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Kurz R, Hebron C. "Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain". Physiother Theory Pract 2024; 40:983-998. [PMID: 36373211 DOI: 10.1080/09593985.2022.2144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.
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Affiliation(s)
- Raffaela Kurz
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Physiotherapy MSK Department, Sussex Community NHS Foundation Trust, Horsham Hospital, Hurst Road, Horsham RH12 2DR, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
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Vanderstraeten R, Fourré A, Demeure I, Demoulin C, Michielsen J, Anthierens S, Bastiaens H, Roussel N. How Do Physiotherapists Explain Influencing Factors to Chronic Low Back Pain? A Qualitative Study Using a Fictive Case of Chronic Non-Specific Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105828. [PMID: 37239555 DOI: 10.3390/ijerph20105828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND While pain is influenced by multiple factors including psychosocial factors, previous research has shown that physiotherapists still favour a biomedical approach. PURPOSE To evaluate: (1) how physiotherapists explain the patient's chronic non-specific low back pain (LBP); (2) whether physiotherapists use one or multiple influencing factors, and (3) whether these factors are framed in a biopsychosocial or biomedical approach. MATERIALS AND METHODS This exploratory qualitative study uses a vignette depicting chronic non-specific LBP and employs a flexible framework analysis. Physiotherapists were asked to mention contributing factors to the pain based on this vignette. Five themes were predefined ("Beliefs", "Previous experiences", "Emotions", "Patients behaviour", "Contextual factors") and explored. RESULTS Physiotherapists use very brief explanations when reporting contributing factors to chronic pain (median 13 words). Out of 670 physiotherapists, only 40% mentioned more than two different themes and 2/3rds did not see any link between the patients' misbeliefs and pain. Only a quarter of the participants mentioned the patient's worries about pain and movement, which is considered to be an important influencing factor. CONCLUSION The lack of a multifactorial approach and the persistent biomedical beliefs suggest that it remains a challenge for physiotherapists to fully integrate the biopsychosocial framework into their management of chronic LBP.
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Affiliation(s)
- Rob Vanderstraeten
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Antoine Fourré
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Neurosciences, Université de Mons, 7000 Mons, Belgium
| | - Isaline Demeure
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, EVAREVA, 4000 Liege, Belgium
- Faculty of Motricity Sciences, UCLouvain, 1348 Louvain-la-Neuve, Belgium
| | - Jozef Michielsen
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Anatomy and Research Centre (ASTARC), University Hospital of Antwerp, Antwerp Surgical Training, 2650 Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Nathalie Roussel
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Caeiro C, Moore A, Price L. Clinical encounters may not be responding to patients' search for meaning and control over non-specific chronic low back pain - an interpretative phenomenological analysis. Disabil Rehabil 2022; 44:6593-6607. [PMID: 34420461 DOI: 10.1080/09638288.2021.1966679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Considering the need to study the experiences of individuals with musculoskeletal problems in contexts that have not yet been investigated as well as the relevance of fostering a research agenda towards person-centred care, this study aimed to explore the experiences of non-specific chronic low back pain from the perspective of Portuguese individuals living with it. MATERIAL AND METHODS An interpretative phenomenological analysis was employed to explore the experiences of eight participants, who were recruited purposefully from two primary care centres and one clinic. Semi-structured one-to-one interviews were carried out, audio-recorded and transcribed verbatim. RESULTS Three themes were generated as interrelated parts of an extended account that explored the participants' meaning making of their experience: "Non-specific chronic low back pain as a disruptive experience"; "Searching for the meaning of non-specific chronic low back pain"; and, "Clinical encounters that perpetuate the lack of understanding about non-specific chronic low back pain." CONCLUSIONS This study offers insight into the Portuguese individuals' experiences of non-specific chronic low back pain. Particularly, it suggests that clinical encounters may not be aligned with patients' needs and expectations. These findings may help clinicians in transferring this knowledge to therapeutic approaches to individuals with similar experiences/contexts.IMPLICATIONS FOR REHABILITATIONPatients with NSCLBP need to understand their pain and to retain a sense of control over their lives.Encounters with health professionals may perpetuate the lack of understanding about pain and strategies to control it, as patients consider themselves unable to have an active role in the decision-making and are disempowered to deal with their pain.Health professionals should involve patients and promote the co-construction of an explanation that integrates both health professionals' knowledge and patients' narratives.There is a need to align both the patients' and health professionals' perspectives regarding health care in order to implement patient-centred and individually tailored treatment.
