Everyday occupational problems perceived by participants in a pain rehabilitation programme

Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation

OBJECTIVE

To investigate outcomes in patients with chronic pain after participation in an interdisciplinary pain rehabilitation programme with language interpreters, and to investigate the outcomes in women and men separately.

DESIGN

Prospective multi-centre cohort study.

PATIENTS

Ninety-five patients in Sweden with chronic pain who have insufficient knowledge of the Swedish language.

METHODS

Duration and intensity of pain, anxiety and depression, health-related quality of life and fear of movement were evaluated before and after the programme. Patients were compared with a reference group comprising Swedish-speaking patients participating in an ordinary interdisciplinary pain rehabilitation programme.

RESULTS

Before the interdisciplinary pain rehabilitation programme with language interpreters, all variables except pain duration differed significantly to the detriment of the studied group. The studied group showed significant improvements after the interdisciplinary pain rehabilitation programme with language interpreters, with regards to pain intensity, depression and fear of movement. The reference group improved significantly for all variables. The women in the studied group showed significant improvements for the same variables as the whole group, while the men in the studied group did not improve in any of the variables.

CONCLUSION

This study indicates that patients with chronic pain, and especially women, who have insufficient knowledge of Swedish seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result may be of value for the further development of rehabilitation programmes with language interpreters.

Experiences of occupational therapists within an ACT-based interdisciplinary pain management program

BACKGROUND

Acceptance and Commitment Therapy (ACT)-based interdisciplinary pain rehabilitation programs have shown effective results. While occupational therapy within these programs has made a unique contribution to pain management because of its focus on occupation and use of group activities, little is known about occupational therapists' own experiences of it.

AIM

The aim of this study was to describe the occupational therapists' experiences of working in a manual-based interdisciplinary pain management program grounded in ACT.

MATERIAL AND METHODS

Six occupational therapists at a pain rehabilitation clinic were interviewed. Data were analysed using Braun and Clark's thematic analysis.

RESULTS

The occupational therapists experienced that ACT and occupational therapy complement each other and that ACT facilitated comprehension of occupational therapy interventions. With ACT, the team gained a common language, which made teamwork and patient comprehension more efficient. A behavioural analysis (SORC) served as a link between occupational therapy and ACT.

CONCLUSIONS

Manual-based occupational therapy activity group interventions with elements of ACT were felt to enhance the patient's understanding of their rehabilitation and supported teamwork.

SIGNIFICANCE

This study provides further support for use of ACT in occupational therapy within interdisciplinary pain management programs. Occupational therapists' use of SORC is an area of development.

High-impact chronic pain: evaluation of risk factors and predictors

Background

The concept of high-impact chronic pain (HICP) has been proposed for patients with chronic pain who have significant limitations in work, social life, and personal care. Recognition of HICP and being able to distinguish patients with HICP from other chronic pain patients who do not have life interference allows the necessary measures to be taken in order to restore the physical and emotional functioning of the affected persons. The aim was to reveal the risk factors and predictors associated with HICP.

Methods

Patients with chronic pain without life interference (grade 1 and 2) and patients with HICP were compared. Significant data were evaluated with regression analysis to reveal the associated risk factors. Receiving operating characteristic (ROC) analysis was used to evaluate predictors and present cutoff scores.

Results

One thousand and six patients completed the study. From pain related cognitive processes, fear of pain (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.98; P = 0.007) and helplessness (OR, 1.06; 95% CI, 1.01-1.12; P = 0.018) were found to be risk factors associated with HICP. Predictors of HICP were evaluated by ROC analysis. The highest discrimination value was found for pain intensity (cut-off score > 6.5; 83.8% sensitive; 68.7% specific; area under the curve = 0.823; P < 0.001).

Conclusions

This is the first study in our geography to evaluate HICP with measurement tools that evaluate all dimensions of pain. Moreover, it is the first study in the literature to evaluate predictors and cut-off scores using ROC analysis for HICP.

How to strengthen the RTW process and collaboration between patients with chronic pain and their employers in interdisciplinary pain rehabilitation programs? Patients' experiences of the Demand and Ability Protocol

PURPOSE

To explore how patients who participate in an interdisciplinary pain rehabilitation program (IPRP) experience a three-party meeting based on the Demand and Ability Protocol (DAP) to assist in return to work (RTW). The DAP is a employee and his/her immediate manager under the guidance of medical staff with knowledge of the patient's work requirements and his/her current functional ability.

MATERIALS AND METHODS

Data included 18 semi structured individual interviews with persons having chronic pain, who participated in a DAP-dialogue during their IPRP. Thematic analysis was used to analyze the data.

RESULTS

Four themes were identified: A structured dialogue facilitated new insights; the dialogue enabled employer participation; the facilitator enabled experiences of feeling safe during the dialogue; and the dialogue created a link between rehabilitation and work.

