Appraisal, coping, motivational factors and gender in vocational rehabilitation

The THRIVE model: A framework and review of internal and external predictors of coping with chronic illness

This article explores the ways in which people cope with social and clinical dimensions of their chronic conditions. Existing literature was reviewed to categorize factors identified as being key. They were sorted into six groupings which are reflected by the acronym THRIVE: therapeutic interventions, habit and routine, relational-social, individual differences, values and beliefs, and emotional factors. We found little evidence to suggest different conditions prompt unique coping responses; rather, a range of common factors were observed across diverse conditions. The THRIVE framework not only summarizes current literature but provides a starting point for further research and development of future interventions.

Content and concurrent validity of the motivation for change questionnaire

INTRODUCTION

Musculoskeletal disorders (MSD) are nowadays seen within a biopsychosocial framework, including salutogenic factors, motivation factors, and coping ability. Such a framework recognizes the importance of motivational factors in health promotion and in rehabilitation. The Motivation for Change Questionnaire (MCQ) has been developed to measure the strength of individuals' motivation for change in life, MCQ part 1, and work situation, MCQ part 2. The purpose of the study was to test the content and concurrent validity of the MCQ on patients with prolonged musculoskeletal disorders referred to interdisciplinary rehabilitation as a basis for use in medical and occupational rehabilitation.

METHODS

Content validity was studied among an expert group of 20 rehabilitation professionals at a rehabilitation centre, and with 10 individuals suffering from prolonged MSD in the south of Sweden. The experts evaluated the clinical relevance of each question in MCQ. Concurrent validity was studied on 58 patients with prolonged MSD at an interdisciplinary rehabilitation centre in the south of Sweden. They answered MCQ, QPS Nordic questionnaire, KASAM and the Action theory questionnaire. Spearman's rank correlation coefficient was used in the analyses.

RESULTS

The MCQ covered and measured areas of relevance according to content validity. No floor effects in any of the subscales of MCQ part 1 were seen. In MCQ part 2, floor effects were seen in two sub indexes. As for concurrent validity subscales of MCQ correlated significantly with QPS Nordic questionnaire and KASAM.

CONCLUSIONS

Findings so far indicate the instrument to be valid for use within the present patient group. The questionnaire can be used to identify patient's motivating factors for change in life and work, as a basis for motivational work within rehabilitation.

Elucidating issues stressful for patients in predialysis and dialysis: from symptom to context

Biopsychosocial problems experienced by renal disease patients were studied within a contextual framework the patients themselves defined, the findings being related to sociodemographic and medical data. Participants were 72 predialysis patients and 73 patients being treated by haemodialysis or peritoneal dialysis (106 men and 39 women, aged 18-84 years). Both stress-related global and situational measures of biopsychosocial problems were assessed by questionnaire. Factor analyses revealed five factors--Bodily problems; Work and leisure time; Sleep, cramps and itching complaints; Financial problems; and Dependence-- explaining 71.1 per cent of the total variance. Fatigue loaded both on Bodily problems and Work and leisure time. Sleep disturbances, itching of the skin and muscle cramps were more stressful for the dialysis than the predialysis patients. Also, fatigue, inability to work and limitation on vacation activities appeared more stressful for the dialysis group. The study supports the usefulness of a contextual approach for gaining a better general understanding of renal disease patients' problems.

Development and reliability of the Motivation for Change Questionnaire

PURPOSE

The purpose of this study was to describe the development of the Motivation for Change Questionnaire (MCQ) and to test its intra-patient reliability on musculoskeletal pain patients in interdisciplinary rehabilitation as a basis for use in rehabilitation planning.

METHOD

The MCQ questionnaire was developed from a literature search in the Medline, Cinahl and Psychlit databases concerning motivating factors for change in the life and work situation. Questions covering these factors were developed (item generation). Factor analysis of the questions implied a reduction of the number of questions (item reduction). Inter-item correlation was assessed on the baseline administration of the questionnaire by calculating Cronbach's alpha. When testing the structure of the scales, it was shown that the MCQ questionnaire could be described in two scales, one scale relating to motivation for change in the life situation and the other focusing on motivation for change in the work situation and in total 49 questions.

RESULTS

The test -- retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals were calculated. One question was excluded due to the threshold limit of > 0.5. Seven scales relating to the life situation were accepted by the analysis: social support, mastery in life, challenges in life, control in life, values, self-efficacy and self-confidence. Six scales relating to the work situation were also accepted: co-worker support, supervisory support, challenges in work, job control, interaction and job-satisfaction.

CONCLUSIONS

The MCQ questionnaire with 48 questions is reliable for use on musculoskeletal pain patients in interdisciplinary rehabilitation. It can be used to identify each individual's motivating factors for change in life and work situation as a basis for motivational work within rehabilitation and/or to measure within-subject changes in motivation over time. The validity and the responsiveness of the MCQ, need to be studied.

Motivation for change in patients with prolonged musculoskeletal disorders: a qualitative two-year follow-up study

BACKGROUND AND PURPOSE

The purpose of this study was to obtain a deeper understanding of the process of motivation for change in patients with prolonged musculoskeletal disorders and to identify factors that might influence change resulting in increased independence.

METHOD

A qualitative two-year follow-up study. Data collection and analysis were performed according to the qualitative case study design. An initial conceptual framework was developed to bound and guide the study. Twenty patients were selected using purposive sampling with respect to motivation level (highly motivated to less-motivated) to create a sample of maximum variation. Data were collected using repeated interviews and standardized scales. The study comprised three data collection periods.

RESULTS

Motivation for change followed different processes depending on the level at entry to the study. The highly motivated patients improved in independence, the moderately motivated ones remained at an unchanged level and the less-motivated patients became more dependent. Central themes of importance to the process of motivation for change were: the utilization of professional networks (healthcare, regional social insurance office), emotional support (nuclear family, close relatives), use of personal coping resources (energy, positive beliefs, problem-solving) and social support at work (employers, colleagues).

CONCLUSIONS

The performance of a structured motivation analysis, including questions about emotional networks and social support at work in addition to the clinical examination of the patient, is recommended. This might guide healthcare professionals when it comes to motivation for change in the patient.

Effects of a multidisciplinary rehabilitation programme on health-related quality of life in patients with prolonged musculoskeletal disorders: a 6-month follow-up of a prospective controlled study

PURPOSE

The aim of this prospective, controlled, follow-up study (6 months) was to examine the effects of a multidisciplinary rehabilitation programme on perceived health-related quality of life (HRQL) in patients with prolonged musculoskeletal disorders (PMSD). The programme focused on body awareness therapy and cognitive and relaxation treatment.

METHOD

The rehabilitation group comprised 122 patients, and there were 114 patients in the matched control group (CG). Both groups of patients had access to primary health care. Baseline data were compared with 6-month follow-up data within and between the groups. The following measurements were employed: HRQL (Nottingham Health Profile), body awareness, postural control, pain (VAS), pain-related medicine consumption, isometric arm muscle endurance, aerobic capacity, psychosomatic symptoms, physical and psychosocial working environment and sick leave.

RESULTS

Variables that improved significantly as compared with the CG were: HRQL, anxiety, pain related to movements, psychosomatic symptoms and need for pain-related medicines.

CONCLUSIONS

The multidisciplinary rehabilitation programme used here improved HRQL in patients with PMSD to a greater extent than the standard treatment provided within primary heath care (p = 0.01) at least in the short term.