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Brady B, Pang SM, Dennis S, Chipchase L, Liamputtong P, Jennings M, Tcharkhedian E, Andary T, Pavlovic N, Zind M, Middleton P, Boland R. "IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain. Musculoskeletal Care 2024; 22:e1874. [PMID: 38423991 DOI: 10.1002/msc.1874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To explore the experiences of socio-culturally diverse community members attempting to manage their chronic pain and enact evidence-based management plans following an index Emergency Department (ED) visit. METHODS A convergent parallel mixed-methods design with qualitative interviews and descriptive analysis was undertaken in two public hospitals in a multicultural region in Sydney, Australia. Consecutive adults were recruited from culturally and linguistically diverse (CALD: n = 45) or Australian-born (n = 45) backgrounds, who presented to the ED for a chronic neuromusculoskeletal pain condition. Consenting participants were prescribed an individualised chronic pain management plan following examination by a physiotherapist, who collected standardised measures of pain and health literacy. Six months later, participants underwent a structured phone survey regarding their pain status and whether they had actioned management plans. Participants were invited to participate in a semi-structured interview. RESULTS Six-month data were available for 82 of 90 participants who attended the ED and consented to the baseline assessment (40 CALD and 42 Australian-born). Participants were 52% females, predominately middle-aged (mean age 54.7 years), with an overall mean symptom duration of 10 years (SD 9.0). At 6 months, there were nine representations by six CALD participants and 23 by nine Australian-born participants. Overall, 52% reported unchanged pain, 24% were worse and 23% improved, with similar action plan progress for CALD (58%) and Australian-born (53%) participants. Pain features and health literacy were similar, irrespective of progress with pain management plans. From 41 participants who consented to phone interviews, three themes emerged to explain their progress with recommendations: 'illness model', 'urgency' and 'control orientation'. CONCLUSIONS Patients presenting to the ED with chronic pain might be more likely to action discharge recommendations if primary care providers identify patient-specific and contextual barriers to implementation.
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Affiliation(s)
- Bernadette Brady
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sheng Min Pang
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Dennis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lucy Chipchase
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Pranee Liamputtong
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Matthew Jennings
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Elise Tcharkhedian
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Toni Andary
- Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia
- School of Medical Sciences, UNSW Medical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Pavlovic
- Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Marguerite Zind
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Paul Middleton
- Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Emergency Research Institute (SWERI), The Ingham Institute, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Discipline of Emergency Medicine, University of Sydney, Sydney, New South Wales, Australia
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, New South Wales, Australia
| | - Robert Boland
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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Brady B, Sidhu B, Jennings M, Boland R, Hassett G, Chipchase L, Tang C, Yaacoub S, Pavlovic N, Sayad S, Andary T, Ogul S, Naylor J. The feasibility of implementing a cultural mentoring program alongside pain management and physical rehabilitation for chronic musculoskeletal conditions: results of a controlled before-and-after pilot study. BMC Musculoskelet Disord 2023; 24:47. [PMID: 36658511 PMCID: PMC9850562 DOI: 10.1186/s12891-022-06122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Culturally diverse communities face barriers managing chronic musculoskeletal pain conditions including navigation challenges, sub-optimal healthcare provider engagement and difficulty adopting self-management behaviours. OBJECTIVES To explore the feasibility and trends of effectiveness of implementing a cultural mentoring program alongside clinical service delivery. METHODS This quasi-experimental controlled before-and-after multiple case study was conducted in three hospital-based services that provide treatment for patients with musculoskeletal pain. Two prospective cohorts, a pre-implementation and a post-implementation cohort, of adults with chronic musculoskeletal pain who attended during the 6-month recruitment phase, were eligible if they self-identified with one of the cultures prioritised for mentoring by the clinic. The pre-implementation cohort received routine care for up to 3-months, while the post-implementation cohort received up to 3-months of cultural mentoring integrated into routine care (3 to 10 sessions), provided by a consumer (n = 6) with lived experience. Feasibility measures (recruitment and completion rates, attendance, satisfaction), and trends of effectiveness (Patient Activation Measure and Health Literacy Questionnaire items one and six) were collated over 3-months for both cohorts. Outcomes were presented descriptively and analysed using Mann-Whitney U-tests for between-group comparisons. Translation and transcription of post-treatment semi-structured interviews allowed both cohorts' perspectives of treatment to be analysed using a Rapid Assessment Process. RESULTS The cultural mentor program was feasible to implement in clinical services with comparable recruitment rates (66% pre-implementation; 61% post-implementation), adequate treatment attendance (75% pre-implementation; 89% post-implementation), high treatment satisfaction (97% pre-implementation; 96% post-implementation), and minimal participant drop-out (< 5%). Compared to routine care (n = 71), patients receiving mentoring (n = 55) achieved significantly higher Patient Activation Measure scores (median change 0 vs 10.3 points, p < 0.01) at 3-months, while Health Literacy Questionnaire items did not change for either cohort over time. Three themes underpinned participant experiences and acceptability of the mentoring intervention: 'expectational priming', 'lived expertise' and 'collectivist orientation' to understand shared participant experiences and explore the potential differential effect of the mentoring intervention. CONCLUSION Participant experiences and observations of improved patient activation provide support for the acceptability of the mentoring intervention integrated into routine care. These results support the feasibility of conducting a definitive trial, while also exploring issues of scalability and sustainability.