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Affiliation(s)
- Carmen Caeiro
- School of Health Care, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - Ann Moore
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Lee Price
- School of Health Sciences, University of Brighton, Eastbourne, UK
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Thompson K, Johnson MI, Milligan J, Briggs M. Rethinking pain education from the perspectives of people experiencing pain: a meta-ethnography to inform physiotherapy training. BMJ Open 2022; 12:e046363. [PMID: 35017228 PMCID: PMC8753399 DOI: 10.1136/bmjopen-2020-046363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pain is a complex, global and multidimensional phenomena that impacts the lives of millions of people. Chronic pain (lasting more than 3 months) is particularly burdensome for individuals, health and social care systems. Physiotherapists have a fundamental role in supporting people who are experiencing pain. However, the appropriateness of pain education in pre-registration physiotherapy training programmes has been questioned.Recent research reports identify the need to integrate the voice of patients to inform the development of the pre-registration curriculum. The aim of this meta-ethnography was to develop new conceptual understanding of patients' needs when accessing physiotherapy for pain management. The concepts were viewed through an educational lens to create a patient needs-based model to inform physiotherapy training. METHODS Noblit and Hare's seven-stage meta-ethnography was used to conduct this qualitative systematic review. Five databases (MEDLINE, CINAHL Complete, ERIC, PsycINFO and AMED) were searched with eligibility criteria: qualitative methodology, reports patient experience of physiotherapy, adult participants with musculoskeletal pain, reported in English. Databases were searched to January 2018. Emerge reporting guidelines guided the preparation of this manuscript. RESULTS A total of 366 citations were screened, 43 full texts retrieved and 18 studies included in the final synthesis. Interpretive qualitative synthesis resulted in six distinct categories that represent patients' needs when in pain. Analysing categories through an education lens resulted in three overall lines of argument to inform physiotherapy training. The categories and lines of argument are represented in a 'needs-based' model to inform pre-registration physiotherapy training. DISCUSSION The findings provide new and novel interpretations of qualitative data in an area of research that lacks patient input. This is a valuable addition to pain education research. Findings support the work of others relative to patient centredness in physiotherapy.
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Affiliation(s)
- Kate Thompson
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Mark I Johnson
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - James Milligan
- School of Health, Leeds Beckett University, Leeds, UK
- Centre for Pain Research, Leeds Beckett University, Leeds, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery & Social Work, Manchester University NHS Foundation Trust, Manchester, UK
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Common reported barriers and facilitators for self-management in adults with chronic musculoskeletal pain: A systematic review of qualitative studies. Musculoskelet Sci Pract 2021; 56:102433. [PMID: 34416557 DOI: 10.1016/j.msksp.2021.102433] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Self-management strategies are considered a necessary component of chronic musculoskeletal pain management to address ongoing symptoms and challenges. However uptake of self-management can be impeded by a number of factors. OBJECTIVES The aim of this study was to explore common impeding and facilitating factors of self-management strategies from the patient perspective. METHODS An electronic search was performed between 2009 to May 2020 for the following databases: MEDLINE, AMED, PsychINFO, Cochrane Library, PubMed, CINAHL, PEDro, and Google Scholar. The search terms included peer-reviewed qualitative or mixed-method studies investigating the perspective of chronic musculoskeletal pain patients in regards to the use of self-management strategies. Study rigor and bias was assessed using the CASP (Critical Appraisal Skills Programme) questionnaire specific to qualitative studies. Qualitative data was coded using a three-stage thematic synthesis process. Confidence in findings was assessed using CERQual (The Confidence in the Evidence from Review of Qualitative Research). RESULTS Twenty-seven studies were included with 487 participants. Six major themes were identified and divided into external and internal influencing factors. The external influencing factors were made up of the following three themes: health care practitioner role, supportive environment, accessibility. While the three internal influencing themes were: physical factors, knowledge and understanding, and psychological factors. CONCLUSION Learning to self-manage for patients in chronic pain required ongoing support either from healthcare practitioners or from social circles. To further assist the self-management process practitioners can improve self-efficacy through increasing patient knowledge of chronic pain, utilising goal setting and finding ways an individual can access ongoing support, either from the practitioner or through group programs.
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Kennedy D, Thomas A, Hoefkens T, Limbert C, Seage CH. A service evaluation specifying the active components of a functional restorative programme to promote management of persistent non-specific low back pain. Musculoskelet Sci Pract 2021; 55:102404. [PMID: 34147953 DOI: 10.1016/j.msksp.2021.102404] [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] [Received: 04/22/2020] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Functional Restorative Programmes (FRP) for persistent non-specific lower back pain have been shown to be effective, but they often lack sufficient detailed reporting of the intervention components to allow for accurate replication. OBJECTIVES This study used the Behaviour Change Technique Taxonomy (v1) (BCTi) [1] to identify the main components of one such programme and interviewed patients to identify the most effective programme components and areas for improvement. DESIGN A mixed methods design was used. METHODS Intervention data were coded using the BCT Taxonomy (v1) to identify the BCTs utilised. Following this, semi-structured interviews with nine patients evaluated the BCTs included using thematic analysis and identified possible techniques for inclusion in future developments of the programme. RESULTS Forty-one different BCTs were identified in the coding phase with frequency of occurrence in the programme ranging from forty-nine to one. Four main themes emerged from the interviews: Social Support, Shaping Knowledge, Repetition and Substitution and Changes in Mindset. CONCLUSION The results of this study identify the key ingredients in a programme for persistent, non-specific lower back pain, which facilitates the replication of this intervention and identified areas patients appreciated most as well as areas for improvement.
