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Kessler D, McCutcheon T, Rajachandrakumar R, Lees J, Deyell T, Levy M, Liddy C. Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 115:107885. [PMID: 37473604 DOI: 10.1016/j.pec.2023.107885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs. METHODS A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team. RESULTS Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics. CONCLUSIONS Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs. PRACTICE IMPLICATIONS Including community members and service users in design and implementation may enhance CDSM program access.
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Affiliation(s)
- Dorothy Kessler
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jodie Lees
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Tracy Deyell
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Marisa Levy
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
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Altug Z. Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach. Am J Lifestyle Med 2021; 15:425-433. [PMID: 34366741 PMCID: PMC8299916 DOI: 10.1177/1559827620971547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Lower back pain is a leading cause of work absence and activity limitations globally, with a 60% to 85% lifetime chance of occurrence. This article highlights the role that lifestyle medicine plays in managing lower back pain as a cost-effective intervention strategy. It is suggested that lifestyle medicine strategies, such as incorporating whole foods and a plant-based diet, sustainable physical activity and mind-body exercises, restorative sleep, stress resiliency, awareness and mitigation of substance abuse and addiction, and establishing meaningful social networks and self-care strategies, be a part of managing chronic lower back pain.
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Affiliation(s)
- Ziya Altug
- IntegrativeDPT.com, Los Angeles, California
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Further Examination of the Pain Stages of Change Questionnaires Among Chronic Low Back Pain Patients: Long-term Predictive Validity of Pretreatment and Posttreatment Change Scores and Stability of Posttreatment Scores. Clin J Pain 2020; 35:744-752. [PMID: 31149934 DOI: 10.1097/ajp.0000000000000733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES In order to maximize the therapeutic benefits of cognitive-behavioral therapy (CBT) for chronic pain, individuals need to be motivated to adopt a self-management approach. The Pain Stages of Change Questionnaire (PSOCQ) was developed to measure patients' readiness to adopt a self-management approach to chronic pain. The present study examined whether pretreatment and posttreatment PSOCQ change scores among chronic low back pain patients could predict 6- and 12-month follow-up outcomes, and the stability of posttreatment PSOCQ scores during follow-up. METHODS Participants were recruited from a VA primary care clinic. Data from 60 participants assigned to either regular CBT or a modified CBT (ie, PRIME CBT) condition were analyzed in the present study. Self-report measures including PSOCQ, pain severity, disability, and depressive symptom severity were administered at pretreatment, 10 weeks posttreatment, 6-month and follow-up assessments. RESULTS Multiple regression analyses showed that pretreatment and posttreatment changes in the Action/Maintenance scores significantly predicted pain severity at 6 months, and changes in the Precontemplation scores significantly predicted disability at 6 months. None of the PSOCQ change scores significantly predicted depressive symptom severity. Posttreatment Precontemplation and Action/Maintenance scores were quite stable, even at 12-month follow-up. CONCLUSIONS Changes in patients' attitudes toward adopting a pain self-management approach may serve as one of the therapeutic mechanisms and predict long-term function. This study also revealed that changed attitudes toward chronic pain self-management remain quite stable over time. Adoption of beliefs consistent with chronic pain self-management during treatment may promote sustained benefits.
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Fletcher R, Braithwaite FA, Woodhouse M, MacInnes A, Stanton TR. Does readiness to change influence pain-related outcomes after an educational intervention for people with chronic pain? A pragmatic, preliminary study. Physiother Theory Pract 2019; 37:608-619. [PMID: 31267821 DOI: 10.1080/09593985.2019.1636436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: There is a strong association between chronic pain and unhelpful pain cognitions. Educating patients on pain neuroscience has been shown to reduce pain catastrophization, kinesiophobia, and self-perceived disability. This study investigated whether a group-based pain neuroscience education (PNE) session influenced pain-related outcomes, and whether readiness to change moderated these outcomes.Method: In a pragmatic pre-post-intervention study using a convenience sample, adults with chronic pain participated in one, 90-120 minute PNE session. Pain-related outcomes (i.e. pain catastrophization, kinesiophobia, disability, and pain neuroscience knowledge) and the Pain Stage of Change Questionnaire (PSOCQ) were assessed at baseline and immediately post-intervention. Paired t-tests evaluated pre-post changes in outcomes, and linear regression examined the impact of PSOCQ score changes on PNE-induced changes in clinical outcomes.Results: Sixty-five participants were recruited. All outcomes showed positive intervention effects (p < .01). Relationships between changes in PSOCQ subscale scores and change in post-intervention pain-related outcomes were found; 'Pre-Contemplation' was positively associated with pain catastrophization (p = .01), and 'Action' was negatively associated with kinesiophobia (p = .03).Conclusion: Consistent with previous research, there were improvements in outcomes associated with chronic pain after PNE. Some of these improvements were predicted by changes in PSOCQ scores, however, these findings are preliminary and require further investigation using controlled research designs.
