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

Does coping with pain help the elderly with cardiovascular disease? The association of sense of coherence, spiritual well-being and self-compassion with quality of life through the mediating role of pain self-efficacy

BACKGROUND

Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD).

METHOD

This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion.

RESULTS

The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (β = 0.39), spiritual well-being (β = 0.13) and self-compassion (β = 0.44) with PSE. Although there were significant paths between SOC (β = 0.16) and self-compassion (β = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (β = 0.06). Besides, there was a significant path between PSE and QOL (β = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL.

CONCLUSION

The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model.

Potential Misfortunes in 'Making Sense': A Cross-Sectional Study in People with Chronic Pain

Making sense of one's circumstances is normally regarded as helpful, including in the context of chronic pain. However, sense-making may be associated with adverse impacts in daily functioning. To better understand the functions of sense-making, the objective of the current study was to develop, validate, and preliminarily examine a measure of potentially helpful and unhelpful forms of sense-making behavior in people seeking treatment for chronic pain. This measure is called the Sense Making Questionnaire (SMQ). Research participants included 451 adults consecutively attending a specialty interdisciplinary treatment for chronic pain. Data for this study derived from a standard set of measures participants completed prior to treatment. Exploratory Factor Analysis (EFA) produced a 3-factor solution based on 15 items, including Avoidance of Incoherence, Overthinking, and Functional Coherence. The first 2 of these factors and the total achieved adequate internal consistency. Construct validity of the SMQ scores was supported by significant correlations with measures of pain acceptance, committed action, cognitive fusion, and intolerance of uncertainty. The SMQ total score correlated significantly with pain interference, r = .23, depression, r = .41, and work and social adjustment, r = .30, all P < .001. In multiple regression analyses the total score also significantly predicted depression after age, gender, education, pain duration, pain intensity, and pain acceptance were statistically controlled, and it accounted for an additional 8.0% in explained variance. It appears that there is a distinction between literal coherence and functional coherence. In some situations, it may benefit people with chronic pain to shift focus from efforts to make literal sense of pain and instead to keep the focus on taking effective action even if this does not appear at first to make sense. PERSPECTIVE: This study in people seeking treatment for chronic pain includes development of a measure of behavior patterns related to making sense in chronic pain. It shows that sometimes these behavior patterns can be ineffective, as they appear negatively associated with emotional, physical, and social functioning.

Guided self-determination in treatment of chronic pain - a randomized, controlled trial

OBJECTIVES

To test whether Guided Self-Determination (GSD) used in chronic pain management could improve the health-related quality of life, patient activation and sense of coherence (SoC) as a measurement of life skills in patients with chronic pain. The method has been shown to be effective in other chronic conditions, but has not been tested in chronic pain.

METHODS

A three-site randomised, controlled trial at three major multidisciplinary pain centres in Denmark. 200 patients were included and randomised. In the intervention period, both groups had regular visits to the pain centre with both doctors and nurses. The intervention group additionally received the GSD intervention with weekly sessions for eight weeks. Data were collected from February 2013 to July 2016 and consisted of three questionnaires answered before and after the 8-week intervention period, and after six months. The primary outcome was self-reported health related quality of life. Secondary outcomes included self-reported activation and SoC.

RESULTS

We found no clinically relevant difference between the groups for health-related quality of life, patient activation or SoC at either baseline, at three months or at six months. We also analysed data for trends over time using mixed model analysis, and this did not show any significant differences between groups.

CONCLUSIONS

GSD did not improve health-related quality of life, patient activation or SoC when administered to patients with chronic pain treated in a multidisciplinary pain centre. New research is recommended using a combination of self-reported and objective measures and longer follow-up.

Meaning in Life and Pain: The Differential Effects of Coherence, Purpose, and Mattering on Pain Severity, Frequency, and the Development of Chronic Pain

Objective

Meaning in life is consistently associated with better health outcomes across a range of mental and physical domains. However, meaning in life is a complex construct involving three distinct facets: coherence, purpose, and mattering. While these facets have been studied individually in relation to pain, they have not been assessed concurrently to parse out their potential distinct contributions to pain outcomes. We sought to identify the unique relationships of these individual facets of meaning with pain experiences and specify the components associated with pain-related resilience.

