Eva Denison

Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care

Abstract This study examined the relations between disability, as measured by the Pain Disability Index (PDI) and self‐efficacy, fear avoidance variables (kinesiophobia and catastrophizing), and pain intensity, using a prospective design. Two primary health care samples (n1=210; n2=161) of patients with subacute, chronic or recurring musculoskeletal pain completed sets of questionnaires at the beginning of a physiotherapy treatment period. Multiple hierarchial regression analyses showed that self‐efficacy explained a considerably larger proportion of the variance in disability scores than the fear avoidance variables in the first sample. This finding was replicated in the second sample. Pain intensity explained a small, but significant proportion of the variance in disability scores in one sample only. Gender, age, and pain duration were not related to disability. These findings suggest that self‐efficacy beliefs are more important determinants of disability than fear avoidance beliefs in primary health care patients with musculoskeletal pain. The findings also suggest that pain‐related beliefs, such as self‐efficacy and fear avoidance, in turn, are more important determinants of disability than pain intensity and pain duration in these patients.

Classification of patients with whiplash associated disorders (WAD): reliable and valid subgroups based on the Multidimensional Pain Inventory (MPI-S).

Background Classification of patients with chronic whiplash associated disorders (WAD) into homogenous subgroups is an important objective in order to tailor interventions and to control for subgroup differences when evaluating treatment outcome.

Self-management of persistent neck pain: A randomized controlled trial of a multi-component group intervention in primary health care

Studies regarding self‐management of persistent neck pain are infrequent. Objective: to compare treatment effects of (a) a multi‐component pain and stress self‐management group intervention (PASS) and (b) individually administered physical therapy (IAPT) for patients with persistent musculoskeletal tension‐type neck pain. Methods: Persons seeking physical therapy treatment due to persistent tension‐type neck pain at nine primary health care centers in Sweden were randomly assigned to either PASS or IAPT. Before treatment (baseline) and at 10‐ and 20‐weeks the participants completed a self‐assessment questionnaire comprising: the Self‐Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, the Fear‐Avoidance Beliefs Questionnaire and questions regarding neck pain, analgesics and utilization of health care. Intention‐to‐treat analyses were performed using repeated measures analysis of variance between baseline, 10‐week and 20‐week follow‐up. Results: One hundred and fifty six participants were included (PASS n = 77, IAPT n = 79). On average participants receiving PASS attended seven treatment sessions and participants receiving IAPT 11 sessions over the 20‐week follow‐up period. Repeated measures ANCOVA showed significant time × group interaction effects for ability to control pain , self‐efficacy regarding pain‐interfering activities , disability due to neck pain (p = 0.001) and levels of catastrophic thinking in favour of PASS. Conclusion: PASS had a better effect than IAPT in the treatment of persistent musculoskeletal tension‐type neck pain regarding coping with pain, in terms of patients’ self‐reported pain control, self‐efficacy, disability and catastrophizing, over the 20‐week follow‐up.

Biopsychosocial predictors of pain, disability, health care consumption, and sick leave in first-episode and long-term back pain: a longitudinal study in the general population.

BackgroundLong-term outcome in back pain is related mainly to cognitive factors such as pain-related beliefs and expectations. Most research has been performed on patient samples.PurposeThis study aimed at investigating changes over time in reported back pain, pain intensity, disability, health care consumption, and sick leave as well as biopsychosocial factors over a 12-month period. A second aim was to identify predictors of reported pain, pain intensity, disability, health care consumption, and sick leave.MethodAs parts of a large back pain sample from a general population (n = 1,024), two groups—one with first-episode pain (n = 77) and one with long-term pain (n = 302)—responded twice to a self-administered questionnaire. Among participants reporting pain at both assessments, changes over time were analyzed and predictive models were tested.ResultsGenerally, the results demonstrated overall stability in the self-reports over time. However, reported pain decreased in both groups, while pain catastrophizing and pain expectations increased in the first-episode group. Pain intensity and disability were predicted in regression models including four cognitive factors and initially reported levels of pain intensity and disability.ConclusionThe significance of pain-related beliefs and expectations both in early and later stages of a back pain condition is pointed out. The results in this study based on a sample from the general population are in line with previous research on patient samples.