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Affiliation(s)
- Roland Fletcher
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.,Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada
| | - Felicity A Braithwaite
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mellissa Woodhouse
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aaron MacInnes
- Fraser Health Authority, JPOCSC Pain Management Clinic, Surrey, British Columbia, Canada.,Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha R Stanton
- Body in Mind Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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Adachi T, Sunohara M, Ogawa M, Enomoto K, Fujita Y, Mizuno Y, Miki K, Yukioka M, Maeda L, Nishiwaki Y, Itoh K, Nakanishi M, Iwashita N, Kitagawa H, Sasaki J, Jensen MP, Fukui S. A Cross-Cultural Validation of the Multidimensional Pain Readiness to Change Questionnaire 2 for Japanese Individuals With Chronic Pain. Pain Pract 2019; 19:609-620. [PMID: 30891879 DOI: 10.1111/papr.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The Multidimensional Pain Readiness to Change Questionnaire 2 (MPRCQ2) is a reliable and valid measure that assesses readiness to adopt a variety of discrete pain self-management responses. We sought to translate and evaluate psychometric properties of the Japanese version of the MPRCQ2 (MPRCQ2-J) in individuals with chronic pain. METHODS One hundred seventy-three individuals with chronic pain were asked to complete the MPRCQ2-J, as well as measures assessing pain intensity, pain interference, self-efficacy, and general readiness to adopt a self-management approach for pain. Forty-eight of these participants provided additional MPRCQ2-J data to assess test-retest reliability. RESULTS The findings supported a 2-factor structure of the MPRCQ2-J when error covariances between the some of the nine primary scales were allowed. Adequate internal consistencies of the MPRCQ2-J scales (Cronbach's α ranged 0.71 to 0.86), except for the total score (α = 0.68), were observed. However, adequate test-retest reliabilities (intraclass correlation coefficients ≥ 0.60) were found for only 59% of the MPRCQ2-J scales. The MPRCQ2-J evidenced its construct validity via confirmation of the predicted patterns of associations with validity criterion measures and the anticipated effects of participation in an exercise treatment. DISCUSSION The findings support the internal consistency (except for the total score) and construct validity for MPRCQ2-J scales. However, potential limitations with respect to test-retest reliability of some of the scales were also suggested. The MPRCQ2-J can be used to examine the role that specific readiness domains of pain self-management responses may play in an adjustment process in Japanese individuals with chronic pain.
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Affiliation(s)
- Tomonori Adachi
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A.,Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Momoka Sunohara
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | | | - Kiyoka Enomoto
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.,Center for Pain Management, Osaka University Medical Hospital, Suita, Osaka, Japan
| | - Yoshitsugu Fujita
- Department of Orthopedic Surgery, Japanese Red Cross Otsu Shiga Hospital, Otsu, Shiga, Japan
| | - Yasuyuki Mizuno
- Department of Psychosomatic and General Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kenji Miki
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Osaka, Japan.,Center for Pain Management, Hayaishi Hospital, Osaka, Osaka, Japan.,Department of Rheumatology, Yukioka Hospital, Osaka, Osaka, Japan
| | - Masao Yukioka
- Department of Rheumatology, Yukioka Hospital, Osaka, Osaka, Japan
| | - Lynn Maeda
- Department of Anesthesia and Pain Management, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan
| | - Yuko Nishiwaki
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Kazuki Itoh
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.,Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Miho Nakanishi
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.,Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Narihito Iwashita
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.,Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hirotoshi Kitagawa
- Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Jun Sasaki
- Department of Human Sciences, Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Sei Fukui
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.,Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Adachi T, Sunohara M, Enomoto K, Sasaki K, Sakaue G, Fujita Y, Mizuno Y, Okamoto Y, Miki K, Yukioka M, Nitta K, Iwashita N, Kitagawa H, Shibata M, Sasaki J, Jensen MP, Fukui S. Japanese cross-cultural validation study of the Pain Stage of Change Questionnaire. Pain Rep 2019; 4:e711. [PMID: 31041416 PMCID: PMC6455691 DOI: 10.1097/pr9.