Methods

The associations of coherence, purpose, and mattering with pain outcomes were examined across three studies. Study 1 used data from the Midlife in the United States National Survey to determine associations between facets and the frequency of various recently experienced pains, and the development of chronic pain nine years later. Study 2 cross-sectionally observed the association between facets and recent pain severity in young adults. Using a diary-type approach, Study 3 captured fluctuations of pain severity in relation to the facets across the span of four weeks.

Results

Coherence was uniquely associated with less headache, backache, joint, and extremities pain frequency in Study 1, over and above purpose and mattering, controlling for other health variables. Coherence was also associated with lower odds of developing chronic pain. In Study 2, coherence was associated with less pain severity and fully mediated the relationship between global meaning in life and pain. Study 3 found that coherence predicted the most unique variance in weekly pain fluctuations.

Conclusion

Across three studies and timescales, coherence was uniquely associated with fewer and less severe pain experiences over and above purpose and mattering. These findings provide support for the value of coherence as a resilience factor in the context of pain and suggest a potential benefit for coherence-specific interventions in clinical settings.

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.

Can social support enhance sense of coherence and perceived professional benefits among Chinese registered nurses? A mediation model

AIM

To investigate the mediation role of social support in the relationship between a sense of coherence and the perception of professional interests among Chinese registered nurses.

BACKGROUND

Job burnout is become exceedingly common among registered nurses. Perceived professional benefits and a sense of coherence can help regulate nurses' negative emotions, reduce job burnout and turnover intention and increase nurses' subjective well-being. However, little is known about the mediating effect of social support on sense of coherence and perceived professional benefits.

METHODS

From May to August 2017, data from 765 Chinese registered nurses were collected from a 4-part questionnaire: general information, the sense of coherence scale, social support rating scale and perceived professional benefits questionnaire. The independent factors of perceived professional benefits were tested by multiple regression analysis. Structural equation model was used to study the moderating effect of social support.

RESULTS

The mean perceived professional benefits score differed across professional title (p < .001). Social support mediated 58% of the relationships between a sense of coherence and perceived professional benefits.

CONCLUSION

In conclusion, our study revealed that social support partially mediates the relationship between a sense of coherence and perceived professional benefits among Chinese registered nurses. Therefore, interventions based on social support to enhance the sense of coherence and to strengthen nurses' perceived professional benefits should be developed.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should create more learning opportunities to improve nurses' abilities in clinical nursing and the social support of nurses through many ways, so as to enhance nurses' sense of coherence and nurses' perceived professional benefits.

Relación entre sentido de coherencia y diabetes mellitus: una revisión sistemática

Resumen El objetivo fue sintetizar las mejores evidencias científicas sobre el efecto del sentido de coherencia en el desarrollo de la enfermedad, tratamiento e indicadores biomédicos de control metabólico y desarrollo de complicaciones de personas en riesgo de desarrollar diabetes y en diabéticos. El método utilizado fue la revisión sistemática. Búsqueda y selección por dos revisores independientes en las bases de datos Scopus, Web of Science, PubMed, Ebsco, Science Direct y manuales, disponibles hasta 2017, en español e inglés, en población con edad superior a 18 años. De un total de 154 estudios, 20 artículos fueron incluidos en la revisión sistemática. Más de la mitad de los estudios utilizaron la versión SOC-13 para la verificación del sentido de coherencia y el indicador de control metabólico más frecuente fue la hemoglobina glucosilada. Además, 14, de los 20 estudios, encontraron una relación estadísticamente significativa entre el sentido de coherencia y la diabetes. Se concluye que el sentido de coherencia tiene una fuerte correlación con la diabetes en las diferentes fases de la enfermedad y está relacionado con la reducción del riesgo para el desarrollo de la enfermedad, la reducción de los valores de hemoglobina glucosilada y la aparición de complicaciones de la diabetes mellitus.

Association between health-related quality of life and sense of coherence among health professionals working in primary health centers consuming tobacco in Jaipur, India

Background:

Health-related quality of life (HRQOL) and senses of coherence (SoC) can be affected by the use of tobacco. Hence, the aim of the present study was to explore the association between HRQOL and SoC among health professionals working in primary health centers (PHCs) consuming Tobacco.

Materials and Methods:

It was a cross-sectional descriptive study where sampling technique used was systematic stratified random sampling. Jaipur District has 37 PHCs retrieved from site of NRHM Rajasthan. A close-ended questionnaire was prepared to conduct the interview.