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Affiliation(s)
- Danica Kennedy
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, Wales, UK.
| | - Amy Thomas
- Back in Action Programme, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Toni Hoefkens
- Back in Action Programme, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Caroline Limbert
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Catherine Heidi Seage
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, Wales, UK
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Leake HB, Moseley GL, Stanton TR, O'Hagan ET, Heathcote LC. What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain 2021; 162:2558-2568. [PMID: 33960326 DOI: 10.1097/j.pain.0000000000002244] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach; responses of participants who self-identified as "improved" were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although divergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.
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Affiliation(s)
- Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren C Heathcote
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Braeuninger-Weimer KL, Anjarwalla N, McGregor AH, Roberts L, Sell P, Pincus T. Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians' perceptions of persistent low back pain consultations. BMJ Open 2021; 11:e052938. [PMID: 34531223 PMCID: PMC8449963 DOI: 10.1136/bmjopen-2021-052938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to explore the perceptions of orthopaedic clinicians about consultations for people with persistent musculoskeletal low back pain (PMLBP) in which surgery is not recommended. Surgery is not recommended for the majority of PMLBP consulting in secondary care settings. SETTING Secondary care sector in the UK. PARTICIPANTS Semi-structured qualitative interviews were conducted with 24 orthopaedic team clinicians from 17 different hospitals in the UK and Ireland. Interviews explored clinicians' perceptions of the challenges in consultations where surgery is not indicated. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Two meta-themes, Difficulties and Enablers, each consisting of several subthemes were identified. Difficulties included challenges around the choice of appropriate terminology and labels for PMLBP, managing patients' expectations, working with mentally vulnerable patients and explaining imaging findings. Enablers included early management of expectations, use of routine imaging, triaging, access to direct referral elsewhere, including other non-surgical practitioners in the team, training to improve communication skills and understanding of psychological issues. CONCLUSION The findings highlight clinicians' perceived need for concordance in messages delivered across the care pathway and training of orthopaedic clinicians to deliver effective reassurance and address patients' needs in circumstances where surgery is not indicated.
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Affiliation(s)
| | | | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lisa Roberts
- Health Sciences, University of Southampton, Southampton, UK
| | - Philip Sell
- Department of Orthopaedics, Leicester University Hospitals, Leicester, UK
| | - Tamar Pincus
- Department of Psychology, University of London, London, UK
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Hambraeus J, Hambraeus KS, Sahlen KG. Patient perspectives on interventional pain management: thematic analysis of a qualitative interview study. BMC Health Serv Res 2020; 20:604. [PMID: 32611397 PMCID: PMC7329503 DOI: 10.1186/s12913-020-05452-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Chronic pain is a widespread problem that is usually approached by focusing on its psychological aspects or on trying to reduce the pain from the pain generator. Patients report that they feel responsible for their pain and that they are disempowered and stigmatized because of it. Here, we explored interventional pain management from the patient’s perspective to understand the process better. Methods A purposive sample of 19 subjects was interviewed by an independent interviewer. The interviews were transcribed into text and thematic analysis was performed. Results The subjects’ perceptions covered three key themes: themselves as objects; the caregivers, including the process of tests and retests, the encounters and interactions with professionals, and the availability of the caregivers; and finally the outcomes, including the results of the tests and treatments and how these inspired them to think of other people with pain. Linking these themes, the subjects reported something best described as “gained empowerment” during interventional pain management; they were feeling heard and seen, they gained knowledge that helped them understand their problem better, they could ask questions and receive answers, and they felt safe and listened to. Conclusions Many of the themes evolved in relation to the subjects’ contact with the healthcare services they received, but when the themes were merged and structured into the model, a cohesive pattern of empowerment appeared. If empowerment is a major factor in the positive effects of interventional pain management, it is important to facilitate and not hinder empowerment. Trial registration Clinicaltrials.gov 2013-04-24 (Protocol ID SE-Dnr-2012-446-31 M-3, ClinicalTrials ID NCT01838603).
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Affiliation(s)
- Johan Hambraeus
- Department of Epidemiology and Global Health, Umeå University, SE90185, Umeå, Sweden.
