Exploring the Influence of Patient-Professional Partnerships on the Self-Management of Chronic Back Pain: A Qualitative Study

Exploring mHealth applications for self-management of chronic low back pain: A survey of features and benefits

The adoption of Mobile Health (mHealth) for self-management is growing. mHealth solutions are commonly used in public healthcare and health services, where they are appreciated for their ease of use, broad reach, and wide acceptance. Chronic Low Back Pain (CLBP) is one of the most common health problems and a leading cause of disability. As such, it imposes a tremendous burden on patients and society. Studies have proposed that mHealth self-management solutions, such as mobile applications, can supplement traditional care methods and benefit patients, particularly in self-managing CLBP easier. To this end, the number of available mobile applications for CLBP has increased. This paper i) provides an overview of scientific studies on mobile applications for CLBP management from three different viewpoints: researchers, health professionals, and patients, ii) uncovers the application features that were seen as beneficial in the studies, and iii) contrasts the currently available applications for CLBP in Google Play Store and Apple App Store against the discovered features. The findings show that "Personalization and customization" is the most significant feature as it is beneficial from stakeholders' viewpoint and is represented by most applications. In contrast, "Gamification" and "Artificial intelligence" are the least significant features, indicating a lack of attention from application creators and researchers in this area.

Challenges, Concerns, and Experiences of Community-Dwelling Older Women with Chronic Low Back Pain—A Qualitative Study in Hong Kong, China

Background and Objectives: Although chronic low back pain (CLBP) is known to negatively affect multiple aspects of the lives of older people, prior qualitative studies mainly focused on the lived experiences of older people with CLBP in Western countries. Given cultural and contextual differences and poor understanding of CLBP in older women with CLBP, it is important to better understand the concerns and lived experiences of Chinese older women with CLBP. The current study aimed to investigate the experiences, challenges, concerns, and coping strategies of older women with CLBP in Hong Kong. Research Design and Methods: A total of 15 community-dwelling older women with CLBP aged ≥60 years were recruited from a physiotherapy clinic or a community center for semi-structured interviews. The interviews were audio recorded and transcribed ‘verbatim’. The transcription was imported to NVivo 12 software. Thematic analysis was conducted using Braun and Clarke’s method. Results: Five themes were identified: (1) physical impacts of CLBP on daily life; (2) psychological influences of CLBP; (3) management of CLBP; (4) family support; and (5) social activities and support. Discussion and implications: Negative physical and psychosocial impacts of CLBP were common among older women, and they adopted diverse pain management strategies, although some of their treatment options were influenced by the Chinese culture. Misbeliefs and responses of family and friends also affected their management strategies. Elderly community centers are a significant source of social support for older women with CLBP, making it an ideal platform for establishing self-help groups to facilitate their self-management of CLBP.

Self-management support in flemish primary care practice: the development of a preliminary conceptual model using a qualitative approach

Background

Coping with a chronic disease can be really challenging. Self-management represents a promising strategy to improve daily life experiences. The role of primary healthcare professionals cannot be underestimated in supporting self-management. Due to a shortage of theory, implementation of self-management support is hindered in primary care practice. The aim of this study is to create a conceptual model for self-management support by analysing patients’ care experiences towards self-management support.

Methods

An explorative-descriptive qualitative study was conducted in Flanders, Belgium. Semi-structured interviews were performed with 16 patients and their informal caregiver (dyads) using a purposive sampling strategy and processed by an inductive content analysis, according to Graneheim and Lundman.

Results

Interviews revealed in-depth insights into patients’ care experiences. A conceptual model was developed for primary care practice, including five fundamental tasks for healthcare professionals - Supporting, Involving, Listening, Coordinating and Questioning (SILCQ) – contributing to the support of self-management of chronic patients.

Conclusions

This qualitative paper emphasises the use of the SILCQ-model to develop optimal roadmaps and hands-on toolkits for healthcare professionals to support self-management. The model needs to be further explored by all stakeholders to support the development of self-management interventions in primary care practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01652-8.

Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies

BACKGROUND

Self-management strategies are considered a necessary component of chronic musculoskeletal pain management to address ongoing symptoms and challenges. However uptake of self-management can be impeded by a number of factors.

OBJECTIVES

The aim of this study was to explore common impeding and facilitating factors of self-management strategies from the patient perspective.