Results:

Majority of study participants (57; 37.01%) were of 36–40 years of age. Males respondents (86; 55.85%) consuming tobacco were more in number than female respondents. Majority of study subjects (91; 59.09%) consumed smoked kind of tobacco, in which most contributed were nurses (49; 62.82%). On applying a linear regression model, it was determined that all subscale of SF-36 was significantly (P ≤ 0.000) associated with SoC.

Conclusion:

From above, it was concluded that there was a strong association between HRQOL and SoC among health professionals working in primary health centers consuming tobacco.

Associations of sense of coherence and self-efficacy with health status and disease severity in COPD

Sense of coherence and self-efficacy has been found to affect health-related quality of life in chronic diseases. However, research on respiratory diseases is limited. Here we report findings on quality of life (QoL) of COPD patients and the associations with coherence and self-efficacy. This study consists of the Greek national branch of the UNLOCK study, with a sample of 257 COPD patients. Coherence and self-efficacy are positively inter-correlated (Pearson rho = 0.590, p < 0.001). They are negatively correlated with the quality of life (CAT) [Pearson rho: coherence = −0.29, p < 0.001; self-efficacy = −0.29, p < 0.001) and mMRC (coherence = −0.37, p < 0.001; self-efficacy rho = −0.32, p < 0.001)]. Coherence is inversely associated with (Global Initiative for Chronic Obstructive Lung Disease) GOLD 2018—CAT and GOLD 2018—mMRC classification and “having at least one exacerbation in the past year”. Findings are stressing the need for their incorporation in primary health care and COPD guidance as it maybe that enhancing coherence and self-efficacy will improve QoL.

Change in sense of coherence and health-related quality of life after injury - a prospective cohort study

PURPOSE

To investigate how accidents leading to fracture affect sense of coherence and health-related quality of life 6 months later and the association between the two phenomena.

MATERIALS AND METHODS

A cohort study including 201 patients admitted to hospital with fractures was conducted. Data were based on structured interviewing a few days after admission and 6 months later. Sense of coherence was evaluated with a nine-item scale and health-related quality of life was examined with the subscales of Short Form-36 (SF-36).

RESULTS

Follow-up comprised 164 patients (81.6%), mean age 47 years. Sense of coherence changed to be either stronger (43%) or weaker (41%) and was stable for 15.9% of the participants. Health-related quality of life changed positively after 6 months but did not reach normative values. Strong sense of coherence was significantly associated with the SF-36 subscales emotional role functioning, social functioning, vitality, and mental health.

CONCLUSIONS

Accidents leading to fracture can be stressful life events that could influence an individual's sense of coherence to be stronger or weaker. The association between sense of coherence and health-related quality of life emphasises the importance of therapists supporting the patients' personal resources and promote a salutogenic focus.IMPLICATIONS FOR REHABILITATIONAn injury may change an individual's sense of coherence to be stronger or weaker.For patients who sustain fracture, sense of coherence should be included in therapists' analysis of personal resources and support a salutogenic perspective.Health-related quality of life is especially for younger individuals affected by an accident and its consequences and need a guided and meticulous rehabilitation course.

Evaluation of coping with chronic rheumatic disease, in the context of socio-demographic factors and disease duration, based on the example of patients with ankylosing spondylitis

Objectives

Ankylosing spondylitis (AS) impairs patients' functioning, reducing their quality of life. The author of salutogenesis, Antonovsky, claims that maintaining an inner balance in a chronic disease is possible through a high sense of coherence. The aim of the current study was to identify socio-demographic factors and disease duration related to the feeling of coherence of patients with AS, acceptance of disease and risk of depression.

Material and methods

The study was conducted on 82 patients with diagnosed AS. The research method was a diagnostic survey using the Life Orientation Questionnaire (SOC-29), Beck Depression Inventory (BDI) and Acceptance of Illness Scale (AIS).

Results

In the study, the majority of the patients were male (89%), aged 42 (±11.3). The average duration of AS is 13 (±7.8) years. It was reported that with age, illness acceptance got worse (r_p = -0.567, p < 0.0001), and the risk of depressive disorders increased (r_p = 0.648, p < 0.0001). The longer the patient suffered from AS, the weaker was their illness acceptance (r_p = -0.446, p < 0.0001) and sense of coherence (r_p = -0.448, p < 0.001) whereas the risk of depressive disorder increased (r_p = 0.479, p < 0.0001). A high linear correlation between illness acceptance and sense of coherence (r_p = 0.638, p < 0.0001) and a very high negative correlation between overall sense of coherence and risk of depression (r_p = -0.857, p < 0.0001) were observed.

Conclusions

Patients with low sense of coherence demonstrated poorer adaptation to the illness and a greater risk of depressive disorders. Factors lowering the sense of coherence and illness acceptance and increasing risk of depression in the studied patients with AS were progressing illness, older age and lower education level.

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Background

To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care.

Methods

An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model.

Results

After twelve months, there were no statistically significant differences between the intervention group (n = 60) and the control group (n = 61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p = 0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test.

Conclusions

No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.

Trial registration

ClinicalTrials.gov: NCT02531282. Registered on August 212,015

Vulnerability and Resilience in Patients with Chronic Pain in Occupational Healthcare: A Pilot Study with a Patient-Centered Approach

OBJECTIVES

The aim of this pilot study was to describe vulnerability and resilience and possible subgroups in patients with chronic work related musculoskeletal pain in occupational healthcare. A second aim was to evaluate a patient-centered approach.

METHODS

This study was based on consecutive patients with chronic pain, seen by the same physician and sick-listed full or part time three months or longer. They were included during a period of three months. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8 months. A patient-centered approach was applied where the patient's whole situation was taken into account.

RESULTS

A dominance of an insecure dismissing attachment pattern and a subnormal sense of coherence (SOC) was reported both at baseline and at follow-up. The patients (n=38) reported significant improvement of pain severity (p=0.01), pain interference (p=0.001), life control (p=0.01), affective distress (p=0.02), and dysfunction (p=0.001) on the multidimensional pain inventory (MPI) and fewer patients were sick-listed full time at follow-up (13 patients versus 21). By means of multivariate data analyses this change in MPI was confirmed and was also correlated with a significant increase in health related quality of life (HRQoL). Moreover subgroups with different outcome at follow-up were identified according to attachment pattern and subgroups on MPI.

CONCLUSION

A patient-centered approach may be of value for patients with chronic pain in occupational healthcare, improving pain and dysfunction. Patients with chronic pain are a heterogeneous group where outcome of treatment might be influenced by individual resilience and/or vulnerability.

Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study

BACKGROUND

Musculoskeletal pain is one of the leading causes of sick leave, especially among women, in Western countries. The aim of the present study was to identify factors associated with work ability and well-being, respectively, among women on sick leave due to long-term pain in the neck/shoulders and/or back.

METHODS

A cross-sectional study with a correlational design was conducted on women who were sick-listed due to long-term pain in the neck/shoulders and/or back. A total of 208 participants responded to a survey comprising eight instruments: Multidimensional Pain Inventory scale, General Self-Efficacy scale, Sense of Coherence scale, Coping Strategies Questionnaire, Demand-Control-Support Questionnaire, Hospital Anxiety and Depression Scale, Work Ability Index and Life Satisfaction questionnaire. Multiple linear regression analyses were performed to identify factors associated with work ability and well-being, respectively.

RESULTS

Women who more strongly believed they would return to the same work had greater work ability (β = 0.39, p < 0.001), whereas women with higher pain intensity (β = - 0.30, p < 0.001) and higher job strain (β = - 0.12, p < 0.05) had lower work ability. Women with higher self-efficacy rated greater well-being (β = 0.14, p < 0.05). As the women's scores for depression increased, their well-being decreased by 48%, which was statistically significant (p < 0.001). The regression models for work ability and well-being were significant (p < 0.001), and their adjusted R- square values were 48% and 59%, respectively.

CONCLUSIONS

The study suggests that the factors beliefs to be back at the same work, pain intensity and job strain are predictive of work ability. Moreover, the factors self-efficacy and depression seem to be predictive of well-being. The findings highlight factors that should be considered by health care professionals and policy-makers to guide attempts to reduce sick leave.

Health-related quality of life of a very special population: monks of Holy Mountain Athos, Greece

PURPOSE

The investigation of Health-Related Quality of Life (HRQOL) of Orthodox Christian monks who live at the Holy Mount Athos in Greece, and its correlation with demographic characteristics and Sense of Coherence (SOC-13).

METHODS

A cross-sectional study was designed. The seven monasteries and five scetes with the largest number of monk population were invited to participate. Two monasteries and 1 scete gave their permission for the study. The final monks sample was formed by 166 monks from 215 who participated to the study. HRQOL was assessed using the SF-12 and Sense of Coherence the SOC-13 scales that were completed by monks from May to August 2012. Μultiple linear regression analyses were conducted to explore the association of the HRQOL subscales with the demographics and SOC-13.

RESULTS

The mean age was 45.5 ± 13.0 years; 83.7% lived in communal monasteries, and the mean number of years in monasticism was 18.4 ± 12.1. The mean value of their Physical Component Summary (PCS) score was 47.3 ± 5.3, which is lower than in the general Greek men population, while their Mental Component Summary (MCS) score was 56.4 ± 5.8, which is higher than in the general Greek men population. The mean value of SOC-13 was 65.7 ± 6.5. Positive association for PCS appeared for place of living (β = 5.43, SE = 1.27, p < 0.001) and negative association for age (β = -0.16, SE = 0.03, p < 0.001) while for MCS for number of years in monasticism (β = 0.07, SE = 0.06, p = 0.023) and sense of coherence (β = 0.47, SE = 0.06, p < 0.001).

CONCLUSIONS

The results indicated that monks had better mental health but worse physical health compared to the general Greek male population. More studies are required to validate the above findings.

The SPADE Symptom Cluster in Primary Care Patients With Chronic Pain

OBJECTIVES

Sleep disturbance, pain, anxiety, depression, and low energy/fatigue, the SPADE pentad, are the most prevalent and co-occurring symptoms in the general population and clinical practice. Co-occurrence of SPADE symptoms may produce additive impairment and negatively affect treatment response, potentially undermining patients' health and functioning. The purpose of this paper is to determine: (1) prevalence and comorbidity (ie, clustering) of SPADE symptoms; (2) internal reliability and construct validity of a composite SPADE symptom score derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) measures; and (3) whether improvement in somatic symptom burden represented by a composite score predicted subsequent measures of functional status at 3 and 12 months follow-up.

METHODS

Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized trial of a collaborative care intervention for Veterans with chronic pain.

RESULTS

Most patients had multiple SPADE symptoms; only 9.6% of patients were monosymptomatic. The composite PROMIS symptom score had good internal reliability (Cronbach's alpha=0.86) and construct validity and strongly correlated with multiple measures of functional status; improvement in the composite score significantly correlated with higher scores for 5 of 6 functional status outcomes. The standardized error of measurement (SEM) for the composite T-score was 2.84, suggesting a 3-point difference in an individual's composite score may be clinically meaningful.

DISCUSSION

Brief PROMIS measures may be useful in evaluating SPADE symptoms and overall symptom burden. Because symptom burden may predict functional status outcomes, better identification and management of comorbid symptoms may be warranted.

Acceptability of a telecare intervention for persistent musculoskeletal pain

Introduction Persistent musculoskeletal pain is a prevalent, disabling, and often undertreated condition. This paper examines the acceptability of a telecare intervention for this condition. Methods The Stepped Care to Optimize Pain Care Effectiveness (SCOPE) intervention couples automatic symptom monitoring (ASM) with optimized analgesic care management by a nurse-physician team. Data from participants in the telecare intervention arm (n = 124) of a randomized control trial of SCOPE were analysed to determine the acceptability of the telecare intervention as indicated by patient use and satisfaction. Results Most (93.5%) patients completed at least one ASM report, selecting equally web-based (49%) or interactive voice-recorded (51%) reporting. The median number of ASM reports and nurse contacts per patient was 15 and 12, respectively. Of 12 demographic and clinical factors examined, none predicted the number of ASM reports, whereas nurse contacts were more frequent in patients with higher pain severity or receiving opioids. Only a minority of ASM reports required an expedited nurse call, with the most frequent alerts being for a medication change, a nurse call or side effects. Most (92%) patients rated ASM as easy to use and found the ASM reporting (76%) and nurse contacts (81%) very or moderately helpful. Nearly three-fourths of patients rated their overall pain treatment as good to excellent. The most common suggestions from patient feedback were for a free-text messaging function, more frequent nurse contact and less redundancy in ASM reporting items. Discussion Participants generally found the telecare intervention a user-friendly and helpful approach for treating persistent musculoskeletal pain.