| | | | - Klas-Göran Sahlen
- Department of Epidemiology and Global Health, Umeå University, SE90185, Umeå, Sweden
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Valenzuela-Pascual F, García-Martínez E, Molina-Luque F, Soler-González J, Blanco-Blanco J, Rubí-Carnacea F, Climent-Sanz C, Briones-Vozmediano E. Patients’ and primary healthcare professionals’ perceptions regarding chronic low back pain and its management in Spain: a qualitative study. Disabil Rehabil 2019; 43:2568-2577. [DOI: 10.1080/09638288.2019.1705923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | | | - Fidel Molina-Luque
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Department of Geography and Sociology, University of Lleida, Lleida, Spain
| | - Jorge Soler-González
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
- Catalan Health Institute, Lleida, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, IRBLleida, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
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People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother 2019; 65:124-135. [PMID: 31227280 DOI: 10.1016/j.jphys.2019.05.010] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
QUESTION What health information needs are perceived by people with low back pain? DESIGN Systematic review of publications examining perceived health information needs related to low back pain identified through Medline, EMBASE, CINAHL and PsycINFO (1990 to 2018). PARTICIPANTS Adults with low back pain of any duration. DATA EXTRACTION AND ANALYSIS Two reviewers independently extracted descriptive data regarding study design and methodology, and assessed risk of bias. Aggregated findings of the perceived needs of people with low back pain regarding health information were meta-synthesised. RESULTS Forty-one studies (34 qualitative, four quantitative and three mixed-methods) were identified. Two major areas of perceived health information needs for low back pain emerged. The first major area was needs related to information content: general information related to low back pain, its cause and underlying pathology; strong desire for diagnosis and imaging; prognosis, future disability and effect on work capacity; precipitants and management of flares; general management approaches; self-management strategies; prevention; and support services. The second major area of needs related to how the information was delivered. People with low back pain wanted clear, consistent information delivered in suitable tone and understandable language. CONCLUSION Available data suggest that the information needs of people with low back pain are centred around their desire for a diagnosis, potentially contributing to expectations for and overuse of imaging. People with low back pain expressed a strong desire for clear, consistent and personalised information on prognosis, treatment options and self-management strategies, related to healthcare and occupational issues. To correct unhelpful beliefs and optimise delivery of evidence-based therapy, patient and healthcare professional education (potentially by an integrated public health approach) may be warranted.
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García-Martínez E, Soler-González J, Rubí-Carnacea F, García-Martínez B, Climent-Sanz C, Blanco-Blanco J, Valenzuela-Pascual F. The influence of an educational internet-based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain: study protocol of a mixed methods approach. BMC FAMILY PRACTICE 2019; 20:31. [PMID: 30791879 PMCID: PMC6383219 DOI: 10.1186/s12875-019-0919-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/13/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment. METHODS The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain. DISCUSSION This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.
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Affiliation(s)
| | - Jorge Soler-González
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Faculty of Medicine, University of Lleida, Lleida, Spain
- Institut Català de la Salut, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
| | | | - Carolina Climent-Sanz
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
| | - Joan Blanco-Blanco
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
| | - Fran Valenzuela-Pascual
- Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Institut de Recerca Biomèdica, Lleida, Spain
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Devan H, Hale L, Hempel D, Saipe B, Perry MA. What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther 2018; 98:381-397. [PMID: 29669089 DOI: 10.1093/ptj/pzy029] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 02/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-management interventions fostering self-efficacy improve the well-being of people with chronic pain. PURPOSE The purpose of this study was to synthesize the enablers (what works) and barriers (what does not) of incorporating self-management strategies for people in everyday life after completion of a pain self-management intervention. DATA SOURCES Major electronic databases (MEDLINE, AMED, PsycINFO, Cochrane Library, PubMed, CINAHL, Scopus, and Google Scholar) were searched from inception to July 2016. STUDY SELECTION Study selection included qualitative and mixed-method studies that explored the perceptions of individuals with chronic pain after completion of a self-management intervention. DATA EXTRACTION A thematic analysis approach was used to synthesize the review findings, and a Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence. DATA SYNTHESIS Thirty-three studies with 512 participants were included. Enablers to self-management included self-discovery-the ability to distinguish self (ie, body, thoughts, and feelings) from pain; feeling empowered by incorporating self-management strategies into practice; and supportive ambience via collaborative relationships with clinicians and support from family and friends. Barriers to self-management included difficulty with sustaining motivation for pain self-management; distress experienced from ongoing pain, anxiety, and depression; and unsupportive relationships with clinicians, family, and friends. LIMITATIONS This review only included interventions that involved at least 4 self-management skills; thus, informative studies may have been missed. The follow-up period varied from immediately after the intervention to 72 months following the intervention; therefore, it is uncertain which of the key enablers and barriers were most influential long term. Only articles published in the English language were included; studies conducted in low- and middle-income countries could not be located. CONCLUSIONS The sustained effort to self-manage chronic pain could be exhausting, and motivation could wane over time following intervention. Providing intermittent support in the form of booster sessions and peer support groups may be important. Person-centered care via shared decision making and guided problem solving is essential to facilitating ongoing self-management.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB)