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Affiliation(s)
- Bernadette Brady
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia ,grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Balwinder Sidhu
- grid.410692.80000 0001 2105 7653Multicultural Health Unit, South Western Sydney Local Health District, 5/39 Stanley Street, Bankstown, NSW 2200 Australia
| | - Matthew Jennings
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia
| | - Robert Boland
- grid.1013.30000 0004 1936 834XSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia ,grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Geraldine Hassett
- grid.410692.80000 0001 2105 7653Liverpool Hospital, South Western Sydney Local Health District, Locked Bag 7103 Liverpool, BC, Sydney, NSW 1871 Australia
| | - Lucy Chipchase
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA 5042 Australia
| | - Clarice Tang
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia
| | - Sylvia Yaacoub
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Natalie Pavlovic
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Samia Sayad
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia ,grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia
| | - Toni Andary
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Shaniya Ogul
- grid.410692.80000 0001 2105 7653Fairfield Hospital, South Western Sydney Local Health District, PO Box 5, Fairfield, Sydney, NSW 1851 Australia
| | - Justine Naylor
- grid.410692.80000 0001 2105 7653South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432SWS Clinical School UNSW, Locked Bag 7103, Liverpool BC, Sydney, NSW 1871 Australia ,grid.429098.eIngham Institute Applied Medical Research, 1 Campbell St, Liverpool, Liverpool, NSW 2170 Australia
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Moukhaiber N, Summers SJ, Opar D, Imam J, Thomson D, Chang WJ, Andary T, Cavaleri R. The effect of theta burst stimulation over the primary motor cortex on experimental hamstring pain: A randomised, controlled study. The Journal of Pain 2022; 24:593-604. [PMID: 36464137 DOI: 10.1016/j.jpain.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/02/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
Theta burst stimulation (TBS) over the primary motor cortex (M1) is an emerging technique that may have utility in the treatment of musculoskeletal pain. However, previous work exploring the analgesic effects of noninvasive brain stimulation has been limited largely to the arm or hand, despite 80% of acute musculoskeletal injuries occurring in the lower limb. This is a pertinent point, given the functional and neurophysiological differences between upper and lower limb musculature, as well as evidence suggesting that reorganization of corticomotor pathways is region-specific. This study investigated the effect of excitatory TBS on pain, function, and corticomotor organization during experimentally induced lower limb pain. Twenty-eight healthy participants attended 2 experimental sessions. On Day 0, participants completed 10 sets of 10 maximal eccentric contractions of the right hamstring muscles to induce delayed onset muscle soreness. Four consecutive blocks of either active or sham TBS were delivered on Day 2. Measures of mechanical sensitivity, pain (muscle soreness, pain intensity, pain area) function (single-leg hop distance, maximum voluntary isometric contraction, lower extremity functional scale), and corticomotor organization were recorded before and after TBS on Day 2. Pain and function were also assessed daily from Days 2 to 10. Active TBS reduced mechanical sensitivity compared to sham stimulation (P = .01). Corticomotor organization did not differ between groups, suggesting that improvements in mechanical sensitivity were not mediated by changes in M1. Subjective reports of pain intensity and function did not change following active TBS, contrasting previous reports in studies of the upper limb. PERSPECTIVE: M1 TBS reduces mechanical sensitivity associated with experimentally induced hamstring pain. Though further work is needed, these findings may hold important implications for those seeking to expedite recovery or reduce muscle sensitivity following hamstring injury.
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Affiliation(s)
- Nadia Moukhaiber
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Simon J Summers
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia; Queensland University of Technology, School of Biomedical Sciences, Queensland, Australia
| | - David Opar
- Australian Catholic University, Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, School of Behavioural and Health Sciences, Victoria, Australia
| | - Jawwad Imam
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Daniel Thomson
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia
| | - Wei-Ju Chang
- University of Newcastle, College of Health Medicine and Wellbeing, School of Health Sciences, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Centre for Pain IMPACT, New South Wales, Australia
| | - Toni Andary
- South Western Sydney Local Health District, New South Wales, Australia
| | - Rocco Cavaleri
- Western Sydney University, Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, New South Wales, Australia.
