Sense of coherence and other predictors of pain and health following laparoscopic cholecystectomy

Sense of coherence as a predictor for patients' quality of recovery after total hip or knee arthroplasty - A descriptive cohort study

BACKGROUND

Patients' postoperative quality of recovery (QOR) is an important outcome measurement and predicting and preventing impaired quality of recovery is essential. In this study, we aimed to investigate if patients Sense of Coherence (SOC) could be a potential predictor and screening instrument for impaired quality of recovery. We hypothesized that patients' SOC is positively related to their QOR.

MATERIAL AND METHODS

The study was performed as a descriptive single-center prospective cohort study. Data was collected using digital questionnaires. Patients undergoing total hip (THA) or knee arthroplasty (TKA) received the SOC13 questionnaire prior to their surgery to establish their SOC and a questionnaire on postoperative day 2 and 7, respectively, establishing their QOR. Multiple linear regression was used to fit a model for the QOR score using SOC, age, sex, and type of surgery as potential explanatory variables.

RESULTS

206 patients were included in the study analysis. The results showed a highly significant positive correlation between patients' SOC and their postoperative QOR on both postoperative day 2 and 7 (p < 0.01). Patients with a lower SOC score also presented a significantly lower QOR score, meaning they experienced impaired QOR compared to patients with a higher SOC score.

CONCLUSIONS

The results indicate that a weak SOC (low SOC score) can be considered a clinically important indicator for risk of impaired QOR (low QOR score) after THA and TKA. The SOC13 questionnaire may be a potential screening instrument identifying patients in risk of impaired postoperative QOR based on a low SOC score.

Occurrence and characteristics of pain after ICU discharge: A longitudinal study

BACKGROUND

Pain is a serious problem for intensive care unit (ICU) patients, but we are lacking data on pain at the hospital ward after ICU discharge.

AIMS AND OBJECTIVES

To describe pain intensity, -interference with function and -location in patients up to 1 year after ICU discharge. To identify demographic and clinical variables and their association with worst pain intensity and pain interference.

DESIGN

A longitudinal descriptive secondary analysis of a randomized controlled trial on nurse-led follow-up consultations on post-traumatic stress and sense of coherence after ICU discharge.

METHODS

Pain intensity, -interference, and -location were measured using Brief Pain Inventory at the hospital ward and 3, 6, and 12 months after ICU discharge. For associations, data were analysed using multivariate linear mixed models for repeated measures.

RESULTS

Of 523 included patients, 68% reported worst pain intensity score above 0 (no pain) at the ward. Estimated means for worst pain intensity and -interference (from 0 to 10) after ICU discharge were 5.5 [CI 4.6-6.5] and 4.5 [CI 3.7-5.3], and decreased to 3.8 [CI 2.8-4.8] (P ≤ .001) and 2.9 [CI 2.1-3.7] after 12 months (P ≤ .001). Most common pain locations were abdomen (43%), lower lumbar back (28%), and shoulder/forearm (22%). At 12 months, post-traumatic stress (PTS) symptoms ≥25 (scale 10-70), female gender, shorter ICU stay, and more traumatic ICU memories were significantly associated with higher worst pain intensity. PTS symptoms ≥25, female gender, more traumatic ICU memories, younger age, and not having an internal medical diagnosis were significantly associated with higher pain interference.

CONCLUSIONS

Early after ICU discharge pain was present in 68% of patients. Thereafter, pain intensity and -interference declined, but pain intensity was still at a moderate level at 12 months. Health professionals should be aware of patients' pain and identify potentially vulnerable patients.

IMPLICATION FOR PRACTICE

Longitudinal assessment of factors associated with pain early after ICU discharge and the following year is a first step that could improve follow-up focus and contribute to reduced development of chronic pain.

Patients' experiences with cholecystitis and a cholecystectomy

Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

Sense of coherence and pain experience in older age

BACKGROUND

We investigate to what extent pain in older individuals is predicted by on the one hand chronic morbidity as a resistance deficit, and on the other hand psychological resistance resources and the sense of coherence. For the first time, we tested the salutogenic hypothesis that the sense of coherence mediates the relationship between resources/deficits and pain.

METHODS

In our questionnaire study, we assessed selected psychological resistance resources (self-esteem, generalized self-efficacy, optimism, and social support), the number of self-reported medical diagnoses of chronic illness, the sense of coherence, and pain (SF-36 Bodily Pain subscale) in a sample of 387 older persons (at the mean age of 73.8 years).

RESULTS

Using hierarchical regression, we found that morbidity and sense of coherence were the only significant predictors of pain, with morbidity showing the strongest effect. Using path analysis, the sense of coherence was a mediator of the relationship between resistance resources/deficits and pain.

CONCLUSIONS

With respect to our analytical model, in which pain experience was the criterion variable, morbidity and the sense of coherence are important predictors of pain. Moreover, we found evidence for the salutogenic idea that the sense of coherence represents a mediator variable as it pools resistance/deficits influences on pain. We recommend a prospective design to explore these assumed causal chains in future research.

Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain

BACKGROUND

Sense of Coherence (SOC) is a measure of an individual's capacity to use various coping mechanisms and resources when faced with a stressor. Chronic pain is one of the most prevalent and disabling conditions in clinical practice. This study examines the extent to which a strong SOC is associated with less pain and better health related quality of life (HRQoL) among patients with chronic pain.

METHODS

We analyzed data from the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial which enrolled 250 patients with persistent (3 months or longer) musculoskeletal pain who were receiving care in an United States Department of Veterans Affairs (VA) primary care clinic. The abbreviated three-item SOC scale was used to measure personal coping capability. Participants were categorized into Strong SOC (score 0-1) and Weak SOC (score 2-6). The Brief Pain Inventory (BPI) was used to assess the severity and disability associated with pain. Additionally, pain self-efficacy (ASES) and catastrophizing (CSQ) were assessed. HRQoL was assessed with the 36-item Short-Form Health Survey (SF-36) social functioning, vitality, and general health subscales. Multiple linear regression models were performed to examine whether SOC was independently associated with pain-specific and HRQoL outcomes, after adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities and major depression.

RESULTS

Of the 250 study patients, 61% had a strong SOC whereas 39% had a weak SOC. Multivariable linear regression analysis showed that a strong SOC was significantly associated with better general health, vitality, social functioning and pain self-efficacy as well as less pain catastrophizing. These significant findings were partially attenuated, but remained statistically significant, after controlling for major depression. SOC was not significantly associated with pain severity or pain disability.

CONCLUSIONS

A strong SOC is associated with better HRQoL and self-efficacy as well as less catastrophizing in patients with chronic pain. SOC may be an important coping mechanism (strategy) for patients with chronic musculoskeletal pain.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00926588.