1
|
Stagg AL, Madan I, Fear N, Stevens MJ, Wainwright E, Hoving JL, Macfarlane GJ, Hollick R, Morton L. Do current methods of measuring the impact of chronic pain on work reflect the experience of working-age adults? An integrated mixed-methods systematic narrative review. Pain 2024; 165:1472-1481. [PMID: 38381946 PMCID: PMC11190898 DOI: 10.1097/j.pain.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/09/2023] [Accepted: 12/03/2023] [Indexed: 02/23/2024]
Abstract
ABSTRACT Chronic pain affects individuals' work participation. The impact of chronic pain on work has historically been measured through sickness absence, though it is now appreciated that the impacts on work are far wider. This mixed-methods review aimed to identify the full range of impacts of pain on work in addition to impacts that are currently measured quantitatively to inform the development of a new questionnaire assessing the wider impacts of chronic pain on work. MEDLINE, Embase, PsychINFO, and CINAHL were searched for studies that included quantitative measures of the impact of chronic pain on work and for qualitative studies where individuals described impacts of their chronic pain on work. Quantitative measures, and text from qualitative studies, were analysed thematically. A thematic framework was developed for establishing the types of impacts measured or described in the literature. Forty-four quantitative and 16 qualitative papers were identified. The literature described impacts within 5 areas: changes at work and to working status; aspects of the workplace and work relationships; pain and related symptoms at work; psychological factors; and factors and impacts outside the work environment related to work. Quantitative measures mainly assessed impacts related to the quantity and quality of work (29 of 42 measures). Seventeen aspects were only discussed within the qualitative literature. This study identifies a discrepancy between the impacts that have been the focus of quantitative measures and the range that individuals working with chronic pain experience and highlights the need for a new measure assessing a wider range of issues.
Collapse
Affiliation(s)
- Anne L. Stagg
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (Guy's & St Thomas' NHS Foundation Trust and King's College London), London, United Kingdom
| | - Ira Madan
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (Guy's & St Thomas' NHS Foundation Trust and King's College London), London, United Kingdom
| | - Nicola Fear
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (King's Centre for Military Health Research, King's College London), London, United Kingdom
| | - Martin J. Stevens
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (University of Aberdeen), Aberdeen, United Kingdom
| | - Elaine Wainwright
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (University of Aberdeen), Aberdeen, United Kingdom
| | - Jan L. Hoving
- Department of Public and Occupational Health, Cochrane Work, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gary J. Macfarlane
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (University of Aberdeen), Aberdeen, United Kingdom
| | - Rosemary Hollick
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (University of Aberdeen), Aberdeen, United Kingdom
| | - LaKrista Morton
- Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work (University of Aberdeen), Aberdeen, United Kingdom
| |
Collapse
|
2
|
Ampiah JA, Moffatt F, Diver C, Ampiah PK. A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana. BMJ Open 2023; 13:e073538. [PMID: 37474173 PMCID: PMC10360413 DOI: 10.1136/bmjopen-2023-073538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana. OBJECTIVES To explore the psychosocial impact of CLBP among patients with CLBP in Ghana. DESIGN Qualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy. PARTICIPANTS Thirty patients with CLBP attending physiotherapy at two hospitals in Ghana. RESULTS Five categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived. CONCLUSION CLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients' psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial.
