary interventions in paediatric chronic pain management: a systematic review and subset meta-analysis. Br J Anaesth. 2019 Aug;():e359–71. 10.1016/j.bja.2019.01.024 DOI: