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Gustavsson C, Koch L. Pain self‐management intervention supports successful attainment of self‐selected rehabilitation goals—secondary analysis of a randomized controlled trial. Health Expect 2022; 25:1157-1167. [PMID: 35285115 PMCID: PMC9122423 DOI: 10.1111/hex.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 01/18/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives (i) Describe patients' self‐selected activity‐related rehabilitation goals, and (ii) compare attainment of these rehabilitation goals among people with persistent tension‐type neck pain receiving a group‐based pain and stress self‐management intervention (PASS) or individual physiotherapy (IPT). Methods Before intervention and random allocation to PASS or IPT, 156 people (PASS n = 77, IPT n = 79), listed three self‐selected activity‐related rehabilitation goals by use of the Patient Goal Priority Questionnaire (PGPQ). For each activity goal, participants rated limitations in activity performance, self‐efficacy and fear of activity performance, readiness to change to improve performance, and expectations of future activity performance. At follow‐ups (10 weeks, 20 weeks, 1 year and 2 years after inclusion), participants also responded to a question on changes made to improve activity performance. Mann–Whitney U test was used to evaluate between‐group differences. Results There were between‐group differences in favour of PASS in the attainment of self‐selected rehabilitation goals with regard to activity limitations and satisfaction with activity performance at all follow‐ups. Conclusions PASS was more successful than IPT for the attainment of self‐selected rehabilitation goals, improvements in activity limitations and satisfaction with activity performance as measured by PGPQ. The PASS programme emphasized the importance of applying active pain‐ and stress‐coping techniques in personal ‘risk situations’ for pain flare‐ups, which appear to support people with persistent tension‐type neck pain to make changes in their lives to improve activity performance. Patient or Public Contribution Patient engagement in rehabilitation by self‐selected goals was investigated, but patients were not involved in the design or conduct of the study.
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Affiliation(s)
- Catharina Gustavsson
- Center for Clinical Research Dalarna Uppsala University Falun Sweden
- Department of Public Health and Caring Science Uppsala University Uppsala Sweden
- School of Health and Welfare Dalarna University Falun Sweden
| | - Lena Koch
- Department of Neurobiology, Care Science and Society Karolinska Institutet Stockholm Sweden
- Theme Neuro Karolinska University Hospital Stockholm Sweden
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Zetterberg H, Flink I, Spörndly-Nees S, Wagner S, Karlsten R, Åsenlöf P. Behavioral Medicine Physiotherapy in the Context of Return to Work for Chronic Pain: A Single-Case Experimental Design Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031509. [PMID: 35162528 PMCID: PMC8835028 DOI: 10.3390/ijerph19031509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022]
Abstract
Effective interventions are needed for return-to-work (RTW) for individuals with chronic pain on long-term sick leave. In this study, a behavioral medicine physiotherapy protocol was systematically replicated and added to workplace components. The intervention was evaluated for fidelity and effects on target activities and work ability. A single-case experimental design was used with five participants. Daily and weekly ratings of personalized target activities at work as well as work ability were carried out throughout the study period of 26–28 weeks. Effects of the behavioral medicine physiotherapy intervention were evaluated for each individual using visual analysis of displayed graphs and quantitative non-overlap methods. Goal achievement for target activities was reviewed. Three participants completed the intervention. The results indicated an effect from the behavioral medicine physiotherapy intervention on task-specific self-efficacy for target activities, but no consistent effect on experience of target activities or work ability. All three participants had increased function in target activities in line with pre-defined goals. Fidelity to the intervention manual was good. Behavioral medicine physiotherapy can be successfully adapted to work disability and was here replicated in an RTW context for individuals with chronic pain. The intervention protocol should be further evaluated in large-scale studies.
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Affiliation(s)
- Hedvig Zetterberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (S.S.-N.); (S.W.); (P.Å.)
- Correspondence: ; Tel.: +46-18-471-42-60
| | - Ida Flink
- The Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, 701 82 Örebro, Sweden;
| | - Sören Spörndly-Nees
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (S.S.-N.); (S.W.); (P.Å.)
| | - Sofia Wagner
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (S.S.-N.); (S.W.); (P.Å.)
| | - Rolf Karlsten
- Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden;
| | - Pernilla Åsenlöf
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (S.S.-N.); (S.W.); (P.Å.)
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Levack WMM, Weatherall M, Hay‐Smith EJC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev 2015; 2015:CD009727. [PMID: 26189709 PMCID: PMC8941379 DOI: 10.1002/14651858.cd009727.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. OBJECTIVES To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. DATA COLLECTION AND ANALYSIS Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. MAIN RESULTS We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. AUTHORS' CONCLUSIONS There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.
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Affiliation(s)
- William MM Levack
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Mark Weatherall
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - E. Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Sarah G Dean
- University of ExeterUniversity of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Kathryn McPherson
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
| | - Richard J Siegert
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
- Auckland University of TechnologySchool of Public Health and Psychosocial StudiesAucklandNew Zealand
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Sands WA, McNeal JR, Murray SR, Stone MH. Dynamic Compression Enhances Pressure-to-Pain Threshold in Elite Athlete Recovery. J Strength Cond Res 2015; 29:1263-72. [DOI: 10.1519/jsc.0000000000000412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hislop J, Adewuyi TE, Vale LD, Harrild K, Fraser C, Gurung T, Altman DG, Briggs AH, Fayers P, Ramsay CR, Norrie JD, Harvey IM, Buckley B, Cook JA. Methods for specifying the target difference in a randomised controlled trial: the Difference ELicitation in TriAls (DELTA) systematic review. PLoS Med 2014; 11:e1001645. [PMID: 24824338 PMCID: PMC4019477 DOI: 10.1371/journal.pmed.1001645] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 04/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are widely accepted as the preferred study design for evaluating healthcare interventions. When the sample size is determined, a (target) difference is typically specified that the RCT is designed to detect. This provides reassurance that the study will be informative, i.e., should such a difference exist, it is likely to be detected with the required statistical precision. The aim of this review was to identify potential methods for specifying the target difference in an RCT sample size calculation. METHODS AND FINDINGS A comprehensive systematic review of medical and non-medical literature was carried out for methods that could be used to specify the target difference for an RCT sample size calculation. The databases searched were MEDLINE, MEDLINE In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Methodology Register, PsycINFO, Science Citation Index, EconLit, the Education Resources Information Center (ERIC), and Scopus (for in-press publications); the search period was from 1966 or the earliest date covered, to between November 2010 and January 2011. Additionally, textbooks addressing the methodology of clinical trials and International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) tripartite guidelines for clinical trials were also consulted. A narrative synthesis of methods was produced. Studies that described a method that could be used for specifying an important and/or realistic difference were included. The search identified 11,485 potentially relevant articles from the databases searched. Of these, 1,434 were selected for full-text assessment, and a further nine were identified from other sources. Fifteen clinical trial textbooks and the ICH tripartite guidelines were also reviewed. In total, 777 studies were included, and within them, seven methods were identified-anchor, distribution, health economic, opinion-seeking, pilot study, review of the evidence base, and standardised effect size. CONCLUSIONS A variety of methods are available that researchers can use for specifying the target difference in an RCT sample size calculation. Appropriate methods may vary depending on the aim (e.g., specifying an important difference versus a realistic difference), context (e.g., research question and availability of data), and underlying framework adopted (e.g., Bayesian versus conventional statistical approach). Guidance on the use of each method is given. No single method provides a perfect solution for all contexts.