Collapse
Affiliation(s)
- Josephine Ahenkorah Ampiah
- Division of Physiotherapy, Chiropractic and Sports Rehabilitation, London South Bank University, London, UK
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Claire Diver
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| | - Paapa Kwesi Ampiah
- Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
3
|
Grant M, O-Beirne-Elliman J, Froud R, Underwood M, Seers K. The work of return to work. Challenges of returning to work when you have chronic pain: a meta-ethnography. BMJ Open 2019; 9:e025743. [PMID: 31227529 PMCID: PMC6596973 DOI: 10.1136/bmjopen-2018-025743] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS To understand obstacles to returning to work, as perceived by people with chronic non-malignant pain and as perceived by employers, and to develop a conceptual model. DESIGN Synthesis of qualitative research using meta-ethnography. DATA SOURCES Eleven bibliographic databases from inception to April 2017 supplemented by citation tracking. REVIEW METHODS We used the methods of meta-ethnography. We identified concepts and conceptual categories, and developed a conceptual model and line of argument. RESULTS We included 41 studies. We identified three core categories in the conceptual model: managing pain, managing work relationships and making workplace adjustments. All were influenced by societal expectations in relation to work, self (self-belief, self-efficacy, legitimacy, autonomy and the meaning of work for the individual), health/illness/pain representations, prereturn to work support and rehabilitation, and system factors (healthcare, workplace and social security). A mismatch of expectations between the individual with pain and the workplace contributed to a feeling of being judged and difficulties asking for help. The ability to navigate obstacles and negotiate change underpinned mastering return to work despite the pain. Where this ability was not apparent, there could be a downward spiral resulting in not working. CONCLUSIONS For people with chronic pain, and for their employers, navigating obstacles to return to work entails balancing the needs of (1) the person with chronic pain, (2) work colleagues and (3) the employing organisation. Managing pain, managing work relationships and making workplace adjustments appear to be central, but not straightforward, and require substantial effort to culminate in a successful return to work.
Collapse
Affiliation(s)
- Mary Grant
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
| | | | - Robert Froud
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, UK
| | - Kate Seers
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
| |
Collapse
|
4
|
Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL. “A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria. Disabil Rehabil 2016; 39:779-790. [DOI: 10.3109/09638288.2016.1161844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chinonso N. Igwesi-Chidobe
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria
| | - Sheila Kitchen
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Isaac O. Sorinola
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Emma L. Godfrey
- Department of Physiotherapy, Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| |
Collapse
|
5
|
Physiotherapists' assessment of patients' psychosocial status: Are we standing on thin ice? A qualitative descriptive study. ACTA ACUST UNITED AC 2015; 20:328-34. [DOI: 10.1016/j.math.2014.10.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/25/2014] [Accepted: 10/07/2014] [Indexed: 11/19/2022]
|
6
|
MacNeela P, Doyle C, O'Gorman D, Ruane N, McGuire BE. Experiences of chronic low back pain: a meta-ethnography of qualitative research. Health Psychol Rev 2013; 9:63-82. [DOI: 10.1080/17437199.2013.840951] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Padraig MacNeela
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Catherine Doyle
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - David O'Gorman
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Nancy Ruane
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Department of Anaesthesia, Galway University Hospital, Galway, Ireland
| |
Collapse
|
7
|
Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
8
|
|
9
|
Ashby S, Fitzgerald M, Raine S. The Impact of Chronic Low Back Pain on Leisure Participation: Implications for Occupational Therapy. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13522194759897] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: Chronic low back pain can reduce engagement and participation in all areas of daily life. Previous research has focused on employment and vocational rehabilitation initiatives, with less attention paid to its impact on leisure. This paper examines the difficulties men with chronic low back pain experienced in the maintenance of their leisure activities. It explores the connection between leisure and social networks and the potential barriers to resuming leisure occupations due to chronic low back pain. Method: This ethnographic study examined the experiences of 11 men involved in a vocational rehabilitation programme in New South Wales, Australia. Data were gathered using participant observation and semi-structured interviews. Findings: Chronic low back pain has a critical impact on leisure occupations. It creates two barriers to a client's engagement in former leisure occupations: physical restrictions and financial barriers. Conclusion: The findings build on knowledge of how leisure impacts on social dimensions of health and wellbeing. Occupational therapists can play an important role in enabling people with chronic low back pain to re-engage in leisure. These interventions may reduce the social isolation experienced by individuals due to the loss of leisure activity.
Collapse
Affiliation(s)
- Samantha Ashby
- Lecturer in Occupational Therapy, School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Maureen Fitzgerald
- Medical Anthropologist, formerly at the University of Sydney, Lidcombe, New South Wales, Australia
| | - Simon Raine
- Therapy Unit Manager, Karana Therapy Unit, Lingard Private Hospital, Merewether, New South Wales, Australia
| |
Collapse
|