METHODS

An electronic search was performed between 2009 to May 2020 for the following databases: MEDLINE, AMED, PsychINFO, Cochrane Library, PubMed, CINAHL, PEDro, and Google Scholar. The search terms included peer-reviewed qualitative or mixed-method studies investigating the perspective of chronic musculoskeletal pain patients in regards to the use of self-management strategies. Study rigor and bias was assessed using the CASP (Critical Appraisal Skills Programme) questionnaire specific to qualitative studies. Qualitative data was coded using a three-stage thematic synthesis process. Confidence in findings was assessed using CERQual (The Confidence in the Evidence from Review of Qualitative Research).

RESULTS

Twenty-seven studies were included with 487 participants. Six major themes were identified and divided into external and internal influencing factors. The external influencing factors were made up of the following three themes: health care practitioner role, supportive environment, accessibility. While the three internal influencing themes were: physical factors, knowledge and understanding, and psychological factors.

CONCLUSION

Learning to self-manage for patients in chronic pain required ongoing support either from healthcare practitioners or from social circles. To further assist the self-management process practitioners can improve self-efficacy through increasing patient knowledge of chronic pain, utilising goal setting and finding ways an individual can access ongoing support, either from the practitioner or through group programs.

Afflexivity in post-qualitative inquiry: prioritising affect and reflexivity in the evaluation of a health information website

Increasingly, people turn to online sources for health information, creating human-non-human relationalities. Health websites are considered accessible in scope and convenience but can have limited capacity to accommodate complexities. There are concerns about who gets to 'assemble' with these resources, and who is excluded. Guided by Ahmed's socio-political theories of emotions, we questioned our feelings as we intra-acted with a consumer information website about back pain (MyBackPain). This encouraged us to approach resource evaluation in a way that alters conventional rational/cognitive judgement processes. Our inquiry was 'supra-disciplinary' involving public health, sociology, allied health and consumer collaborators. Specifically, we considered relationality - the feelings circulating between bodies/objects and implicated in MyBackPain's affective practices; impressions - the marks, images or beliefs MyBackPain makes on bodies/objects; and directionality - how these intra-actions pushed in some directions and away from others. Although Ahmed would likely not consider herself 'post-humanist', we argue that her socio-political theories of how objects and emotions entangle are of great interest to furthering critical post-human understandings of health. Rather than threatening decision-making, we suggest that feelings (and their affects) are central to it. The article demonstrates the productive potential of critical post-human inquiry in identifying/countering 'othering' possibilities, and catalysing a 'nomadic shift' towards new human-non-human formations.

Partnership between Nurse Navigators and adult persons living with complex chronic disease-An exploratory study

AIMS AND OBJECTIVES

The aim of this study was to explore nurse navigators and consumers' experience of partnership.

BACKGROUND

The nurse navigator has recently emerged as an advanced practice role in the care of persons with complex and chronic disease states. Self-care is an important principle in chronic disease models of care, requiring healthcare practitioners to partner with clients in their care. How nurse navigators and consumers [clients and family] experience partnership has not been explored.

DESIGN

An interpretive exploratory qualitative approach was used. Semi-structured interviews were conducted with seven nurse navigators working with adults with complex disease states and eleven of their clients. Interviews were analysed using descriptive content analysis. (COREQ checklist Data S1).

RESULTS

Five themes about partnership emerged. Three themes from nurse navigators were as follows: establishing and sustaining relationships, nurse-led planning and aligning care with clients' needs. The two consumer themes were as follows: regular contact means access to the health system and nurse presence is valued. The secondary analysis revealed two themes about partnership between the nurse and consumer: establishing relationships require nursing effort to be established and partnerships are person-focused and nurse-led.

CONCLUSIONS

Partnership begins with a relationship, largely driven by the nurse navigator through regular communication and personal contact that was valued by consumers. The nurse-led partnership reduced opportunities for consumers to learn to manage their treatments, particularly how and when to access services, meaning that self-care may not be fully achieved. Client navigation occurs over long periods, which could lead to the navigators being overwhelmed, raising an issue of sustainability.

RELEVANCE TO CLINICAL PRACTICE

Nurse navigators establish a client relationship as a foundation for partnership. This partnership needs a focus on promoting client self-care, self-management of treatment, including when and how to access available services, to ensure the sustainability of the nurse navigator model of care.

The Effect of Progressive Muscle Relaxation Exercises on Pain on Patients with Sickle Cell Disease: Randomized Controlled Study

PURPOSE

The study aimed to evaluate the effect of progressive muscle relaxation exercises on pain in patients with sickle cell disease.

