Elin Damsgård

Factors Affecting Caregiver Burden 1 Year After Severe Traumatic Brain Injury: A Prospective Nationwide Multicenter Study.

Objectives:To assess burden in the caregivers of patients with severe traumatic brain injury (TBI) 1 year postinjury, related to caregivers demographic data and social network, patients demographic data, injury severity, and functional status. Design:Prospective national multicenter study. Self-report from caregivers, patient data collected from the national cohort on patients with severe TBI. Participants:92 caregivers. Main outcome measure:The Caregiver Burden Scale (CBS). Results:Total caregiver burden was reported high in 16% of caregivers and moderate in 34%. The mean total burden index was 2.12, indicating a moderate burden. Caregivers reported highest scores on the General strain index, followed by the Disappointment index. Poor social network, feeling loneliness, and caring for patients with severe disability were significant predictors of higher burden in univariate analyses (P < .01). Multiple linear regression analyses showed that experiencing loneliness and caring for a patient with more severe disability were independent predictors for higher caregiver burden for all CBS indices. Marital status (married) and low frequency of meeting friends were significant results in some indices. Conclusions:Lack of a social network, feeling loneliness, and patients functional status are predictors of caregiver burden. General strain, disappointment, and isolation were identified as areas in which caregiver burden is high.

Life satisfaction in subjects with long-term musculoskeletal pain in relation to pain intensity, pain distribution and coping.

OBJECTIVE To investigate levels of life satisfaction in subjects with long-term musculoskeletal pain in relation to pain characteristics and coping. DESIGN Cross-sectional study. METHODS A total of 232 (42%) respondents answered self--report questionnaires regarding life satisfaction, self-efficacy, sense of coherence, pain distribution and pain intensity at rest and during activity. RESULTS Levels of life satisfaction and scores for sense of coherence were low. Pain intensity at rest was negatively correlated with global life satisfaction. This result was also obtained in multiple regression analyses together with the coping factors. The life satisfaction domains activities of daily living/contacts were negatively correlated with pain intensity during activity, and the domains work/economy were negatively correlated with pain distribution. Pain was not associated with satisfaction with family life, partner relationship or sexual life. Younger age, being married/cohabitant and being female were protective for some domains. Clinically meaningful subgroups with regard to adaptation were identified by cluster analysis, and the highest level of coping was found in the adaptive cluster with high life satisfaction/low pain intensity at rest. CONCLUSION Long-term pain is related to low levels of life satisfaction, and pain intensity and distribution influence satisfaction in different domains. Pain intensity is negatively associated with coping. The results support efforts to reduce pain, together with strengthening active coping processes and addressing individual needs.

Readiness to adopt a self-management approach to pain – Are profiles of subscale scores on the Pain Stages of Change Questionnaire useful?

The study evaluated the ability of the Pain Stages of Change Questionnaire (PSOCQ) to classify subjects into specific profiles of readiness to adopt a self‐management approach to pain. An analysis was made of whether the five earlier described PSOCQ‐profiles Precontemplation, Contemplation, Non‐contemplative Action, Participation and Ambivalent could be reproduced by two different methods, cluster analysis and visual analysis. The 184 included subjects completed the PSOCQ, the Hopkins Symptom Checklist (HSCL‐25), the Tampa scale of Kinesiophobia (TSK) and five self‐efficacy questions from the arthritis self‐efficacy questionnaire (ASES). Profiles were drawn based on the mean scores of the four subscales in PSOCQ. All the five predefined profiles were identified visually by two coders with an interrater agreement of Kappa 0.731. A 6‐cluster solution generated the four profiles Precontemplation, Contemplation, Non‐contemplative Action and Participation. Discriminant function analysis (DFA) on cluster analysis classified 83.5% of cases in the same group, and DFA on visual classification 72.1% of cases. Fifty‐three percent were classified in the same profile by cluster and visual analysis. The two profiles Precontemplation and Participation seem to identify distinct subgroups that differ in educational level, pain during activity and psychometric measures. Non‐contemplative Action share characteristics with Precontemplation, and the Contemplation group has scores in between. In conclusion, more research on the validity of the PSOCQ is needed. Outcome studies after pain treatment programmes could focus three main states that differ on measures for concurrent validity: Profiles that can be identified as Precontemplation or Non‐contemplative action, Contemplators, and subjects with Participation profiles.