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Although evidence supports efficacy of treatments that enhance self-management of chronic pain, the efficacy of these treatments has been hypothesized to be influenced by patient readiness for self-management. The Pain Stage of Change Questionnaire (PSOCQ) is a reliable and valid measure of patient readiness to self-manage pain. However, there is not yet a Japanese version of the PSOCQ (PSOCQ-J), which limits our ability to evaluate the role of readiness for pain self-management in function and treatment response in Japanese patients with chronic pain. OBJECTIVE Here, we sought to develop the PSOCQ-J and evaluate its psychometric properties. METHODS We recruited 201 patients with chronic pain. The study participants were asked to complete the PSOCQ-J and other measures assessing pain severity, pain interference, catastrophizing, self-efficacy, and pain coping strategies. RESULTS The results supported a 4-factor structure of the PSOCQ-J. We also found good to excellent internal consistencies and good test-retest reliabilities for the 4 scales. The Precontemplation scale had weak to moderate positive correlations with measures of pain-related dysfunction and maladaptive coping. The Action and Maintenance scales had weak to moderate positive correlations with measures of self-efficacy and adaptive coping. The Contemplation scale had weak positive correlations with measures of pain interference and both adaptive and maladaptive coping. CONCLUSIONS The PSOCQ-J demonstrated adequate psychometric properties in a sample of Japanese patients with chronic pain. This measure can be used to evaluate the role that readiness to self-manage pain may play in adjustment to chronic pain in Japanese pain populations.
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Affiliation(s)
- Tomonori Adachi
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Japan Society for the Promotion of Science, Chiyoda, Tokyo, Japan
| | - Momoka Sunohara
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Kiyoka Enomoto
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Center for Pain Management, Osaka University Medical Hospital, Suita, Osaka, Japan
| | | | | | - Yoshitsugu Fujita
- Department of Orthopedic Surgery, Japanese Red Cross Otsu Shiga Hospital, Otsu, Shiga, Japan
| | - Yasuyuki Mizuno
- Department of Psychosomatic and General Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yoshiaki Okamoto
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Hyogo, Japan
| | - Kenji Miki
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Osaka, Japan
- Center for Pain Management, Hayaishi Hospital, Osaka, Osaka, Japan
- Department of Rheumatology, Yukioka Hospital, Osaka, Osaka, Japan
| | - Masao Yukioka
- Department of Rheumatology, Yukioka Hospital, Osaka, Osaka, Japan
| | | | - Narihito Iwashita
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hirotoshi Kitagawa
- Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masahiko Shibata
- Center for Pain Management, Osaka University Medical Hospital, Suita, Osaka, Japan
- Department of Health Science, Naragakuen University, Nara, Japan
| | - Jun Sasaki
- Department of Human Sciences, Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sei Fukui
- Pain Management Clinic, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Department of Anesthesiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Cognitive-Behavioural Therapy for Inflammatory Bowel Disease: 24-Month Data from a Randomised Controlled Trial. Int J Behav Med 2017; 24:127-135. [PMID: 27432441 PMCID: PMC5288424 DOI: 10.1007/s12529-016-9580-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT. METHODS The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models. RESULTS CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn's Disease Activity Index (CDAI), p = 0.92; Simple Clinical Colitis Activity Index (SCCAI), p = 0.88) or blood parameters (C-reactive protein (CRP), p < 0.62; haemoglobin (Hb), p = 0.77; platelet, p = 0.64; white cell count (WCC), p = 0.59) nor did CBT significantly affect mental health, coping or quality of life (all p > 0.05). CONCLUSIONS Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time.
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Mikocka-Walus A, Bampton P, Hetzel D, Hughes P, Esterman A, Andrews JM. Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomised controlled trial. BMC Gastroenterol 2015; 15:54. [PMID: 25934170 PMCID: PMC4427935 DOI: 10.1186/s12876-015-0278-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/13/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have demonstrated usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD); however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone. METHODS A 2-arm parallel pragmatic randomised controlled trial (+CBT - standard care plus either face-to-face (F2F) or online CBT over 10 weeks versus standard care alone (SC)) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure while the secondary outcome measures were mental health status and quality of life (QoL). Linear mixed-effect models were used to compare groups on outcome variables while controlling for baseline. RESULTS Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression or coping at 6 or 12 months (p >0.05). When only participants classified as 'in need' (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = .034, d = .56) at 6 months. Online CBT group had a higher score on Precontemplation than the F2F group, which is consistent with less developed coping with IBD in the cCBT group (p = .045). CONCLUSIONS Future studies should direct psychological interventions to patients 'in need' and attempt to recruit larger samples to compensate for significant attrition when using online CBT. TRIAL REGISTRATION The protocol was registered on 21/10/2009 with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279).