CONCLUSIONS

The DAP dialogue was experienced as a supportive measure for RTW where the employer naturally participated in IPRP. The structure of the dialogue supported concrete planning for workplace adaptations. Furthermore, the dialogue enabled a connection between rehabilitation and the activity of work in everyday life. The results reinforce the importance of including efforts close to the workplace in IPRP in order to facilitate rehabilitation outcomes related to RTW.IMPLICATIONS FOR REHABILITATIONA structured collaboration and dialogue between the employee, employer, and rehabilitation supports the RTW process.Collaboration between stakeholders is important and should be intertwined in IPRP to jointly facilitate the employee's RTW.Clarifying the work demands provides motivation for the RTW process.Healthcare professionals should collaborate with the workplace to promote employer participation.

Patients' experiences of occupational therapy within a multidisciplinary pain management programme: A qualitative study

BACKGROUND

Occupational problems are common for adults experiencing chronic pain, but occupational therapists are not always accessed as part of the multidisciplinary team. Despite evidence of benefit for work-focused interventions, there is limited evidence for broader benefit from occupational therapy interventions within the context of multidisciplinary pain management. The aim of this study was to explore the experiences of programme attendees who received structured intervention from an occupational therapist as part of a multidisciplinary pain management programme, and gain an understanding as to how they felt it influenced changes they made to occupational participation.

METHOD

A qualitative approach was undertaken with 9 individual patients recruited from a group pain management programme for adults with chronic low back pain. Semi-structured interviews were carried out, recorded and transcribed. Thematic analysis was used to identify themes in the data.

RESULTS

Three key themes were identified: 1) the helpfulness of activity pacing techniques 2) the value of participating in a therapeutic activity-based session and 3) an increased understanding of the importance of leisure and creative activities in the context of their lives.

CONCLUSION

Participants perceived the specific occupational therapy content of the programme to be helpful in a number of different ways. The findings suggest that occupational therapy can be important in facilitating patients to apply theoretical techniques in the real world, thereby increasing the likelihood of long term benefit.

Participant-perceived occupational outcomes after two years of yoga for chronic pain

Introduction

The study aim was to investigate the perceived impact and experience of long-term involvement in community-based group yoga for people with chronic pain.

Methods

Eleven participants, who previously completed an 8-week yoga intervention and continued attending yoga at a community pain clinic for 2 years, participated in the study. A mixed-methods approach was employed. Canadian Occupational Performance Measure data were collected during the 8-week yoga study (baseline) and after 2 years of yoga (follow-up). Baseline and follow-up Canadian Occupational Performance Measure data were compared to measure change in perceived occupational performance and satisfaction. Individual qualitative interviews were conducted to explore participants’ perceived impact and experience of long-term yoga involvement. Canadian Occupational Performance Measure data were analyzed using Wilcoxon signed-rank tests, and qualitative interviews were analyzed using an inductive approach.

Findings

Canadian Occupational Performance Measure scores significantly improved between baseline and follow-up. Three main themes emerged from qualitative interviews: (a) Occupational shift from “existing” to “living,” (b) The change process is “progressive,” and (c) Yoga is “a positive thing I do in my life.”

Conclusion

Long-term involvement in community-based group yoga may improve and sustain occupational performance and satisfaction. Occupational therapists may consider yoga as a tool to promote occupational gains in people with chronic pain.

Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age

BACKGROUND

Chronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work.

AIM

To investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP.

MATERIAL AND METHODS

Data were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups.

RESULTS

There were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups.

CONCLUSIONS

These findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.

Exploring perceived occupational balance in women with fibromyalgia. A descriptive study

BACKGROUND

People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation.

OBJECTIVE

To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms.

METHODS

A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure.

RESULTS

One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance.

CONCLUSION

Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance.

SIGNIFICANCE

Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.

Effects of a pain management programme on occupational performance are influenced by gains in self-efficacy

Introduction

The perceived capacity to perform particular activities or skills (i.e. self-efficacy) is paramount in occupational therapy and is thought to be reinforced by actual functional capacity. This study examined whether changes in self-efficacy or confidence to lift weighted items influences changes in occupational performance and disability levels in patients attending a cognitive behavioural therapy pain management programme.

Method

Clients attending an 8-week cognitive behavioural therapy pain management programme ( N = 125) completed questionnaires before treatment, at discharge, and at 3-month and 6-month reviews, including measures of pain self-efficacy, disability and self-perceived performance and satisfaction using the Canadian occupational performance measure. Analyses examined disability and occupational performance over time, adjusting for baseline characteristics (age, sex, education), and sought to determine whether self-efficacy or lifting confidence influenced the outcomes.

Results

The level of disability, lifting confidence, self-efficacy and occupational performance all improved over time; however, only occupational performance and lifting confidence maintained improvements up to the 6-month review. Self-efficacy had a greater impact on occupational performance than lifting confidence.

Yoga improves occupational performance, depression, and daily activities for people with chronic pain

BACKGROUND

Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain.