PAIN BELIEF SCREENING INSTRUMENT: DEVELOPMENT AND PRELIMINARY VALIDATION OF A SCREENING INSTRUMENT FOR DISABLING PERSISTENT PAIN

OBJECTIVE To develop and test the ability of a screening instrument to identify subgroups among primary healthcare patients with musculoskeletal pain. The Pain Belief Screening Instrument covers pain intensity, disability, self-efficacy, fear avoidance and catastrophizing. DESIGN Cross-sectional, correlational and comparative study. SUBJECTS Patients in primary healthcare (n1 = 215; n2 = 93) with a pain duration of 4 weeks or more were included. METHODS Items for the Pain Belief Screening Instrument were derived from principal component analyses of: the Self-efficacy Scale, the Tampa Scale of Kinesiophobia and the Catastrophizing subscale in the Coping Strategies Questionnaire. Cluster solutions of scores on the screening instrument and the original instruments were cross-tabulated. The reliability of items in the Pain Belief Screening Instrument was examined. RESULTS The screening instrument identified 2 groups: high- or low-risk profile for pain-related disability. Validity was in-between moderate and substantial (kappa = 0.61, p < 0.001). The reliability of each item in the Pain Belief Screening Instrument in relation to the corresponding item in the original instruments was moderate to high (rs 0.50-0.80, p < 0.01). CONCLUSION The screening instrument fairly well replicated subgroups identified by the original instruments. The reliability of items in the screening instrument was acceptable. Further testing of predictive validity for a primary healthcare population is needed..

Self-management of persistent neck pain: two-year follow-up of a randomized controlled trial of a multicomponent group intervention in primary health care.

Study Design. A 2-year follow-up of a randomized controlled trial. Objective. To compare long-term effects of (a) a multicomponent pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) on patients with persistent tension–type neck pain in a primary health care (PHC) setting. Summary of Background Data. In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability, and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, for example, maintenance of improvement and adherence to coping skills are sparsely investigated. Methods. Persons with persistent tension–type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures. Results. The study included 156 participants (PASS n = 77, IAPT n = 79). Between baseline, 10-week, 20-week, 1-year, and 2-year follow-up, significant time-by-group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (P < 0.001) and self-efficacy for performing activities in spite of pain (P = 0.002), and the secondary outcome catastrophic thinking (P < 0.001) but not in neck pain–related disability. Conclusion. The initial treatment effects of a self-management group intervention were largely maintained over a 2-year follow-up period and with a tendency to have superior long-term effects as compared to individually-administered physical therapy, in the treatment of persistent tension–type neck pain with regard to coping with pain, in terms of pain control, self-efficacy, and catastrophizing.

The associations between pain intensity, psychosocial variables, and pain duration/recurrence in a large sample of persons with nonspecific spinal pain

ObjectivesThe aims of this study were: (1) to describe and compare pain intensity, disability, cognitive, physical, behavioral, and environmental variables in 4 predefined categories, on the basis of duration and recurrence of nonspecific spinal pain; and (2) to compare disability, cognitive, physical, behavioral, and environmental variables in these 4 predefined categories, after controlling for pain intensity. MethodsPostal questionnaires were sent to a random sample of 5000 persons, aged 20 to 50 years, in Sweden. The response rate was 39%. One thousand and twenty-four participants reporting spinal pain were divided into 4 predefined categories (n=100, 215, 172, and 537) based on duration and recurrence of pain. Multivariate analyses of variance and covariance were performed to investigate differences between the 4 pain duration/recurrence groups. ResultsThe first analyses revealed that the 4 pain duration/recurrence groups differed in pain intensity, disability, 7 cognitive variables, and perceived social support. After controlling for pain intensity, small but significant group differences were identified in depression, catastrophizing, pain expectations, and perceived social support. Higher levels of catastrophizing and pain expectations and lower levels of perceived social support were seen in groups with longer duration of pain. DiscussionAfter controlling for pain intensity, categories based on pain duration/recurrence differed in 3 cognitive variables and perceived social support. Pain expectations, catastrophizing and perceived social support were related to longer duration of pain. Between-group differences were small and pain duration/recurrence was not an important explanatory factor.