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Affiliation(s)
- Antonina Mikocka-Walus
- School of Nursing and Midwifery and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia. .,Department of Health Sciences, University of York, Area 4, ARRC Building, Heslington, YO10 5DD, UK. .,School of Psychology, University of Adelaide, Adelaide, Australia.
| | - Peter Bampton
- School of Medicine, Flinders University, Adelaide, Australia. .,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, Australia.
| | - David Hetzel
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.
| | - Patrick Hughes
- Nerve-Gut Research Laboratory, Discipline of Medicine, University of Adelaide, Adelaide, Australia.
| | - Adrian Esterman
- School of Nursing and Midwifery and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
| | - Jane M Andrews
- School of Medicine, Flinders University, Adelaide, Australia. .,Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia. .,School of Medicine, University of Adelaide, Adelaide, Australia.
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Evans JR, Jastrowski Mano K, Guite JW, Weisman SJ, Hainsworth KR. Psychometric Properties of the Pain Stages of Change Questionnaire: New Insights on the Measurement of Readiness to Change in Adolescents, Mothers, and Fathers. THE JOURNAL OF PAIN 2015; 16:645-56. [PMID: 25863171 DOI: 10.1016/j.jpain.2015.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 03/13/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED There is increasing interest in the measurement of "readiness to change," or willingness to engage in a self-management approach to pain coping, as a predictor of treatment response in pediatric pain populations. The primary aim of the present study was to provide cross-validation of the Pain Stages of Change Questionnaire-Adolescent and -Parent versions in a new, independent pediatric chronic pain sample by examining aspects of reliability, validity, and generalizability of the factor structures identified in the initial validation study. Secondary aims were to 1) expand upon previously identified differences between the Pain Stages of Change Questionnaire-Adolescent and -Parent versions and 2) examine previously unreported aspects of father data. Although slight differences emerged, the factor structures identified in the initial validation were largely replicated, suggesting that the psychometric properties of the measure are robust across pediatric outpatient chronic pain samples. Variability between parent and adolescent reports suggests that there may be meaningful differences in the interpretation of each measure and that factors other than readiness to change may influence response patterns. Findings highlight the need for more fine-tuned analyses of the way the construct operates in youth with pediatric pain and their parents. PERSPECTIVE Findings provide further validation of the Pain Stages of Change Questionnaire-Adolescent and -Parent versions measures in a new outpatient pediatric chronic pain sample. Previously uninvestigated father data showed good reliability and patterns of findings similar to validated mother reports. Moreover, the study suggests that the adolescent and parent versions may function in meaningfully different ways.
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Affiliation(s)
- Jenny R Evans
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
| | - Kristen Jastrowski Mano
- Department of Psychology, McMicken College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jessica W Guite
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Steven J Weisman
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Keri R Hainsworth
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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Røe C, Damsgård E, Fors T, Anke A. Psychometric properties of the pain stages of change questionnaire as evaluated by Rasch analysis in patients with chronic musculoskeletal pain. BMC Musculoskelet Disord 2014; 15:95. [PMID: 24646065 PMCID: PMC3994659 DOI: 10.1186/1471-2474-15-95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 03/12/2014] [Indexed: 12/05/2022] Open
Abstract
Background Our objective was to evaluate the measurement properties of the Pain Stages of Change Questionnaire (PSOCQ) and its four subscales Precontemplation, Contemplation, Action and Maintenance. Methods A total of 231 patients, median age 42 years, with chronic musculoskeletal pain responded to the 30 items in PSOCQ. Thresholds for item scores, and unidimensionality and invariance of the PSOCQ and its four subscales were evaluated by Rasch analysis, partial credit model. Results The items had disordered threshold and needed to be rescored. The 30 items in the PSOCQ did not fit the Rasch model Chi- square item trait statistics. All subscales fitted the Rasch models. The associations to pain (11 point numeric rating scale), emotional distress (Hopkins symptom check list v 25) and self-efficacy (Arthritis Self-Efficacy Scale) were highest for the Precontemplation subscale. Conclusion The present analysis revealed that all four subscales in PSOCQ fitted the Rasch model. No common construct for all subscales were identified, but the Action and Maintenance subscales were closely related.