OBJECTIVES

In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression.

METHODS

Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated.

RESULTS

83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size.

CONCLUSION

Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.

Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review

Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.

Lifestyle Redesign® for Chronic Pain Management: A Retrospective Clinical Efficacy Study

OBJECTIVE

Our objective was to determine the efficacy of a Lifestyle Redesign^® intervention for people living with chronic pain on quality of life (QOL), function, self-efficacy, and pain levels.

METHOD

Clinical outcomes were collected from 45 patients who completed an individual outpatient Lifestyle Redesign occupational therapy program for chronic pain as part of their usual plan of medical care. Outcome measures included the Canadian Occupational Performance Measure, the 36-Item Short-Form Survey, the Brief Pain Inventory, and the Pain Self-Efficacy Questionnaire. We analyzed scores using paired-samples t tests.

RESULTS

Significant changes were observed in occupational performance and satisfaction scores, physical and social functioning, role limitations due to physical and emotional problems, energy and fatigue, general health, and pain self-efficacy.

CONCLUSION

Lifestyle Redesign interventions, when integrated into a patient's medical plan of care, can improve patient functioning, self-efficacy, and QOL.

Change Narratives That Elude Quantification: A Mixed-Methods Analysis of How People with Chronic Pain Perceive Pain Rehabilitation

Chronic pain negatively impacts health, well-being, and social participation. Effective rehabilitation often hinges on long-term changes in pain-related perceptions and behaviors. However, there are important gaps in understanding how patients perceive these changes. The present pilot study addresses this gap by using qualitative and quantitative methodologies to explore how patients perceive and experience changes in function, participation, and pain-related factors following a chronic pain rehabilitation program. A mixed-method design was used in which the core method was qualitative. Descriptive quantitative data was used to further characterize the sample. Semistructured interviews were conducted 1-6 months following treatment completion. Questionnaires were administered before and after treatment and at follow-up. Interview data was analyzed thematically. Participants' individual descriptive data was compared to established cut-scores and criteria for change. A major theme of personal growth emerged in the qualitative analysis. Participants also discussed the factors that facilitated personal growth and the ongoing challenges to this growth. The quantitative data revealed limited improvement on measures of pain, disability, catastrophizing, and depression. These findings suggest that, despite limited improvement on treatment-related questionnaires, patients can experience an important and enduring sense of personal growth. Clinical and theoretical implications are discussed.

The Satisfaction with Daily Occupations (SDO-13) Scale: Psychometric Properties among Clients in Primary Care in Sweden

This article describes the results to expand and develop the use of the Satisfaction with Daily Occupations (SDO-13) Scale. Data were collected in primary care before (I) and after intervention (II) among clients with stress-related disorders and musculoskeletal pain. The Cronbach's alpha values of the SDO-13 Scale were 0.80 and 0.88. Convergent validity was assessed against global occupational satisfaction and general health, resulting in rs = -0.65 (p < 0.001) and rs = -0.46 (p < 0.001). The SDO-13 Scale could not discriminate between the primary care sample and a psychiatric sample (p = 0.15), whereas number of current occupations could (p < 0.001). The SDO-13 was not sensitive to change (p = 0.92). Future studies need to explore criterion and construct validity based on more dissimilar samples and more standardized interventions. Applications of these results to practice are discussed.

Returning to work - a long-term process reaching beyond the time frames of multimodal non-specific back pain rehabilitation

PURPOSE

To explore and describe health professionals' experience of working with return to work (RTW) in multimodal rehabilitation for people with non-specific back pain.

METHOD

An interview study using qualitative content analysis. Fifteen participants were interviewed, all were working with multimodal rehabilitation for people with non-specific back pain in eight different rehabilitation units.

RESULTS

The participants experienced RTW as a long-term process reaching beyond the time frames of the multimodal rehabilitation (MMR). Their attitudes and, their patients' condition, impacted on their work which focused on psychological and physical well-being as well as participation in everyday life. They often created an action plan for the RTW process, however the responsibility for its realisation was transferred to other actors. The participants described limited interventions in connection with patients' workplaces.

CONCLUSIONS

Recommended support in the RTW process in MMR comprises the provision of continuous supervision of vocational issues for the health care professionals, the development of guidelines and a checklist for how to work in close collaboration with patients' workplaces and employers, the provision of long-term follow-up in relation to the patients' work, and the development of proper interventions in order to promote transitions between all the different actors involved.

IMPLICATIONS FOR REHABILITATION

Rehabilitation programs targeting return to work (RTW) for people with non-specific back pain needs to include features concretely focusing on vocational issues. Health and RTW is often seen as a linear process in which health comes before RTW. Rehabilitation programs could be tailored to better address the reciprocal relationship between health and work, in which they are interconnected and affect each other. The RTW process is reaching beyond the time frames of the multimodal rehabilitation but further support from the patients are asked for. The rehabilitation programs needs to be designed to provide long-term follow-up in relation to the patients' work.