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago
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Singh G, Newton C, O'Sullivan K, Soundy A, Heneghan NR. Exploring the lived experience and chronic low back pain beliefs of English-speaking Punjabi and white British people: a qualitative study within the NHS. BMJ Open 2018; 8:e020108. [PMID: 29440143 PMCID: PMC5829944 DOI: 10.1136/bmjopen-2017-020108] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Disabling chronic low back pain (CLBP) is associated with negative beliefs and behaviours, which are influenced by culture, religion and interactions with healthcare practitioners (HCPs). In the UK, HCPs encounter people from different cultures and ethnic backgrounds, with South Asian Indians (including Punjabis) forming the largest ethnic minority group. Better understanding of the beliefs and experiences of ethnic minorities with CLBP might inform effective management. OBJECTIVES To explore the CLBP beliefs and experiences of English-speaking Punjabi and white British people living with CLBP, explore how beliefs may influence the lived experience of CLBP and conduct cross-cultural comparisons between the two groups. DESIGN Qualitative study using semistructured interviews set within an interpretive description framework and thematic analysis. SETTING A National Health Service hospital physiotherapy department, Leicester, UK. PARTICIPANTS 10 CLBP participants (5 English-speaking Punjabi and 5 white British) purposively recruited from physiotherapy waiting lists. RESULTS Participants from both groups held negative biomedical CLBP beliefs such as the 'spine is weak', experienced unfulfilling interactions with HCPs commonly due to a perceived lack of support and negative psychosocial dimensions of CLBP with most participants catastrophising about their CLBP. Specific findings to Punjabi participants included (1) disruption to cultural-religious well-being, as well as (2) a perceived lack of understanding and empathy regarding their CLBP from the Punjabi community. In contrast to their white British counterparts, Punjabi participants reported initially using passive coping strategies; however, all participants reported a transition towards active coping strategies. CONCLUSION CLBP beliefs and experiences, irrespective of ethnicity, were primarily biomedically orientated. However, cross-cultural differences included cultural-religious well-being, the community response to CLBP experienced by Punjabi participants and coping styles. These findings might help inform management of people with CLBP.
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Affiliation(s)
- Gurpreet Singh
- Musculoskeletal Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Christopher Newton
- Musculoskeletal Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kieran O'Sullivan
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
- Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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15
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Nøst TH, Steinsbekk A, Riseth L, Bratås O, Grønning K. Expectations towards participation in easily accessible pain management interventions: a qualitative study. BMC Health Serv Res 2017; 17:712. [PMID: 29126444 PMCID: PMC5681789 DOI: 10.1186/s12913-017-2668-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with chronic pain use a range of healthcare services, but they also report a high degree of dissatisfaction with treatments. One reason for dissatisfaction might be participants' expectations towards treatments. The aim of this study was to explore expectations of people with chronic pain towards participation in easily accessible pain management interventions delivered in public primary care. METHODS A qualitative study using semi-structured individual face-to-face interviews with 21 informants. The informants were recruited among participants enrolled in a randomised controlled trial on the effect of an easily accessible self-management course for people with chronic pain. The data were analysed thematically using Systematic Text Condensation. RESULTS Having experienced pain for a long time, there was no specific expectation of a cure or a significant alleviation of the pain. The informants' expectations mainly concerned a hope that participation could lead to a better everyday life. The informants said that hope was important as it motivated them to keep going and continue self-care activities. The hope acted as a driving force towards trying new interventions and maintaining motivation to do activities they experienced as beneficial. Both concrete aspects of the current intervention and an understanding of what interventions in general could offer contributed to the informants hope. The expectations centred about the interventions being something new, as they had not previously tried this service, an opportunity to gain and reinforce skills, to help them continue to grow as a person, to meet others in similar situations, and to access professional support in an easy manner. Participating in interventions provided by healthcare services was seen by some as an act of self-care, where they did something active to manage their health. CONCLUSIONS Expectations towards the interventions were related to a hope for participation leading to a better everyday life. The role of hope for peoples' motivation to self-care implies that service providers should be aware of and help to maintain hope for a better everyday life. The importance of social support as part of self-care should be acknowledged when developing interventions targeting chronic pain. TRIAL REGISTRATION ClinicalTrials.gov: NCT02531282 . Registered on August 21 2015.
