Occupation and meaning in the lives of women with chronic pain

Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography

BACKGROUND

Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed.

AIM

Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach.

MATERIAL AND METHODS

The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data.

RESULTS

Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied.

CONCLUSION AND SIGNIFICANCE

The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

Career Transitions Caused by Chronic Illness: A Career Construction Perspective

Purpose:People living with chronic illness face significant challenges with employment. This study explores the impact of participating in the Career Construction Interview (CCI) on the career exploration of individuals facing a forced career transition due to the onset or exacerbation of a chronic illness.

Method:An instrumental multiple case study design was used in this qualitative study. A purposeful, homogeneous sample of three female adults was used to gain multiple perspective of forced career transitions. The participants were within 2 years of their diagnosis or exacerbation of one or more chronic health conditions and had to change their career because of the impact of their condition(s).

Results:Eight open codes and five axial codes were discovered through the process of constant comparative analysis. For this study one open code (CCI experience) and five axial codes will be discussed.

Conclusions:This study found patterns related to chronic illness and career and that the Career Construction Interview was helpful to the participants in assisting them with making decisions about potential careers and options for employment. Implications for rehabilitation counseling practice and suggestions for future research.

Patients' experiences of occupational therapy within a multidisciplinary pain management programme: A qualitative study

BACKGROUND

Occupational problems are common for adults experiencing chronic pain, but occupational therapists are not always accessed as part of the multidisciplinary team. Despite evidence of benefit for work-focused interventions, there is limited evidence for broader benefit from occupational therapy interventions within the context of multidisciplinary pain management. The aim of this study was to explore the experiences of programme attendees who received structured intervention from an occupational therapist as part of a multidisciplinary pain management programme, and gain an understanding as to how they felt it influenced changes they made to occupational participation.

METHOD

A qualitative approach was undertaken with 9 individual patients recruited from a group pain management programme for adults with chronic low back pain. Semi-structured interviews were carried out, recorded and transcribed. Thematic analysis was used to identify themes in the data.

RESULTS

Three key themes were identified: 1) the helpfulness of activity pacing techniques 2) the value of participating in a therapeutic activity-based session and 3) an increased understanding of the importance of leisure and creative activities in the context of their lives.

CONCLUSION

Participants perceived the specific occupational therapy content of the programme to be helpful in a number of different ways. The findings suggest that occupational therapy can be important in facilitating patients to apply theoretical techniques in the real world, thereby increasing the likelihood of long term benefit.

Reflecting on conceptualisations of ‘meaning’ in occupational therapy

Abstract In this reflection essay, the authors explore how meaning is represented in occupational therapy literature. A review of occupational therapy and occupational science literature uncovers framings of meaning, meaningful, and meaningfulness that are almost exclusively ‘positive’. Positioning of occupations as inherently ‘positive’ and assuming universal experiences of positive meanings for all members of society, overlooks individual and collective diversities. To perpetuate framings of occupations as inherently and exclusively ‘positively meaningful’ effectively silences experiences that do not conform to dominant assumptions and perspectives. Approaching concepts of ‘meaning’ more broadly may allow occupational therapists and scholars to better comprehend what people do and do not do, and why, better situating the profession to promote the espoused goals of equity, justice, and rights. Neglecting nuanced understandings of meaning may forfeit more complex examinations of occupation to other disciplines, thereby undermining disciplinary claims of expertise in the realm of occupation.

Substance use and meaning: transforming occupational participation and experience

Abstract Introduction We draw on activity theory of concepts to examine ‘meaning of occupation’ and ‘substance use’ beyond preconceived notions of inherent positive or negative experiences. Objective To explore nuanced meanings of substance use and associated occupations. Method An online survey and semi-structured interviews were used to collect data from professionals about prevalence of substance use, substance effects, and personal experiences. In analyzing the interview data, we attended to substance use as a discrete occupation in itself, substance use co-occurring with other occupations, and substance use altering the performance, participation, and experience of occupations. Results Three broad themes related to meaning: i) complex meanings attributed to substance use, ii) meanings of substance use as shifting and variable, and iii) meanings of substance use in the context of other occupations. Substance use enhances occupations, transforms meaning of occupations, and mitigates less desired aspects of occupations. Work, construed as positively meaningful and valued in occupational therapy literature, was a source of stress, unhappiness, and worry; substance use facilitated relaxation and pleasure. Conclusion This study furthers occupational therapy knowledge with respect to implications for conceptualization that extend beyond dualist framings and implications for occupational therapy education, practice, and policy.