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Andary T, Cavaleri R, Chang W, Imam S, Moukhaiber N, Summers S, Thomson D. Investigating the effects of Theta Burst Stimulation (TBS) on experimentally-induced hamstring pain. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Brady B, Andary T, Pang SM, Dennis S, Liamputtong P, Boland R, Tcharkhedian E, Jennings M, Pavlovic N, Zind M, Middleton P, Chipchase L. A Mixed-Methods Investigation into Patients' Decisions to Attend an Emergency Department for Chronic Pain. Pain Med 2021; 22:2191-2206. [PMID: 33739379 PMCID: PMC8500722 DOI: 10.1093/pm/pnab081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study explored factors that underpin decisions to seek emergency department (ED) care for chronic noncancer pain in patients identifying as culturally and linguistically diverse (CALD) or Australian born. DESIGN AND METHODS This mixed-methods study was underpinned by the Behavioral Model of Health Services Use conceptual framework. Consenting consecutive patients attending the ED for a chronic pain condition were recruited to a CALD (n = 45) or Australian-born (n = 45) cohort. Statistical comparisons compared the demographic, pain, health literacy, and episode of care profiles of both cohorts. Twenty-three CALD and 16 Australian-born participants consented to an audio-recorded semi-structured interview (n = 24) or focus group (n = 5 focus groups) conducted in their preferred language. Interviews were translated and transcribed into English for analysis using applied thematic analysis, guided by the conceptual framework. Data were triangulated to investigate the patterns of ED utilization and contributing factors for both cohorts. RESULTS ED attendance was a product of escalating distress, influenced by the degree to which participants' perceived needs outweighed their capacity to manage their pain. This interaction was amplified by the presence of predisposing factors, including constrained social positions, trauma exposure, and biomedical health beliefs. Importantly, experiences varied between the two cohorts with higher degrees of pain catastrophizing, lower health literacy, and greater social challenges present for the CALD cohort. CONCLUSION This study highlights the role contextual factors play in amplifying pain-related distress for CALD and Australian-born patients with chronic pain. The findings support a need for health care providers to recognize features of higher vulnerability and consider streamlining access to available support services.
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Affiliation(s)
- Bernadette Brady
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Toni Andary
- Fairfield Hospital, Fairfield, NSW, Australia
| | - Sheng Min Pang
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarah Dennis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Pranee Liamputtong
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Robert Boland
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Fairfield Hospital, Fairfield, NSW, Australia
| | | | - Matthew Jennings
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
| | | | - Marguerite Zind
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Paul Middleton
- Liverpool Hospital, Liverpool, NSW, Australia
- South Western Emergency Research Institute (SWERI), The Ingham Institute, Liverpool, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Discipline of Emergency Medicine, University of Sydney, Sydney, Australia
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, Australia
| | - Lucy Chipchase
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia
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Brady B, Veljanova I, Andary T, Southwell T, Chipchase L. Recognising ethnocultural diversity in chronic pain assessment: validation of the Pictorial Representation of Illness and Self Measure (PRISM) for use with culturally diverse communities. Health Qual Life Outcomes 2019; 17:56. [PMID: 30961623 PMCID: PMC6454629 DOI: 10.1186/s12955-019-1126-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/26/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A comprehensive and accurate assessment of pain is critical for successful pain management. However, there is a lack of reliable and valid assessment tools for exploring multidimensional aspects of the chronic pain experience in culturally and linguistically diverse communities. This study investigates the reliability and validity of the Pictorial Representation of Illness and Self Measure + (PRISM+) for evaluating pain-related suffering and the sociocultural context of chronic pain within culturally and linguistically diverse patient cohorts. METHOD Three prospective validation studies are reported for three culturally and linguistically diverse communities. Two hundred and fifty-one patients with chronic pain who self-identified as Assyrian (n = 85), Arabic (n = 83) or Vietnamese (n = 83) completed a PRISM+ assessment, alongside a battery of standardised pain assessments. To evaluate construct validity, the position of the 'pain' disk placement was correlated with the Brief Pain Inventory (BPI), Depression Anxiety and Stress Scale (DASS), and the Short-Form 36 Health Survey (SF-36). For content validity, thematic analysis of patient narratives accompanying each disk placement was conducted. Test-retest reliability of repeated 'pain' and five additional disks (PRISM+) values was analysed using intra-class correlation coefficients. RESULTS The PRISM pain assessment demonstrated moderate to good test-retest reliability for Arabic (ICC 0.76; 95% CI 0.65-0.84), Assyrian (ICC 0.65; 95% CI 0.50-0.76) and Vietnamese (ICC 0.82; 95% CI 0.73-0.88) patients. Moderate correlations between the PRISM 'pain' disk and sub-scores for the BPI, DASS and SF-36 were found (p < 0.001). Patient interpretations of the 'pain' disk aligned with accepted definitions of suffering, supporting content validity for PRISM. For the additional disks (PRISM+), moderate to good test-retest reliability (ICC 0.67-0.88) was observed and qualitative analysis highlighted each disk reflected social and cultural values. CONCLUSION The PRISM demonstrates acceptable psychometric properties for measuring pain-related suffering for participants with chronic pain across three culturally and linguistically diverse communities. The use of additional disks (PRISM+) presents a reliable and valid option for exploring social and cultural dimensions of chronic pain in clinical encounters.
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Affiliation(s)
- Bernadette Brady
- School of Science and Health, Western Sydney University, Sydney, NSW Australia
- Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 1871 Australia
| | - Irena Veljanova
- School of Social Science and Psychology, Western Sydney University, Sydney, NSW Australia
| | - Toni Andary
- Physiotherapy Department, Fairfield Hospital, Fairfield, NSW Australia
| | - Troy Southwell
- School of Science and Health, Western Sydney University, Sydney, NSW Australia
| | - Lucinda Chipchase
- School of Science and Health, Western Sydney University, Sydney, NSW Australia
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