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Affiliation(s)
- Jenni Hislop
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Luke D. Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kirsten Harrild
- Population Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Tara Gurung
- Warwick Evidence, University of Warwick, Coventry, United Kingdom
| | - Douglas G. Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Andrew H. Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Peter Fayers
- Population Health, University of Aberdeen, Aberdeen, United Kingdom
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Craig R. Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - John D. Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Ian M. Harvey
- Faculty of Health, University of East Anglia, Norwich, United Kingdom
| | | | - Jonathan A. Cook
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Sands WA, McNeal JR, Murray SR, Ramsey MW, Sato K, Mizuguchi S, Stone MH. Stretching and Its Effects on Recovery. Strength Cond J 2013. [DOI: 10.1519/ssc.0000000000000004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Parents who catastrophize about their child's pain prioritize attempts to control pain. Pain 2012; 153:1695-1701. [PMID: 22657401 DOI: 10.1016/j.pain.2012.04.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/17/2012] [Accepted: 04/30/2012] [Indexed: 12/31/2022]
Abstract
How parents respond to their child in pain is critically important to how both parent and child attempt to cope with pain. We examined the influence of parental catastrophic thinking about child pain on their prioritization for pain control. Using a vignette methodology, parents reported, in response to different pain scenarios, on their imagined motivation for 2 competing goals: to control their child's pain (ie, pain control) or to encourage their child's participation in daily activities (ie, activity engagement). The effects of parent gender, pain intensity, and duration on parental goal priority were also explored. Findings indicated that higher levels of parental catastrophic thoughts were associated with the parents prioritizing child pain control over activity engagement. This effect was significantly moderated by pain duration. Specifically, pain control was more of a priority for those high in catastrophic thinking when the pain was more acute. In contrast, parental catastrophic thoughts had no effect on the pain control strategy favored by parents in situations with longer-lasting pain. Furthermore, independently of parental catastrophic thoughts, heightened priority for pain control was observed in highly intense and chronic pain situations. Moreover, in highly intense pain, priority for pain control was stronger for mothers compared with fathers. Theoretical and clinical implications and directions for future research are discussed.
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The role of educational and learning approaches in rehabilitation of whiplash-associated disorders in lessening the transition to chronicity. Spine (Phila Pa 1976) 2011; 36:S280-5. [PMID: 22101751 DOI: 10.1097/brs.0b013e3182388220] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The study design was descriptive. OBJECTIVE The aim of this chapter was to illustrate and discuss educational and learning perspectives in the rehabilitation of patients with acute whiplash-associated disorders (WAD). SUMMARY OF BACKGROUND DATA WAD is a major problem for the individual and the society. Several treatment options have been studied without giving convincing results for lessening the transition to chronicity. Current management of acute WAD include among other things advice of exercise and educational activities. METHODS A literature search on the PubMed database was conducted with additional topic discussions with the research colleagues at a symposium. These resulted the present state-of-the-art review. RESULTS There are several possible cognitive factors and behavioral learning processes such as self-efficacy, fear of movement and (re)injury, and catastrophizing that are important to focus on in decreasing acute WAD to becoming a chronic condition. Learning based on behavioral medicine approach in physiotherapy framework has gained evidence in other musculoskeletal pain conditions. CONCLUSION Exercise, education, and learning with a behavioral medicine approach should be focused on in the future studies of acute WAD management.
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Friedberg F. Chronic fatigue syndrome, fibromyalgia, and related illnesses: a clinical model of assessment and intervention. J Clin Psychol 2010; 66:641-65. [PMID: 20186721 DOI: 10.1002/jclp.20676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A clinically informative behavioral literature on chronic fatigue syndrome (CFS) and fibromyalgia (FM) has emerged over the past decade. The purpose of this article is to (a) define these conditions and their less severe counterparts, i.e., unexplained chronic fatigue (UCF) and chronic widespread pain; (b) briefly review the behavioral theory and intervention literature on CFS and FM; and (c) describe a user-friendly clinical model of assessment and intervention for these illnesses. The assessments described will facilitate understanding of the somewhat unusual and puzzling somatic presentations that characterize these patients. Using an individualized cognitive-behavioral approach the mental health clinician can offer significant help to these often stigmatized and medically underserved patients.