Exploring perceived occupational balance in women with fibromyalgia. A descriptive study

BACKGROUND

People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation.

OBJECTIVE

To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms.

METHODS

A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure.

RESULTS

One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance.

CONCLUSION

Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance.

SIGNIFICANCE

Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.

Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review

Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.

"Our child's significant disability shapes our lives": experiences of family social participation

PURPOSE

This study explored the stories of parents of youth with severe physical disabilities to understand how they viewed the quality of their family social participation; the barriers to social participation faced as families and the strategies and supports that might be used to reduce these barriers.

METHOD

Ten parents of youth (10-18 years) with severe physical disabilities, recruited through specialist schools, health and disability services, were interviewed using a narratively-oriented interview tool: the Occupational Performance History Interview-II. Interviews were audio-recorded and transcribed verbatim. Narrative and thematic analytic approaches were used to construct each parent's story of family social participation issues, and to identify themes across stories.

RESULTS

Parents used highly structured routines and required substantial resources, particularly adult assistance and financial means, to facilitate family social participation. Needs were greater when the youth was more severely impaired, heavier, incontinent or had fragile health. Parents' choice of family activities and belief that they could influence the quality, enjoyment and satisfaction derived from family social participation were shaped by past experiences and the perceived benefits of participation.

CONCLUSIONS

Family social participation relied on flexible supports tailored to families' needs and preferences. Greater choice and control of resources are central to enabling valued participation. Implications for Rehabilitation Government resources need to be directed towards improving community based wheelchair accessibility and public toilet facilities for youth with Level V GMFCS-E&R impairments and their families. Disability service delivery models need to enable families to choose the types of high quality care and support that will facilitate valued family social participation. Clinicians need to be aware that families of the most severely impaired children, who are heavier, incontinent or in fragile health, will require substantially more resources than other families to facilitate their social participation.

The impact of spinal cord stimulation for upper extremity complex regional pain syndrome on level of function

Background/aims

Spinal cord stimulation (SCS) is able to provide significant pain relief in individuals with complex regional pain syndrome (CRPS). Less is known about how this treatment impacts on function, particularly from the patients' perspective. This qualitative exploratory study was part of a larger service evaluation into current and future management of this patient group. This evaluation aimed to gain insight into the influence of SCS on daily activity and work and to explore the patients' journey from symptoms to diagnosis, SCS implant and afterwards.

Methods

A purposive sample of three patients took part in semi-structured interviews. Thematic content analysis of the data was then used to extract themes and subthemes.

Results

Thematic content analysis identified two emerging concepts: freedom and conflict. Within these two concepts, seven subthemes were apparent. Although participants described feelings of independence due to the effect of SCS on activity levels, other less encouraging issues were identified. These include a dependence on the stimulator, a lack of control over the future, and a perceived lack of understanding of their condition by others.

Conclusion

How these concepts relate to patients' ability to return to work is explored and areas for further research are identified.

A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain

Background

The alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.

Aim

The aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.

Methods

We used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.

Results

Our findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.

Conclusion

Our model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The road to recovery: experiences and occupational lives of icelandic women with breast cancer

ABSTRACT The purpose of this qualitative study was to explore the experiences and occupational lives of Icelandic women with breast cancer. In all 18 women were interviewed using the Occupational Performance History Interview as a guide. The women employed different modes of interpreting and responding to the cancer event with occupational participation being the central vehicle to resist the illness. Adjustment to breast cancer survivorship was characterized by permanent changes in the women's lives with both positive and negative consequences. When working with women with breast cancer, occupational therapists should focus on their needs as occupational beings.