Sense of Coherence as a Predictor of Quality of Life Among Iranian Students Living in Ahvaz

OBJECTIVES

There is evidence to support the correlation between a stronger sense of coherence (SOC) and better perceived quality of life (QOL). However, this association has not been described among Iranian students.

METHODS

Students were selected by stratified randomization and demographic data including age, gender, and employment status were collected. SOC was measured using the short-form of the Sense of Coherence Scale (SOC-13). The World Health Organization Quality of Life (WHOQOL)-BREF questionnaire was used to assess the QOL. Data was collected over one year between 2014 and 2015.

RESULTS

A total of 459 students participated in the study. The Cronbach's alpha score in domains of physical health, psychological health, environmental health, social relationships, and WHOQOL-BREF total score were 0.84, 0.83, 0.84, 0.78, and 0.94, respectively. Measured Cronbach's alpha for domains of meaningfulness, manageability, comprehensibility, and SOC-13 total score were 0.68, 0.67, 0.76, and 0.87, respectively. Marital status was not related to SOC whereas married students had significantly higher scores of QOL in the domains of psychological health, social relationships, and environment health (p=0.006, p<0.0001 and p=0.043, respectively). There were significant strong positive relationships between all components of SOC (meaningfulness, manageability, and comprehensibility) and all domains of WHOQOF-BREF (p<0.0001 for all).

CONCLUSION

This study shows that SOC and marital status are significant predictors of QOL among Iranian students.

Beneficial Effects of Improvement in Depression, Pain Catastrophizing, and Anxiety on Pain Outcomes: A 12-Month Longitudinal Analysis

Depression, pain catastrophizing, and anxiety commonly co-occur with chronic pain. However, the degree to which improvement in these psychological comorbidities predicts subsequent pain outcomes and, in particular, the relative effects of these 3 psychological factors with respect to each other is only partially known. Longitudinal analysis of 250 primary care patients with chronic musculoskeletal pain enrolled in the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial was examined, using data gathered at baseline, and at 3 and 12 months. Mixed effects model repeated measures analyses were used to determine if changes in depression, pain catastrophizing, and anxiety predicted a subsequent reduction in pain intensity or interference and pain-related disability. Defining a clinically significant change as twice the standard error of measurement for each predictor, we found that a 2-standard error of measurement improvement in depression, pain catastrophizing, and anxiety resulted in, respectively, an effect size decrease in pain intensity or interference of .45, .33, and .12; a 14%, 12%, and 6% reduction in the number of pain-specific disability days; and a 43%, 30%, and 28% decreased likelihood of high disability (defined as ≥10 pain-specific disability days in the past 4 weeks). In summary, improvements in 3 common psychological comorbidities predicted better pain outcomes.

PERSPECTIVE

Because depression, pain catastrophizing, and anxiety commonly accompany chronic pain and might adversely affect pain outcomes, treatment of these modifiable psychological factors is warranted to optimize the effectiveness of pain-specific therapies.

Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis - surgical outcome: A 5-year follow-up study

This study investigated the association between the 3-month postoperative sense of coherence and the 5-year postoperative outcome of decompressive surgery for lumbar spinal stenosis. The participants with a lower sense of coherence at the 3-month follow-up had a poorer functional ability and lower satisfaction with surgery, higher pain ratings, lower life satisfaction and more depressive symptoms 5 years postoperatively. A low 3-month sense of coherence associated with greater pain and a poorer functional ability 5 years postoperatively. Evaluating sense of coherence and depressive symptoms in patients who have had lumbar spinal stenosis surgery may help in identifying those in need of enhanced support for postoperative recovery.

Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease

AIM: To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD).

METHODS: This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn’s disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky’s SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL.

RESULTS: Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL.

CONCLUSION: Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.

Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life

Both posttraumatic stress disorder (PTSD) and depression are highly comorbid with chronic pain and have deleterious effects on pain and treatment outcomes, but the nature of the relationships among chronic pain, PTSD, and depression has not been fully elucidated. This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psychological status, quality of life, and disability, it is important for clinicians to recognize and treat both mental disorders in patients with chronic pain.