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Affiliation(s)
- Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ullevål, Pb4956 Nydalen 0429, Oslo, Norway.
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11
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Development of the Italian version of the Pain Stages of Change Questionnaire in patients with chronic low back pain: cross-cultural adaptation, confirmatory factor analysis, reliability and validity. Int J Rehabil Res 2014; 37:205-11. [PMID: 24557491 DOI: 10.1097/mrr.0000000000000056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Translating, culturally adapting and validating the Italian version of the Pain Stages of Change Questionnaire (PSOCQ-I) to allow its use with Italian-speaking patients with low back pain. The PSOCQ-I was developed by forward-backward translation, a final review by an expert committee and a test of the prefinal version to establish its correspondence with the original English version. Psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach's α) and test-retest reliability (intraclass coefficient correlation), and construct validity by comparing PSOCQ-I with the Pain Catastrophising Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland Morris Disability Scale (RMDQ), a pain Numerical Rating Scale (NRS), and the Hospital Anxiety and Depression Scale (Pearson's correlation). The questionnaire was administered to 308 patients with chronic low back pain. Factor analysis confirmed a four-factor solution (namely, Precontemplation, Contemplation, Action, and Maintenance), achieving an acceptable data-model fit. Internal consistency (α=0.91-93) and test-retest reliability (intraclass coefficient correlation=0.74-0.81) were satisfactory. Construct validity showed moderate correlations between Precontemplation and PCS (r=0.318), TSK (r=0.385), RMDQ (r=0.320) and NRS (r=0.335); low correlations were found between the other PSOCQ subscales and PCS (r=-0.062; 0.039), TSK (r=-0.164; 0.024), RMDQ (r=-0.073; 0.004) and NRS (r=-0.170; 0.020). Low correlations were found between the PSOCQ-I subscales and anxiety (r=-0.132; 0.150) and depression (r=-0.113; 0.186). The PSOCQ was translated successfully into Italian, and proved to have a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for research purposes.
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Braathen TN, Brage S, Tellnes G, Eftedal M. Psychometric properties of the readiness for return to work scale in inpatient occupational rehabilitation in Norway. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:371-380. [PMID: 23271500 DOI: 10.1007/s10926-012-9414-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To investigate internal consistency and construct validity of the Readiness for return to work (RTW) scale in a sample participating in a Norwegian inpatient occupational rehabilitation program. METHODS A cross-sectional study was conducted on baseline measures from a prospective cohort study evaluating a 5 days inpatient occupational rehabilitation program. The participants in the program were 18-67 years, on sickness absence or at risk of sickness absence (N = 193). The Readiness for RTW scale, sociodemographic-, work- and health-related questionnaires were answered by the participants on their first day in the program. Statistical analysis included exploratory factor analyses, reliability analyses and correlations with related instruments. RESULTS In the scale for those not working (N = 124) two factors were found, representing (1) RTW inability and (2) RTW uncertainty. These factors corresponded to the precontemplation and contemplation stages in a previous Canadian study. The original prepared for action stages were not identified in this sample. In the scale for those working shortly before the program (N = 60) two factors were identified, representing (1) Uncertain work maintenance and (2) Proactive work maintenance, comparable to the stages in the Canadian study. The factors had satisfactory internal consistency (Cronbach's alpha >0.7), except for proactive work maintenance (Cronbach's alpha = 0.59). Expected relationships were found between the readiness for RTW stages and the pain stages of change, fear avoidance beliefs for work, subjective health complaints, decision control and coping at work. CONCLUSION Internal consistency and construct validity of the readiness for RTW stages found were satisfactory, except for proactive work maintenance. The results indicate that the construct of readiness for RTW may vary by culture and patient setting.
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Affiliation(s)
- Tore N Braathen
- Department of Community Medicine, Institute of Health and Society, The University of Oslo, Oslo, Norway.