A Literature Review on Chronic Pain: The Daily Overcoming of a Complex Problem

Introduction:

Chronic pain has an impact on the working life of those affected, but what about other areas of daily living? The objective in this research paper is to review the relationship between chronic pain and engagement in instrumental activities of daily living (IADLs), sleep and family life.

Method:

A search in the Medline (2006–2010) and the Cumulative Index to Nursing and Allied Health (CINAHL) (2004–2010) databases using the key terms ‘chronic pain’, ‘family’, ‘sleep disorders’ and ‘occupation’ was carried out. To be included, articles had to refer to the effects of chronic pain on IADLs, on sleep or on the family. Studies in which a specific diagnosis or condition was discussed were excluded to provide a more general view of the effects of chronic pain. Quality was assessed using the STROBE statement scale (for descriptive studies, from Strengthening the Reporting of Observational studies in Epidemiology), the Qualitative Research Guidelines Project (for qualitative studies) and the PRISMA statement scale (for systematic reviews, from Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Results:

Of the 256 articles obtained from the search, 13 met the inclusion criteria. The articles show that chronic pain indeed has an impact on the lives of those affected in other areas besides work rehabilitation.

Conclusion:

Occupational therapists must consider levels of performance and engagement in all occupational domains of an individual, even when focusing on a single domain due to the work setting or commissioning process.

Living well with rheumatoid arthritis

PURPOSE

The overall aim of this study was to understand the occupational lives of people with rheumatoid arthritis. Further aims were to identify the creative agency that occurs while performing these occupations and to understand the socio-cultural aspects of engaging in valued occupations.

METHODS

Five participants were recruited and various qualitative methods of data collection were engaged, including open interviews, participant observation and gathering occupational diaries. A combination of thematic and narrative analysis was performed.

RESULTS

Findings uncovered six themes, including; changing occupations; environmental factors count; taking control over occupations; being or becoming normal; people and objects are important; hopes and dreams matter. Subthemes uncovered how individuals constantly adapt and alter their occupations; some radically changing lifestyles for the better, while others work towards regaining occupational control. Meaning of occupations became apparent. People were creative agents. Work and leisure occupations featured strongly. Objects and other individuals were significant factors to individuals when engaging in occupations. People strived to be 'normal' in their occupational worlds.

CONCLUSION

The implication of these results in relation to professional practice for therapists is that attention should be refocused on the occupational narratives of clients, working with the positive, creative aspects that people are already employing and building on these in areas that might not been seen as traditional, such as work and leisure.

The Flow Experiences of People with Chronic Pain

This electronic momentary assessment study explored the relationship between flow and pain intensity and examined whether flow is an optimal experience for people with chronic pain. Adults with chronic pain ( n = 30) were signaled randomly seven times daily during 1 week to respond to a flow questionnaire via personal digital assistant. The participants responded to 718 questionnaires from 1,447 beeps (response rate = 49.6%). Results indicated that participants were most commonly at home, doing self-care activities, with family or alone. Participants experienced flow 34.9%, apathy 44.6%, relaxation 11.6%, and anxiety 8.9% of the sampled time. Participants' mean concentration, self-esteem, motivation, and potency scores were highest in flow compared to the other three states. Separate one-way between-groups analyses of variance comparing concentration ( F(3) = 11.85; p < .001), self-esteem ( F(3) = 11.98; p < .001), motivation ( F(3) = 29.29; p < .001), positive affect ( F(3) = 2.89; p = .035), potency ( F(3) = 19.88; p < .001), and pain intensity ( F(3) = 1.39; p = .245) scores across the four states showed a significant overall effect on all comparisons except pain intensity and positive affect.

Review of occupational therapy for people with chronic pain

BACKGROUND/AIM

Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.

METHODS

A broad range of literature is reviewed and analysed using causal layered analysis, a post-structural critical futures methodology. This layered analysis moves through four layers of analysis; the litany layer, the social causes layer, the worldview analysis layer and the grand myth and metaphor layer.