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Affiliation(s)
- Fred Friedberg
- Putnam Hall/South Campus, Stony Brook University, Stony Brook, NY 11794-8790, USA.
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Asenlöf P, Söderlund A. A further investigation of the importance of pain cognition and behaviour in pain rehabilitation: longitudinal data suggest disability and fear of movement are most important. Clin Rehabil 2010; 24:422-30. [PMID: 20442254 DOI: 10.1177/0269215509353264] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tailored treatments are topical in pain rehabilitation. One key issue for correlational studies is the identification of factors having a potential causal impact on essential treatment outcomes. OBJECTIVE To study associations between pain beliefs and disability with regard to the amount and time-frame of available data. DESIGN A prospective, correlational design. SUBJECTS AND SETTING Ninety-two patients consulting physical therapists in primary care for persistent musculoskeletal pain. MAIN MEASURES The Pain Disability Index, the Self-Efficacy Scale and the Tampa Scale of Kinesiophobia. RESULTS Functional self-efficacy and fear of movement/(re)injury explained variance in pain-related disability pretreatment (adj R(2) = 0.41). Self-efficacy was the most salient predictor. Adding data from immediately post treatment decreased explained variance (adj R(2) = 0.25). Functional self-efficacy and fear of movement/ (re)injury lost their significant contribution in favour of pain-related disability at baseline. Change scores in functional self-efficacy and fear of movement/(re)injury accounted for a modest share of explained variance in change scores of disability (adj R(2) = 0.11). Fear of movement/(re)injury but not functional self-efficacy was related to a reliable change in pain-related disability. CONCLUSIONS Longitudinal data suggest that pretreatment levels of pain-related disability and changes in fear of movement/(re)injury are most important to immediate treatment outcomes and individual reliable change. Disability and elevated fear of movement/(re)injury should therefore be addressed in tailored pain treatments.
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Affiliation(s)
- Pernilla Asenlöf
- Department of Neurosciences, Section of Physiotherapy, Uppsala University.
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Sandborgh M, Lindberg P, Åsenlöf P, Denison E. Implementing behavioural medicine in physiotherapy treatment. Part I: Clinical trial. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/14038190903480664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sandborgh M, Åsenlöf P, Lindberg P, Denison E. Implementing behavioural medicine in physiotherapy treatment. Part II: Adherence to treatment protocol. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/14038190903480672] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Patient Goal Priority Questionnaire is moderately reproducible in people with persistent musculoskeletal pain. Phys Ther 2009; 89:1226-34. [PMID: 19745026 DOI: 10.2522/ptj.20090030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Patient Goal Priority Questionnaire (PGPQ) is a patient-specific measure for identification of behavioral goals and evaluation of clinically significant changes. The use of such a measure in clinical settings and research requires that identified goals be consistent over time. Self-reports of behaviors related to the goals should be reliably estimated. OBJECTIVE The purpose of this study was to estimate chance-corrected agreement and test-retest reliability of the PGPQ. Chance-corrected agreement between the PGPQ and a similar therapist-guided goal identification tool, the Patient Goal Priority List (PGPL), also was estimated. DESIGN A correlative and prospective design with 3 measurement points (M1, M2, and M3) was used in the study. METHODS Fifty-four people who consulted physical therapists in primary care for persistent musculoskeletal pain were included in the study. Analyses of chance-corrected agreement and test-retest reliability of the PGPQ were done at M1 and M2. Chance-corrected agreement between procedures (PGPQ and PGPL) also was analyzed at M1 and M3. RESULTS The percentage of agreement on content of the priority lists of the PGPQ at M1 and M2 was 52%. Cohen kappa values for agreement of rankings ranged between .47 and .64. Test-retest reliability coefficients for the self-report scales of the PGPQ ranged from .35 to .81. Chance-corrected agreement decreased when physical therapists were involved in the goal identification process using the PGPL (kappa = .08-.46). LIMITATIONS Varying item content and a small, heterogeneous sample possibly increased variation and the standard error of measurements. The feasibility of using traditional approaches to psychometric evaluation of patient-specific measures is questionable. CONCLUSIONS Chance-corrected agreement and test-retest reliability of the PGPQ were moderate. Involving a physical therapist in the goal identification procedure possibly introduced further bias. The size of the measurement error must be taken into account when using the PGPQ for estimations of clinically important changes.