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Affiliation(s)
- Torunn Hatlen Nøst
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway. .,Centre for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
| | - Liv Riseth
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,3T- Fitness Center, Trondheim, Norway
| | - Ola Bratås
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Centre for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjersti Grønning
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Centre for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Process of Change in Pain-Related Fear: Clinical Insights From a Single Case Report of Persistent Back Pain Managed With Cognitive Functional Therapy. J Orthop Sports Phys Ther 2017; 47:637-651. [PMID: 28704623 DOI: 10.2519/jospt.2017.7371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Single case report with repeated measures over 18 months. Background Management of persistent low back pain (PLBP) associated with high pain-related fear is complex. This case report aims to provide clinicians with insight into the process of change in a person with PLBP and high bending-related fear, who was managed with an individualized behavioral approach of cognitive functional therapy. Case Description A retired manual worker with PLBP believed that his spine was degenerating, that bending would hurt him, and that avoidance was the only form of pain control. At baseline, he presented high levels of pain-related fear on the Tampa Scale of Kinesiophobia (score, 47/68) and a high-risk profile on the Örebro Musculoskeletal Pain Questionnaire (score, 61/100). Unhelpful beliefs and behaviors led to a vicious cycle of fear and disengagement from valued life activities. Guided behavioral experiments were used to challenge his thoughts and protective responses, indicating that his behavior was modifiable and the pain controllable. Using a multidimensional clinical-reasoning framework, cognitive functional therapy management was tailored to target key drivers of PLBP and delivered over 6 sessions in a 3-month period. Outcomes Over an 18-month clinical journey, he demonstrated improvements in bending-related fear, pain expectancy, and pain experience, and substantial changes in pain-related fear (Tampa Scale of Kinesiophobia: 33/68; change, -14 points) and risk profile (Örebro Musculoskeletal Pain Questionnaire: 36/100; change, -25 points). Clinical interviews at 6 and 18 months revealed positive changes in mindset, understanding of pain, perceived pain control, and behavioral responses to pain. Discussion This case report provides clinicians with an insight to using a multidimensional clinical-reasoning framework to identify and target the key drivers of the disorder, and to using cognitive functional therapy to address unhelpful psychological and behavioral responses to pain in a person with PLBP and high pain-related fear. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2017;47(9):637-651. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7371.
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17
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Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain. Phys Ther 2016; 96:1397-407. [PMID: 27013577 DOI: 10.2522/ptj.20140570] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/13/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cognitive functional therapy (CFT) has been shown to reduce pain and disability in people with chronic low back pain. OBJECTIVES The purpose of this study was to investigate participants' experience of CFT by comparing participants who reported differing levels of improvement after participation in CFT, potentially yielding insight into the implementation of this approach. DESIGN This was a noninterventional, cross-sectional, qualitative study with an interpretive description framework. METHODS Individuals who had participated in CFT in 2 physical therapy settings (in Ireland and Australia) were recruited through purposive sampling based on disability outcomes postintervention (n=9), and theoretical sampling (n=5). This sampling strategy was used to capture a range of participant experiences but was not used to define the final qualitative groupings. Semistructured interviews were conducted 3 to 6 months postintervention. RESULTS Three groups emerged from the qualitative analysis: large improvers, small improvers, and unchanged. Two themes encapsulating the key requirements in achieving a successful outcome through CFT were identified: (1) changing pain beliefs and (2) achieving independence. Changing pain beliefs to a more biopsychosocial perspective required a strong therapeutic alliance, development of body awareness, and the experience of control over pain. Independence was achieved by large improvers through newly cultivated problem-solving skills, self-efficacy, decreased fear of pain, and improved stress coping. Residual fear and poor stress coping meant that small improvers were easily distressed and lacked independence. Those who were unchanged continued to feel defined by their pain and retained a biomedical perspective. CONCLUSIONS A successful outcome after CFT is dependent on instilling biopsychosocial pain beliefs and developing independence among participants. Small improvers may require ongoing support to maintain results. Further study is needed to elucidate the optimal approach for those who were unchanged.
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18
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Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel) 2016; 4:healthcare4020022. [PMID: 27417610 PMCID: PMC4934575 DOI: 10.3390/healthcare4020022] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/15/2016] [Accepted: 04/19/2016] [Indexed: 01/14/2023] Open
Abstract
Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back pain. A review of the literature was carried out using the databases SPORTDiscuss, Medline and Google Scholar. A general exercise programme that combines muscular strength, flexibility and aerobic fitness is beneficial for rehabilitation of non-specific chronic low back pain. Increasing core muscular strength can assist in supporting the lumbar spine. Improving the flexibility of the muscle-tendons and ligaments in the back increases the range of motion and assists with the patient’s functional movement. Aerobic exercise increases the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain.
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Affiliation(s)
- Rebecca Gordon
- Department of Sport and Health Sciences, University of St Mark and St John, Plymouth PL6 8BH, UK.
| | - Saul Bloxham
- Department of Sport and Health Sciences, University of St Mark and St John, Plymouth PL6 8BH, UK.
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19
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Stenner P, Cross V, McCrum C, McGowan J, Defever E, Lloyd P, Poole R, Moore AP. Self-management of chronic low back pain: Four viewpoints from patients and healthcare providers. Health Psychol Open 2015; 2:2055102915615337. [PMID: 28070378 PMCID: PMC5193271 DOI: 10.1177/2055102915615337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A move towards self-management is central to health strategy around chronic low back pain, but its concept and meaning for those involved are poorly understood. In the reported study, four distinct and shared viewpoints on self-management were identified among people with pain and healthcare providers using Q methodology. Each construes self-management in a distinctive manner and articulates a different vision of change. Identification of similarities and differences among the viewpoints holds potential for enhancing communication between patients and healthcare providers and for better understanding the complexities of self-management in practice.