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Vibe Fersum K, O'Sullivan P, Skouen JS, Smith A, Kvåle A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain 2013; 17:916-28. [PMID: 23208945 PMCID: PMC3796866 DOI: 10.1002/j.1532-2149.2012.00252.x] [Citation(s) in RCA: 294] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-specific chronic low back pain disorders have been proven resistant to change, and there is still a lack of clear evidence for one specific treatment intervention being superior to another. METHODS This randomized controlled trial aimed to investigate the efficacy of a behavioural approach to management, classification-based cognitive functional therapy, compared with traditional manual therapy and exercise. Linear mixed models were used to estimate the group differences in treatment effects. Primary outcomes at 12-month follow-up were Oswestry Disability Index and pain intensity, measured with numeric rating scale. Inclusion criteria were as follows: age between 18 and 65 years, diagnosed with non-specific chronic low back pain for >3 months, localized pain from T12 to gluteal folds, provoked with postures, movement and activities. Oswestry Disability Index had to be >14% and pain intensity last 14 days >2/10. A total of 121 patients were randomized to either classification-based cognitive functional therapy group n = 62) or manual therapy and exercise group (n > = 59). RESULTS The classification-based cognitive functional therapy group displayed significantly superior outcomes to the manual therapy and exercise group, both statistically (p < 0.001) and clinically. For Oswestry Disability Index, the classification-based cognitive functional therapy group improved by 13.7 points, and the manual therapy and exercise group by 5.5 points. For pain intensity, the classification-based cognitive functional therapy improved by 3.2 points, and the manual therapy and exercise group by 1.5 points. CONCLUSIONS The classification-based cognitive functional therapy produced superior outcomes for non-specific chronic low back pain compared with traditional manual therapy and exercise.
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Affiliation(s)
- K Vibe Fersum
- Physiotherapy Research Group, Department of Public Health and Primary Health Care, University of Bergen, Norway.
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Dattalo M, Giovannetti ER, Scharfstein D, Boult C, Wegener S, Wolff JL, Leff B, Frick KD, Reider L, Frey K, Noronha G, Boyd C. Who participates in chronic disease self-management (CDSM) programs? Differences between participants and nonparticipants in a population of multimorbid older adults. Med Care 2012; 50:1071-5. [PMID: 22892650 PMCID: PMC3494793 DOI: 10.1097/mlr.0b013e318268abe7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES To identify individual factors associated with attending CDSM programs in a sample of multimorbid older adults. RESEARCH DESIGN Participants in the intervention arm of a matched-pair cluster-randomized controlled trial of the Guided Care model were invited to attend a 6-session CDSM course. Logistic regression was used to identify factors independently associated with attendance. SUBJECTS All subjects (N = 241) were aged 65 years or older, were at high risk for health care utilization, and were not homebound. MEASURES Baseline information on demographics, health status, health activities, and quality of care was available for CDSM participants and nonparticipants. Participation was defined as attendance at 5 or more CDSM sessions. RESULTS A total of 22.8% of multimorbid older adults who were invited to CDSM courses participated in 5 or more sessions. Having better physical health (odds ratio [95% confidence interval] = 2.3 [1.1-4.8]) and rating one's physician poorly on support for patient activation (odds ratio [95% confidence interval] = 2.8 [1.3-6.0]) were independently associated with attendance. CONCLUSIONS Multimorbid older adults who are in better physical health and who are dissatisfied with their physicians' support for patient activation are more likely to participate in CDSM courses.
