Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention

Level of readiness of chronic pain patients to practise active self-care

BACKGROUND

Given the limited alleviation of chronic pain with pharmacological treatments, various nonpharmacological and self-care approaches are often proposed that require patients' motivation.

OBJECTIVE

To evaluate the level of readiness (LOR) to practise different types of active self-care among chronic pain patients.

METHOD

A quantitative cross-sectional survey was conducted among all chronic pain patients seeking care at the Pain Center of an academic hospital from June 2013 to March 2015. Sociodemographic data, pain characteristics, treatments and the LOR to practise active self-care were investigated.

RESULTS

Among the 1524 eligible patients, 639 (41.9%) were included. The median pain duration was 8.5 years (interquartile range = 7.5). Two-thirds (63.7%) of the patients reported high pain-related disability, and 64.6% had used opioids during the previous six months. Most patients had a high (44.1%) or moderate (24.6%) LOR to practise active self-care. Multivariable multinomial regression analysis showed that independent factors associated with a high LOR were a higher level of education (relative risk ratio (RRR) = 3.42, 95% confidence interval (CI): 1.90-6.13, p < 0.001), unemployed status due to medical condition (RRR = 2.92, 95% CI: 1.30-6.56, p = 0.009), the use of dietary supplements 'against pain' (RRR = 2.77, 95% CI: 1.52-5.04, p = 0.001) and neuropathic pain characteristics (RRR = 1.80, 95% CI: 1.40-3.12, p = 0.036). Older age was a factor predicting a lower LOR (RRR = 0.97, 95% CI: 0.94-0.99, p = 0.039). Long-term chronic pain, severe pain-related disability and the presence of a mood disorder were not associated with a lower LOR.

CONCLUSION

Most chronic pain patients, including those severely affected, indicated their readiness to practise active self-care methods.

SIGNIFICANCE

Most chronic pain patients, even those severely affected, appeared to be ready to practise active self-care therapies and we believe that further studies are needed to investigate their impact on pain and quality of life.

Effect of an Ergonomics-Based Educational Intervention Based on Transtheoretical Model in Adopting Correct Body Posture Among Operating Room Nurses

Background:

One of the preventive strategies for chronic low back pain among operating room nurses is instructing proper body mechanics and postural behavior, for which the use of the Transtheoretical Model (TTM) has been recommended.

Methods:

Eighty two nurses who were in the contemplation and preparation stages for adopting correct body posture were randomly selected (control group = 40, intervention group = 42). TTM variables and body posture were measured at baseline and again after 1 and 6 months after the intervention. A four-week ergonomics educational intervention based on TTM variables was designed and conducted for the nurses in the intervention group.

Results:

Following the intervention, a higher proportion of nurses in the intervention group moved into the action stage (p < 0.05). Mean scores of self-efficacy, pros, experimental processes and correct body posture were also significantly higher in the intervention group (p < 0.05). No significant differences were found in the cons and behavioral processes, except for self-liberation, between the two groups (p > 0.05) after the intervention.

Conclusions:

The TTM provides a suitable framework for developing stage-based ergonomics interventions for postural behavior.

Meta-analytic examination of the strong and weak principles across 48 health behaviors

OBJECTIVE

The strong and weak principles of change state that progress from the precontemplation to the action stage of change is associated with a one standard deviation increase in the pros and a one-half standard deviation decrease in the cons of change. In this study these relationships, originally developed by Prochaska [Prochaska, J.O., 1994. Strong and weak principles for progressing from precontemplation to action on the basis of 12 problem behaviors. Health Psychology, 13, 47-51] based on an examination of 12 studies of 12 different behaviors, were re-examined using many more datasets and much more rigorous statistical methods.

METHODS

The current study analyzes 120 datasets from studies conducted between 1984 and 2003 across and within 48 health behaviors, including nearly 50,000 participants from 10 countries. The datasets were primarily analyzed utilizing meta-analytic techniques.

RESULTS

Despite the range of behaviors and populations, the results were remarkably consistent with the original results (pros=1.00 standard deviation, cons=0.56 standard deviation). Few potential moderators showed any impact on effect size distributions.

CONCLUSIONS

This updated and enhanced examination of two important principles of behavior change is a significant contribution to the field of multiple health risk behaviors, as it clearly demonstrates the consistency of the theoretical principles across multiple behaviors, which has implications for developing multiple health risk behavior interventions.

Representations: an important key to understanding workers' coping behaviors during rehabilitation and the return-to-work process

INTRODUCTION

Every year many workers are excluded from work because of a work disability attributable to a musculoskeletal disorder (MSD). Factors associated with the development and persistence of the work disability can be related to the worker, work environment, compensation policies, healthcare system and insurance system. Workers' understanding/representations of their disability are associated with coping behaviors aimed at helping them adapt to or solve their health problem. A representation is a complex, organized entity incorporating thoughts, beliefs, and attitudes regarding a particular subject. Representations have been studied in anthropology, sociology and psychology since the 1960s, but often in a compartmentalized way. These representations provide an important key to understanding what motivates workers during rehabilitation and the return-to-work process. To build upon disciplinary knowledge and better understand workers' efforts to cope with their persistent disability, this article therefore aims to pool the different knowledge available on the illness representation concept, from the fields of anthropology, sociology and psychology in order to gain a better understanding of its application in the MSD context.

METHODS

An electronic literature search (French, English) from 1960 on was conducted in medical, paramedical and social science databases (MedLINE, PsychINFO, CINAHL, etc.) using predetermined key words. After screening abstracts based on a set of criteria, content analysis was performed on the 131 articles retained.