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20
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Valenzuela-Pascual F, Molina F, Corbi F, Blanco-Blanco J, Gil RM, Soler-Gonzalez J. The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: a mixed methods approach. BMC Med Inform Decis Mak 2015; 15:97. [PMID: 26597937 PMCID: PMC4657202 DOI: 10.1186/s12911-015-0220-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/20/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Low back pain is the highest reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have no clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients' cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver health care information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have demonstrated that websites can change and improve chronic patients' knowledge and have a positive impact on patients' attitudes and behaviors. The aim of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. METHODS/DESIGN This study has a mixed-method sequential exploratory design. The participants are chronic low back pain patients between 18-65 years of age who are attending a primary care setting. For the qualitative phase, subjects will be contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase will be a randomized controlled trial. Subjects will be randomly allocated using a simple random sample technique. The intervention group will be provided access to the web site where they will find information related to their chronic low back pain. This information will be provided in different formats. All of this material will be based on the information obtained in the qualitative phase. The control group will follow conventional treatment provided by their family physician. DISCUSSION The main outcome of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. TRIAL REGISTRATION ClinicalTrials.gov NCT02369120 Date: 02/20/2015.
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Affiliation(s)
- Fran Valenzuela-Pascual
- Universidad de Lleida, Facultad de Enfermería y Fisioterapia, Montserrat Roig 2, Lleida, 25198, Spain. .,Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain. .,Grup de Recerca de Cures de Salut, Institut de Recerca Biomèdica, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain.
| | - Fidel Molina
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Universidad de Lleida, Facultad de Educación, Psicología y Trabajo Social, Av. Estudi General 4, Lleida, 25001, Spain
| | - Francisco Corbi
- Universidad de Lleida, Institut Nacional d'Educació Física de Catalunya, Centro de Lleida, Partida Caparrella s/n, Lleida, 25192, Spain
| | - Joan Blanco-Blanco
- Universidad de Lleida, Facultad de Enfermería y Fisioterapia, Montserrat Roig 2, Lleida, 25198, Spain.,Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Grup de Recerca de Cures de Salut, Institut de Recerca Biomèdica, Avda Alcalde Rovira Roure 80, Lleida, 25198, Spain
| | - Rosa M Gil
- Departamento de Informática e Ingeniería Industrial, Universidad de Lleida, Jaume II 69, Lleida, 25001, Spain
| | - Jorge Soler-Gonzalez
- Grupo de Estudios Sociedad, Salud, Educación y Cultura, Universidad de Lleida, Pl. de Víctor Siurana 1, Lleida, 25003, Spain.,Universidad de Lleida, Facultad de Medicina, Montserrat Roig 2, Lleida, 25198, Spain.,Institut Català de la Salut, Rambla de Ferran 44, Lleida, 25007, Spain
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21
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Bunzli S, Smith A, Schütze R, O'Sullivan P. Beliefs underlying pain-related fear and how they evolve: a qualitative investigation in people with chronic back pain and high pain-related fear. BMJ Open 2015; 5:e008847. [PMID: 26482773 PMCID: PMC4611881 DOI: 10.1136/bmjopen-2015-008847] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The fear-avoidance model describes how the belief that pain is a sign of damage leads to pain-related fear and avoidance. But other beliefs may also trigger the fear and avoidance responses described by the model. Experts have called for the next generation of fear avoidance research to explore what beliefs underlie pain-related fear and how they evolve. We have previously described damage beliefs and suffering/functional loss beliefs underlying high pain-related fear in a sample of individuals with chronic back pain. The aim of this study is to identify common and differential factors associated with the beliefs in this sample. DESIGN A qualitative study employing semistructured interviews. SETTING Musculoskeletal clinics in Western Australia. PARTICIPANTS 36 individuals with chronic back pain and high scores on the Tampa Scale (mean 47/68). RESULTS The overarching theme was a pain experience that did not make sense to the participants. The experience of pain as unpredictable, uncontrollable and intense made it threatening. Attempting to make sense of the threatening pain, participants with damage beliefs drew on past personal experiences of pain, societal beliefs, and sought diagnostic certainty. Met with diagnostic uncertainty, or diagnoses of an underlying pathology that could not be fixed, they were left fearful of damage and confused about how to 'fix' it. Participants with suffering/functional loss beliefs drew on past personal experiences of pain and sought help from healthcare professionals to control their pain. Failed treatments and the repeated failure to achieve functional goals left them unable to make 'sensible' decisions of what to do about their pain. CONCLUSIONS The findings raise the suggestion that sense-making processes may be implicated in the fear-avoidance model. Future research is needed to explore whether fear reduction may be enhanced by considering beliefs underlying fear and providing targeted intervention to help individuals make sense of their pain.
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Affiliation(s)
- Samantha Bunzli
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Robert Schütze
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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22
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Ree E, Harris A, Indahl A, Tveito TH, Malterud K. How can a brief intervention contribute to coping with back pain? A focus group study about participants’ experiences. Scand J Public Health 2014; 42:821-6. [DOI: 10.1177/1403494814554029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants’ perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.