RESULTS

This layered analysis revealed three significant factors shaping the future development of occupational therapy services for people with chronic pain: the influence of the biopsycho-social model within health-care services for people with chronic pain, occupational therapy philosophy and the social construction of people with chronic pain. Recommendations for future research and practice derived from this analysis include the need to research the effectiveness of occupation-based interventions for people with chronic pain, the significance of client-centred occupational therapy and valuing of clients' narratives to avoid pervasive negative social constructions of people with chronic pain influencing occupational therapy practice.

CONCLUSIONS

This critical analysis has made occupational therapy services for people with chronic pain problematic in order to generate reflection, discussion and new insights. This analysis deconstructs contemporary occupational therapy philosophy and practice and therefore provides a new perspective on occupational therapy for people with chronic pain.

Occupation and Meaning: Narrative in Everyday Activities of Women with Chronic Rheumatic Conditions

This ethnographic study explored how processes of meaning take place in the everyday activities of women with chronic rheumatic conditions. Using the French philosopher Ricoeur's theory of narrative in action, the results showed how processes of meaning were closely linked to action and how the participants enacted possible meaning-related stories in their everyday lives. When enacting meaning, the women linked together events in ways that varied according to the situation. Thus, the enacted processes of meaning were not goal directed or clear but rather complex processes embedded in the women's network of cultural activity. Sometimes they enacted meaning as part of a complete story; at other times, meaning appeared as fragments with unclear connections. The results were relevant for occupational science and occupational therapy because the women's everyday activities functioned as interpretative spaces providing opportunities for “trying out” significant issues of meaning and to communicate with their social and material worlds.

Falls Self-Efficacy among Adults with Multiple Sclerosis: A Phenomenological Study

This phenomenological study explored and described the lived experience of falls self-efficacy (i.e., perceived self-efficacy in avoiding a fall during basic activities of daily living) among six individuals with multiple sclerosis and its relationship to their overall volition and occupational lives. Participants were interviewed three times over a 3-month period. All interviews were analyzed using the Empirical, Phenomenological, Psychological method. One main theme (managing fall risk as a means of supporting activity) and six subthemes were reflected in participants' lived experiences: (1) understanding personal multiple sclerosis symptoms, abilities, and fall risk; (2) accepting one's changed capacity; (3) focusing on what you can control; (4) ongoing learning by doing; (5) vigilance while doing; and (6) taking personal responsibility to reduce fall risk. The findings show how falls self-efficacy operates as part of a larger volitional process and can be used to inform the development of fall prevention programs for individuals living with multiple sclerosis.

Studying narrative-in-action in women with chronic rheumatic conditions

In this article we aim to sculpt a possible methodology for studying how a good everyday life comes about when living with chronic rheumatic conditions (CRC). Our "how" focus acknowledges a woman with CRC as one member of a diverse population, whereby we question the biomedically based view that she differs from the population. The more frequently asked "what" question colors study designs and results in categories and characteristics regarding what she is able to do and what adaptations she has made in everyday life as a consequence of her disease. Adopting a narrative approach, we ask how a good everyday life comes about, and illustrate this with ethnographic material of the everyday activities of women living with CRC. We conceptualize narrative as embedded in the process of enacting activities. Furthermore, we highlight hermeneutical interpretative processes of how meaning works in the stream of everyday action.

Narrative slope as a predictor of work and other occupational participation

This study aims to determine the utility of the narrative slope in predicting the vocational/productive outcomes of participants. For 65 participants living in supportive facilities for adults with HIV/AIDS in the United States, narrative slopes, based on the Occupational Performance History Interview II, were constructed and classified as progressive, stable, or regressive. Information regarding participants' productive activities was collected at discharge from intervention programming, and at 3-month intervals, up to 9 months. Data were analyzed to examine the relationship between narrative slope and engagement in employment and other productive activity post-intervention. Demographic variables were also analyzed. None of the demographic factors significantly correlated to outcomes. It was found that a more positive narrative slope was predictive of a higher likelihood of being employed or engaged in other productive activity.