RESULTS

The theoretical models and approaches can be divided into three categories: (1) personal experience; (2) interactionist; and (3) sociocultural. The models found in sociology and anthropology are mainly descriptive and developed in a medical context, and only rarely in an occupational health context. However, these models could add elements to psychosocial models that are more dynamic and oriented toward understanding the reasons behind specific behaviors.

CONCLUSION

Bridging the gap between these disciplines will help us achieve a new level of knowledge that will, by taking social interactions into account, enhance understanding of workers' representations, and the behaviors they adopt to manage their MSD-related disability.

Integrative interventions for MSDs: nature, evidence, challenges & directions

BACKGROUND

When applied to workplace interventions, integrative may be seen in various ways, requiring elucidation.

METHODS

Identification of primary studies through systematic reviews, limited bibliographic literature searches, the Cochrane Occupational Health Field database on intervention studies, and authors' files. Focus was 2000 on. Categorization according to the Cochrane classes and lenses on integrative. Synthesis as narrative review.

RESULTS

Examples of each lens on integrative were uncovered: biomechanical and psychosocial, multiple component, primary and secondary prevention, organizational, and system. Each contributed different understanding to the potential impacts on different knowledge, exposure, behavior, health and administrative outcomes.

CONCLUSIONS

Considerable opportunities exist to expand the range of integrative interventions, particularly at the organizational and system levels, and incorporate a combination of knowledge transfer and exchange with intervention evaluation.

Adjustment to Chronic Pain in Back Pain Patients Classified According to the Motivational Stages of Chronic Pain Management

According to Prochaska's transtheoretical model, the Freiburg Questionnaire stages of chronic pain management (FQ-STAPM) were used to classify chronic back patients into 4 distinct motivational stages. The FQ-STAMP was completed by 163 chronic back pain patients. Pain chronicity was measured by the Mainz Pain Staging System; pain intensity was measured by the numeric rating scale. Healthcare system expenses were considered as number of consulted physicians, number of stays in hospital, and number of rehabilitation programs. As psychometric tests, the lower pain disability index (PDI), the Hospital Anxiety and Depression Scale (HADS), and a quality of life score (SF36) were used. Patients were in the following motivational stages: precontemplation in 30%, preparation in 19%, action in 30%, maintenance in 21%. The intensity of pain in the precontemplation stage patients was significantly higher compared to patients in the maintenance stage. A lower pain chronicity was related to a significantly higher motivation. Moreover, there was a significant increase in healthcare system expenses by the lesser motivated patients. Patients in the maintenance stage used significantly less opioids than patients in the precontemplation stage. The higher motivated patients had a significantly lower PDI, a significantly lower HADS, and a significantly higher quality of life compared to less motivated patients.

PERSPECTIVE

The study indicates that the FQ-STAPM might be a useful tool to classify chronic back pain patients and to work out a strategy together with the patient relevant to the outcome of pain management among chronic back pain patients.

The Validity of the Stages of Change Model in the Adoption of the Self-Management Approach in Chronic Pain

In attempts to decrease chronic pain and the negative impact of chronic pain on broader functioning, patients can be stimulated to adopt self-management skills. However, not all patients are motivated to do so. Insight into the causes of motivation and the process of behavior change could increase the practitioners' effectiveness in stimulating patients to use self-management skills. The stages of change construct is a psychologic construct that maps the process of behavior change. Patients in the Precontemplation stage are not motivated to adopt self-management skills, patients in the Contemplation stage think about it, patients in the Preparation stage are planning to change and are already trying some (parts) of the skills, patients in the Action stage are actively learning to engage in self-management, whereas patients in the Maintenance stage keep on working to stabilize the new behavior pattern. Although the stages of change model is intuitively plausible and has the potential to increase effectiveness of the practitioners' counseling, its validity should be proven before it is applied clinically. The present article reviews the 8 available publications in which the stages of change construct is studied in patients with chronic pain. The results show that the theory of the stages of change needs more articulation, that the operationalization should be more directly derived from the theory, and that the results from more appropriate tests of the theory should be used to change the theory when necessary to develop it. Recommendations are made with regard to the theory, the operationalizations, and the tests to be conducted to develop the theory and assess its validity.

Treatment outcome in individuals with chronic pain: is the Pain Stages of Change Questionnaire (PSOCQ) a useful tool?

The efficacy of psychological treatments emphasising a self-management approach to chronic pain has been demonstrated by substantial empirical research. Nevertheless, high drop-out and relapse rates and low or unsuccessful engagement in self-management pain rehabilitation programs have prompted the suggestion that people vary in their readiness to adopt a self-management approach to their pain. The Pain Stages of Change Questionnaire (PSOCQ) was developed to assess a patient's readiness to adopt a self-management approach to their chronic pain. Preliminary evidence has supported the PSOCQ's psychometric properties. The current study was designed to further examine the psychometric properties of the PSOCQ, including its reliability, factorial structure and predictive validity. A total of 107 patients with an average age of 36.2 years (SD=10.63) attending a multi-disciplinary pain management program completed the PSOCQ, the Pain Self-Efficacy Questionnaire (PSEQ) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) pre-admission and at discharge from the program. Initial data analysis found inadequate internal consistencies of the precontemplation and action scales of the PSOCQ and a high correlation (r=0.66, P<0.01) between the action and maintenance scales. Principal component analysis supported a two-factor structure: 'Contemplation' and 'Engagement'. Subsequent analyses revealed that the PSEQ was a better predictor of treatment outcome than the PSOCQ scales. Discussion centres upon the utility of the PSOCQ in a clinical pain setting in light of the above findings, and a need for further research.