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Affiliation(s)
- Eline Ree
- Uni Research Health, Bergen, Norway
- Department of Health Promotion and Development, University of Bergen, Norway
| | - Anette Harris
- Department of Health Promotion and Development, University of Bergen, Norway
| | - Aage Indahl
- Uni Research Health, Bergen, Norway
- Department of Health Promotion and Development, University of Bergen, Norway
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Norway
| | - Torill H. Tveito
- Uni Research Health, Bergen, Norway
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Norway
| | - Kirsti Malterud
- Uni Research Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Research Unit for General Practice in Copenhagen, Denmark
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Buus N, Jensen LD, Maribo T, Gonge BK, Angel S. Low back pain patients' beliefs about effective/ineffective constituents of a counseling intervention: a follow-up interview study. Disabil Rehabil 2014; 37:936-41. [PMID: 25104215 DOI: 10.3109/09638288.2014.948135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Everyday activities are important factors for avoiding the development of chronic low back pain (LBP). The purpose this study was to explore LBP patients' perspective on long-term effects of participating in a counseling intervention designed to motivate them to change work routines and to exercise. METHOD Follow-up qualitative study. Semi-structured interviews were made of 25 LBP patients who had received the counseling intervention. Interviews were transcribed and explored with an interpretative thematic analysis. The findings were organized around Kleinman's conception of "explanatory models". RESULTS For the individual participant the beliefs about the illness were internally coherent, but most often they were idiosyncratic and fitted to the particular participants' overall explanatory model. Participation in the counseling intervention had created a sense of certainty and potential control over the disease and had legitimized their sick role at work and at home. The majority of the patients reported having integrated exercise into their explanatory models and understood exercise to be beneficial in their continual and concrete management of their LBP. CONCLUSIONS The intervention had affected the patients' personal agency and space for action. We suggest that this effect was linked to the individually tailored approach drawing on both educational and motivational agents. IMPLICATIONS FOR REHABILITATION Maintaining everyday activities, including retaining one's occupation, is an important factor in low back pain rehabilitation. Counselling on low back pain rehabilitation must be aligned with people's beliefs about their illness. A counselling intervention made patients adopt exercising into their long-term management of low back pain.
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Affiliation(s)
- Niels Buus
- Institute of Public Health, University of Southern Denmark , Odense C , Denmark
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Scott-Dempster C, Toye F, Truman J, Barker K. Physiotherapists' experiences of activity pacing with people with chronic musculoskeletal pain: an interpretative phenomenological analysis. Physiother Theory Pract 2013; 30:319-28. [PMID: 24377664 DOI: 10.3109/09593985.2013.869774] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Activity pacing is a strategy used by physiotherapists treating people with chronic pain. Questions as to the usefulness of activity pacing with people with chronic pain have been raised clinically and in research. This study explores physiotherapists' experiences of using activity pacing with people with chronic musculoskeletal pain. METHOD We interviewed six physiotherapists and used the methods of Interpretative Phenomenological Analysis (IPA) to explore the meaning of pacing. RESULTS We identified three master themes. First, activity pacing was perceived as part of a process whereby patients came to realize that change is possible, and that life could be different. Second, in order to use activity pacing effectively the physiotherapist needs to shift from a "fix it" to a "sit with" approach to the treatment. Third physiotherapists described how they used many combined therapeutic approaches in managing chronic pain. CONCLUSIONS This study increases our understanding of activity pacing and will help to make the best use of activity pacing in clinical practice, and optimize outcomes for the patients. These findings suggest that physiotherapists need to develop reflective listening skills, and use an experiential learning approach to facilitate activity pacing.
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Affiliation(s)
- Clare Scott-Dempster
- Physiotherapy Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust , Headington, Oxford , UK and
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Cano A, Gestoso M, Kovacs F, Hale C, Mufraggi N, Abraira V. The perceptions of people with low back pain treated in the Spanish National Health, and their experience while undergoing a new evidence-based treatment. A focus group study. Disabil Rehabil 2013; 36:1713-22. [DOI: 10.3109/09638288.2013.869625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. Br J Gen Pract 2013; 63:e829-41. [PMID: 24351499 PMCID: PMC3839392 DOI: 10.3399/bjgp13x675412] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/14/2013] [Accepted: 09/06/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload. AIM To systematically review and integrate the findings of qualitative research to increase understanding of patients' experiences of chronic non-malignant MSK pain. DESIGN AND SETTING Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC). METHOD Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001-2011 and citation tracking. Full published reports of qualitative studies exploring adults' own experience of chronic non-malignant MSK pain were eligible for inclusion. RESULTS Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain. CONCLUSIONS This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK
| | - Nick Allcock
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Michelle Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - Eloise Carr
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - JoyAnn Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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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.
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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
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Suppose Hippocrates Had Been a Lawyer: a Conceptual Model of Harm to Litigants; Part 2. PSYCHOLOGICAL INJURY & LAW 2013. [DOI: 10.1007/s12207-013-9170-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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