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Affiliation(s)
- Melissa Dattalo
- Johns Hopkins Bayview Internal Medicine Residency Program, 4940 Eastern Avenue, Baltimore, MD 21224, P: 630-921-1715, F: 410-550-0491
| | - Erin R. Giovannetti
- 5200 Eastern Ave, Mason F. Lord Building, 7 Floor, Center Tower, Baltimore, MD 21224 P: 410-274-8824, F: 410-550-8701
| | - Daniel Scharfstein
- 615 N. Wolfe Street, E3547, Baltimore, MD 21117, P: 410-955-2420, F: 410-955-0958
| | - Chad Boult
- 624 N. Broadway, Hampton House Room 693, Baltimore, MD 21205, P: 410-955-6546, F: 410-955-0470
| | - Stephen Wegener
- 600 N. Wolfe Street, Phipps 174, Baltimore, MD 21297, P: 410-502-2438, F: 410-502-2419
| | - Jennifer L. Wolff
- 624 N. Broadway, Hampton House, Room 692, Baltimore, MD 21205, P: 410-502-0458, F: 410-955-0470
| | - Bruce Leff
- 5505 Hopkins Bayview Circle, Beacham Center, Baltimore, MD 21224, P: 410-550-2652, F: 410-550-8701
| | - Kevin D. Frick
- 624 N. Broadway, Hampton House, Room 606, Baltimore, MD 21205, P: 410-614-4018, F: 410-955-0470
| | - Lisa Reider
- 624 N. Broadway, Hampton House Room 355, Baltimore, MD 21205, P: 410-502-3962, F: 410-955-0470
| | - Katherine Frey
- 624 N. Broadway, Hampton House Room 350, Baltimore, MD 21205, P: 410-502-9109, F: 410-955-0470
| | - Gary Noronha
- 3100 Wyman Park Dr, Baltimore, MD 21211, P: 410-338-3421, F: 410-338-3498
| | - Cynthia Boyd
- 5200 Eastern Ave, Mason F. Lord Building, 7 Floor, Center Tower, Baltimore, MD 21224, P: 410-550-8676, F: 410-550-8701
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Fors T, Damsgård E, Røe C, Anke A. Readiness to adopt a self-management approach to pain - Are profiles of subscale scores on the Pain Stages of Change Questionnaire useful? Eur J Pain 2012; 14:1051-8. [DOI: 10.1016/j.ejpain.2010.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 03/03/2010] [Accepted: 04/18/2010] [Indexed: 11/25/2022]
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Elander J, Robinson G, Morris J. Randomized trial of a DVD intervention to improve readiness to self-manage joint pain. Pain 2011; 152:2333-2341. [DOI: 10.1016/j.pain.2011.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 05/09/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022]
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Readiness to change in pediatric chronic pain: initial validation of adolescent and parent versions of the Pain Stages of Change Questionnaire. Pain 2011; 152:2301-2311. [PMID: 21802852 DOI: 10.1016/j.pain.2011.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 05/25/2011] [Accepted: 06/18/2011] [Indexed: 11/20/2022]
Abstract
Despite the clinical importance of readiness to change in predicting treatment outcomes among adults, no studies have examined this construct among pediatric pain patients. Because parents play a key role in adolescent pain management, both adolescent and parent readiness to adopt a self-management approach to pain merit further study. The primary goal of the current study was to validate adolescent and parent-report adaptations of the adult Pain Stages of Change Questionnaire (PSOCQ). Participants included 259 adolescent patients with chronic pain syndromes and their parents presenting to 2 pediatric pain management clinics. Using confirmatory factor analytic techniques, a 4-factor solution was supported for the parent version (PSOCQ-P) that included Precontemplation, Contemplation, Action, and Maintenance factors, whereas the adolescent version (PSOCQ-A) version supported a three-factor model that combines the Action and Maintenance scales. Within both versions, each of the factors was found to be internally consistent. The PSOCQ-A and PSOCQ-P showed evidence of criterion validity through significant correlations with coping strategies and pain catastrophizing. Stability findings at 4 and 8 weeks after a multidisciplinary pain clinic evaluation are reported. Associations between pediatric PSOCQ scores and demographic, pain, and functional domains were explored to inform future research. Further validation of the PSOCQ-A and PSOCQ-P measures with new, separate samples of pediatric pain patients and parents are needed before use in clinical contexts.
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Brouwer S, Franche RL, Hogg-Johnson S, Lee H, Krause N, Shaw WS. Return-to-work self-efficacy: development and validation of a scale in claimants with musculoskeletal disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:244-58. [PMID: 20865445 PMCID: PMC3098360 DOI: 10.1007/s10926-010-9262-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. METHODS Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. RESULTS Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. CONCLUSIONS A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.
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Affiliation(s)
- Sandra Brouwer
- Department of Health Sciences, Work & Health, University Medical Center Groningen, Antonius Deusinglaan, The Netherlands.