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Lambert MJ, Ogles BM. Using clinical significance in psychotherapy outcome research: The need for a common procedure and validity data. Psychother Res 2009; 19:493-501. [DOI: 10.1080/10503300902849483] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Michael J. Lambert
- a Department of Psychology , Brigham Young University , Provo, Utah
- b Department of Psychology , Ohio University , Athens, Ohio, USA
| | - Benjamin M. Ogles
- a Department of Psychology , Brigham Young University , Provo, Utah
- b Department of Psychology , Ohio University , Athens, Ohio, USA
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Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain: statistical and clinical significance. Clin J Pain 2009; 25:156-66. [PMID: 19333163 DOI: 10.1097/ajp.0b013e318185c1c9] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study aimed to investigate the effectiveness of a 3-week multimodal inpatient pain program for children and adolescents with chronic pain. METHODS Effectiveness was investigated for pain-related variables (pain intensity, pain-related disability) and emotional distress in 3 ways: (1) in terms of statistically significant changes; (2) in terms of the clinical significance of these changes by creating post-hoc outcome groups for pain-related variables and emotional distress; and (3) in terms of the clinically significant overall amelioration generalizing the outcome over 3 variables (ie, pain intensity, pain-related disability, and school absence). One hundred sixty-seven adolescents (aged between 11 and 18 y) with various pain disorders (50% with headache) who met inpatient criteria were evaluated at baseline and 3 months posttreatment. RESULTS Patients demonstrated statistically significant changes in all variables with large to medium effect sizes. Seventy-two percent and 45% of the patients demonstrated clinically significant changes in pain intensity and pain-related disability, respectively. The percentages of patients demonstrating clinically significant change in emotional distress ranged from 13% to 26%. Seventy-seven adolescents demonstrated overall amelioration. DISCUSSION Results of the study are promising in at least 2 ways: (1) a multimodal inpatient program might stop the negative effects of chronic pain, disability, and emotional distress in children and adolescents, and (2) the exploration of clinical significance testing has demonstrated utility and can be applied to future effectiveness studies in pediatric pain.
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Senlöf P, Denison E, Lindberg P. Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care. Eur J Pain 2009; 13:1080-8. [PMID: 19268614 DOI: 10.1016/j.ejpain.2009.01.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 11/14/2008] [Accepted: 01/27/2009] [Indexed: 11/18/2022]
Abstract
This study examined long-term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One-hundred and twenty-two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow-up assessments two-year post-treatment were completed by 65 participants. According to per-protocol analyses, short-term effects were maintained in both groups for the primary outcome, pain-related disability. The TBT-group reported lower disability levels compared with the EBT-group. Intention-to-treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self-efficacy were maintained over the 2-year post-treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT-group, and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT. The study supports tailoring of treatments in concordance with patients' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability, for successful immediate outcomes and their maintenance in the long run. Exercise-based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period.
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Affiliation(s)
- Pernilla Senlöf
- Department of Neuroscience, Section of Physiotherapy, Uppsala University, 751 85 Uppsala, Sweden.
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Kamioka Y, Yoshino T, Sugaya K, Saito H, Ohashi Y, Iijima S. Goal-Setting Method and Goal Attainment Measures in Physical Therapy for Stroke Patients: a Systematic Review. J Phys Ther Sci 2009. [DOI: 10.1589/jpts.21.399] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yumiko Kamioka
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences
| | | | - Kimiko Sugaya
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital
| | | | - Yukari Ohashi
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences
| | - Setsu Iijima
- Comprehensive Human Sciences, University of Tsukuba
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