MATERIALS-METHOD

This randomized controlled interventional study was conducted in a hospital in Mersin, Turkey between October 2017 and July 2018. The study sample comprised 58 patients who were aged >18 years, conscious, had sickle cell disease, reported pain, and were treated with non-opioid or weak opioid analgesic based on the physician's recommendation (treatment group = 29, control group = 29). Data were collected by the individual presentation form and visual analog scale. During the study, both groups were treated with analgesics prescribed by the physician for three days. In addition to the analgesics, the treatment group was performed progressive muscle relaxation exercises for 30 minutes whereas the control group was rested. Pain level of both groups was evaluated at three time points every day for three days. In the study, frequency distributions and descriptive statistics were presented for categorical and numerical variables, respectively. Chi-square analysis, independent samples t-test, Mann-Whitney U test, three-way ANOVA, and Sidak test were used to analyze the difference between the variables.

RESULTS

The mean age of the patients was 29.59 ± 6.94 years, and 53.4% of the patients were female and 69% were single. The mean pain score of the treatment group at the third time point on days 1, 2, and 3 was significantly lower than the control group (p < .05). There was no statistically significant difference between the two groups in terms of coping methods for pain, pain location, and complaints accompanying pain (p > .05).

CONCLUSION

Progressive muscle relaxation exercises were found to be effective in the pain management of patients with sickle cell anemia.

A Canadian Survey of Self-Management Strategies and Satisfaction with Ability to Control Pain: Comparison of Community Dwelling Adults with Neuropathic Pain versus Adults with Non-neuropathic Chronic Pain

BACKGROUND

Individuals with chronic pain with neuropathic characteristics (CPNC) describe a different pain experience compared with those with chronic pain without neuropathic characteristics (CP).

AIMS

The aim of this study was to describe and compare pain, self-management strategies, and satisfaction with ability to control pain between adults with CPNC versus CP.

PARTICIPANTS

Seven hundred and ten community-dwelling adults with chronic pain participated in a cross-sectional survey.

METHODS

CPNC was defined as a score ≥12 on the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Self-management and pain control was compared between participants with CPNC and CP using frequency, percent, relative risk (RR), odds ratios (ORs), and 95% confidence intervals (CIs).

RESULTS

Participants with CPNC (188/710) reported lower socioeconomic status, poorer general health, and more intense, frequent, and widespread pain. They were more likely to use prescription medications to manage pain (adjusted OR = 2.25, CI = 1.47-3.42). They were more likely to use potentially negative strategies to ease the emotional burden of living with chronic pain, including substance use (adjusted OR = 1.58, CI = 1.06-2.35), denial (adjusted OR = 2.21, CI = 1.49-3.28), and behavioral disengagement (adjusted OR = 1.68, CI = 1.16-2.45), and they were more likely to be completely dissatisfied with their ability to control pain (RR = 1.77, CI = 1.21-2.58).

CONCLUSIONS

Individuals with CPNC have distinct pain and self-management experiences compared with those with CP that may lead to negative coping strategies and dissatisfaction with ability to control pain. Therefore, self-management assessment and support should be tailored by pain condition.

Socioanthropological contributions to physical therapy in chronic back pain

Abstract Introduction: The high prevalence of chronic back pain is related to biopsychosocial factors. In this respect, pain is understood as a multifactorial phenomenon made unique by the previous ideas of each individual. Thus, the present study aimed Objective: To understand the experience of chronic back pain and the effectiveness of physiotherapeutic approaches to support new care strategies. Methods: In terms of qualitative research, a comprehensive approach was adopted using the theoretical and conceptual framework developed in the fields of anthropology and health. The sample consisted of 13 women residing in the municipality of Várzea Grande, Mato Grosso state (MT), Brazil, over 40 years old, homemakers, diagnosed with chronic back pain, treated at the Univag clinical school and who had completed physiotherapy more than six months previously. Results: Data analysis indicated that more traditional forms of outpatient physiotherapy prompted a significant improvement in chronic back pain. However, because the condition is chronic, all patients relapsed and their pain and dysfunctional conditions returned. Conclusion: Multiple factors influence the experience of chronic back pain and the constant self-management required forms a circular relationship between objective and subjective elements. On the other hand, by disregarding these elements, physiotherapeutic approaches provide predominantly technical and scientific care far removed from the experience of the affected subject. In this respect, the chronic condition requires long-term care, whereby the focus should shift from the pursuit of a cure to the care model.