Predictive factors for disability outcome at twenty weeks AND two years following a pain self-management group intervention in patients with persistent neck pain in primary health care

OBJECTIVE To explore possible predictors associated with short-term (post-treatment) and long-term (2 years) treatment success in terms of pain-related disability for patients with persistent neck pain following a pain and stress self-management intervention (PASS). METHODS Data from 77 participants assigned to PASS in a randomized controlled trial were explored to identify possible predictors of favourable outcome regarding pain-related disability as measured by the Neck Disability Index (NDI), by use of Pearson correlation analysis, partial least squares (PLS) and ordinary least squares (OLS) regression analyses. Data from self-assessment questionnaires completed by the participants before, post-treatment (i.e. 20 weeks after inclusion) and 2 years after inclusion in the study, were used. RESULTS Multivariate PLS regression analysis showed that baseline scores in NDI, the Self-Efficacy Scale (SES) and pain intensity explained 31% of the variance in disability (NDI) post-treatment. Multivariate PLS regression analysis showed that post-treatment scores in NDI, SES and pain intensity explained 68% of the variance in disability (NDI) at 2 years. CONCLUSION Treatment gains, as measured by post-treatment scores at 20-week follow-up, in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability at 2 years, in patients with persistent neck pain participating in a self-management group intervention in primary health care.

Predicting of pain, disability, and sick leave regarding a non-clinical sample among Swedish nurses

Abstract Objective Health care providers, especially registered nurses (RNs), are a professional group with a high risk of musculoskeletal pain (MSP). This longitudinal study contributes to the literature by describing the prevalence and change in MSP, work-related factors, personal factors, self-reported pain, disability and sick leave (>7 days) among RNs working in a Swedish hospital over a 3-year period. Further, results concerning prediction of pain, disability and sick leave from baseline to a 3-year follow-up are reported. Method In 2003, a convenience sample of 278 RNs (97.5% women, mean age 43 years) completed a questionnaire. In 2006, 244 RNs (88% of the original sample) were located, and 200 (82%) of these completed a second questionnaire. Results Logistic regression analyses revealed that pain, disability and sick leave at baseline best predicted pain, disability, and sick leave at follow-up. The personal factors self-rated health and sleep quality during the last week predicted pain at follow-up, while age, self-rated health, and considering yourself as optimist or pessimist predicted disability at follow-up, however weakly. None of the work-related factors contributed significantly to the regression solution. Conclusions The results support earlier studies showing that a history of pain and disability is predictive of future pain and disability. Attention to individual factors such as personal values may be needed in further research.

Chronic pain among older women living alone. A study focusing on disability and morale

Abstract Purpose: To investigate (i) how older women who are living alone perceive chronic musculoskeletal pain, activities of daily living (ADL), physical activity, affective distress, pain-related beliefs, pain management, and rate pain-related disability and morale, and (ii) the relationships between demographic variables, ADL, physical activity, affective distress, pain-related beliefs, and pain management with pain-related disability and morale. Method: The study had a cross-sectional and correlational design. Sixty women, living alone with chronic pain and community support aged ≥ 65 years were included. Results: The women were on average 81 years old and had lived with pain for about 21.5 years. They reported low scores of affective distress, catastrophizing thoughts and self-efficacy, high scores of fear of movement, low degrees of pain-related disability and low levels of morale. The multiple regression analysis showed that only catastrophizing thoughts significantly explained the variation in pain-related disability, and both affective distress and catastrophizing thoughts significantly explained the variation in morale. Conclusion: These older women living alone with chronic pain reported similar prevalence of chronic pain and pain-related disability but lower morale when comparing the results with similar studies about older people in the same age group or older people who are in need of help to manage their daily life. The only variable that was independently associated with both pain-related disability and morale was catastrophizing. Further research should focus on identifying catastrophizing thoughts, on developing a rehabilitation programme based on a biopsychosocial perspective with the goal to decrease catastrophizing, pain-related disability and increase morale for this target group.