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Rodero B, García-Campayo J, Casanueva B, del Hoyo YL, Serrano-Blanco A, Luciano JV. Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia. Health Qual Life Outcomes 2010; 8:37. [PMID: 20385016 PMCID: PMC2876109 DOI: 10.1186/1477-7525-8-37] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 04/12/2010] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to validate a Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ). Pain acceptance is the process of giving up the struggle with pain and learning to live a worthwhile life despite it. The Chronic Pain Acceptance Questionnaire (CPAQ) is the questionnaire most often used to measure pain acceptance in chronic pain populations. Methods A total of 205 Spanish patients diagnosed with fibromyalgia syndrome who attended our pain clinic were asked to complete a battery of psychometric instruments: the Pain Visual Analogue Scale (PVAS) for pain intensity, the Hospital Anxiety and Depression Scale (HADS), the Medical Outcome Study Short Form 36 (SF-36), the Pain Catastrophising Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ). Results Analysis of results showed that the Spanish CPAQ had good test-retest reliability (intraclass correlation coefficient 0.83) and internal consistency reliability (Cronbach's α: 0.83). The Spanish CPAQ score significantly correlated with pain intensity, anxiety, depression, pain catastrophising, health status and physical and psychosocial disability. The Scree plot and a Principal Components Factor analysis confirmed the same two-factor construct as the original English CPAQ. Conclusion The Spanish CPAQ is a reliable clinical assessment tool with valid construct validity for the acceptance measurement among a sample of Spanish fibromyalgia patients. This study will make it easier to assess pain acceptance in Spanish populations with fibromyalgia.
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Affiliation(s)
- Baltasar Rodero
- Department of Psychiatry, Miguel Servet University Hospital, Instituto Aragonés de Ciencias de la Salud, Spain
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Vowles KE, McCracken LM, McLeod C, Eccleston C. The Chronic Pain Acceptance Questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain 2008; 140:284-291. [PMID: 18824301 DOI: 10.1016/j.pain.2008.08.012] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 07/04/2008] [Accepted: 08/18/2008] [Indexed: 11/27/2022]
Abstract
Over the past decade, the importance of acceptance of chronic pain has been demonstrated. Acceptance has often been assessed using the 20-item, two-factor Chronic Pain Acceptance Questionnaire (CPAQ; McCracken, Vowles, Eccleston, Pain 2004;107:159-66). This two-factor model has been supported but awaits further confirmation. The present investigation sought to address this issue in two large samples of pain suffers. Exploratory factor analyses (N=333) examined a number of solutions, ranging from two to five factors. Evaluation indices provided clear support for a 20-item, two-factor solution. Confirmatory factor analyses, using the second sample (N=308), examined a number of models. Fit indices demonstrated that the model identified in the exploratory analyses had the best fit. Finally, a series of cluster analyses were performed using a combined sample (N=641). Results indicated three clusters: one with high scores on both subscales (n=146), one with low scores on both subscales (n=239), and one with discrepant scores that were high on the Activity Engagement subscale and low on the Pain Willingness subscale (n=286). Follow-up analyses indicated significant differences among the clusters across multiple measures of functioning. The cluster with low CPAQ scores reported more difficulties in comparison to the group with high scores, while the group with discrepant CPAQ scores generally reported difficulties that fell in between. These results provide further support for the 20-item, two-factor CPAQ and indicate that it is both theoretically and practically useful.
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Affiliation(s)
- Kevin E Vowles
- Centre for Pain Research, School for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, Bath BA1 1RL, UK
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Franche RL, Corbière M, Lee H, Breslin FC, Hepburn CG. The Readiness for Return-To-Work (RRTW) scale: development and validation of a self-report staging scale in lost-time claimants with musculoskeletal disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2007; 17:450-72. [PMID: 17701326 DOI: 10.1007/s10926-007-9097-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 07/02/2007] [Indexed: 05/05/2023]
Abstract
INTRODUCTION We report on the development and validation of a 22-item scale assessing stage of readiness for return-to-work, the Readiness for Return-to-Work (RRTW) scale. METHODS Lost-time claimants (n = 632) completed a telephone survey one month after a work-related musculoskeletal injury. Exploratory and confirmatory factor analyses of readiness items were conducted with two separate samples, and concurrent validity was examined. RESULTS For workers not working, 60% of the variance was explained by four factors--(1) Precontemplation, (2) Contemplation (3) Prepared for Action-Self-evaluative and (4) Prepared for Action-Behavioral. For those working, 58% of the variance was explained by two factors--(1) Uncertain Maintenance and (2) Proactive Maintenance. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. Concurrent validity of the scale was supported: relationships of readiness with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. CONCLUSIONS Psychometric properties of the newly developed instrument suggest that the application of the Readiness for Change model to return-to-work is relevant to work disability research. The instrument may facilitate the offer of stage-specific services tailored to injured workers' needs, and be used for evaluation of return-to-work interventions.
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Affiliation(s)
- Renée-Louise Franche
- Institute for Work & Health, 481 University Avenue, 8th Floor, Toronto, ON, Canada, M4G 2E9.
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