Keren Fisher

Validation of the Oswestry Low Back Pain Disability Questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience

Recently, there has been growing interest in the development of methods for recording disability as an outcome measure to monitor treatment effectiveness in chronic pain patients. Where these methods have relied on self-report, further information is needed about the validity and reliability of the results. Three such studies are reported on the Oswestry Low Back Pain Disability Questionnaire (ODQ. These involved comparing actual performance on lifting, sitting and walking tasks with reported limitation on the relevant subsections of the ODQ. The results were able to show encouraging validity and reliability. A factor-analytic study was also undertaken, which determined that there were two distinct factors of disability measured by this instrument. A small cohort of patients were followed up after a pain rehabilitation programme and reductions in disability were found to be reliably measured by the ODQ. The relationships between reported disability and the emotional and cognitive context in which the pain...

Body image and patients with amputations: does the prosthesis maintain the balance?

This paper attempts to establish whether dissatisfaction with the artificial limb and/or body image relate to achieved mobility following lower limb amputation in established limb wearers. Patients attending limb fitting clinics (n = 107, 62% male, mean time from amputation 13.9 years; range 1-54) participated. The measures were a specially designed Attitude to Artificial Limbs Questionnaire, a Body Image Questionnaire adapted from an eating disorders instrument including reference to body shape, the Hospital Anxiety and Depression Scale and the Harold Wood Stanmore Mobility Scale. The rehabilitation physician rated prosthetic suitability on a Numerical Rating Scale. The results showed patients were moderately satisfied with their artificial limb, had little experience of body image disruption or distress and there was no overall relationship between these variables and mobility. However, those with a more negative body image were more anxious and in younger patients who sustained more traumatic than vascular amputations, the correlation between body image and mobility was significant, anxiety was higher and physician satisfaction with the prosthesis was lower. It is concluded that body image disruption, anxiety and depression are not common in established limb wearers except in young people with traumatic amputations.

Experimental manipulation of perceived control and its effect on disability

Abstract Perceived control is postulated as a possible moderator of the relationship between impairment and disability. This hypothesis was experimentally investigated in patients with chronic pain attending a clinical psychology department in a hospital. Patients were randomly allocated to experimentally increased (N = 25) or decreased (N = 25) perceptions of control and the effects on disability examined. Perceived control was manipulated using sections of the normal clinical interview which enhanced beliefs in control (asking about times when control had been high) or reduced them (asking about times when control had been low). Results showed that the cognitive manipulations had been effective in modifying cognitions and had resulted in the predicted effects on disability as assessed by a lifting task. The possible emotional mediation of the cognitive manipulation is considered but cannot be reconciled by these data. The results do, however, strengthen the findings from correlational studies suggesting...

Early experiences of a multidisciplinary pain management programme

Chronic pain patients need comprehensive management programmes which emphasize the need for self-control strategies and personal control of the consequences of their disability. Labelling such patients’ complaints as ‘psychological’ is misleading since many do not show evidence of emotional distress. They can, nevertheless, benefit from courses of treatment run on behavioural principles which encourage achievement of individual goals and reduction of pain complaining. The course described here addresses these aims, and is able to show changes in reported disability, in spite of failing to show any reduction in pain ratings.

Two-Component Solutions of Repertory Grid Data: A Comparison of Three Methods

Abstract Of the various ways in which repertory grid data can be summarized, the two-component plot has been the most popular method. These plots are derived in three main ways: (1) Slaters (1977) INGR1D program, (2) subprogram FACTOR in the Statistical Package for the Social Sciences (SPSS) (Nie, Hull, Jenkins, Steinbrenner, & Brent, 1975), and (3) Higgenbotham and Bannisters (1983) CAB program, little attempt has been made to compare the solutions produced by these programs despite widespread use. A small number of single case studies suggest that the solutions are comparable. This paper reports a study that compares the solutions derived from INGRID, SPSS, and CAB for a series of cases. The results show that correspondence was good for the first components, but for the second components the results were less satisfactory

Developing prescribing guidelines for microprocessor-controlled prosthetic knees in the South East England

Background and aim: Microprocessor-controlled prosthetic knees have gained increasing popularity over the last decade. Research supports their provision to address specific problems or to achieve certain rehabilitation goals. However, there are yet no agreed protocols or prescribing criteria to assist clinicians in the identification and appropriate selection of suitable users. The aim is to reach professionals’ agreement on specific prescribing guidelines for microprocessor-controlled prosthetic knees. Technique: The study involved multidisciplinary teams from the Inter Regional Prosthetic Audit Group, representing nine Prosthetic Rehabilitation Centres in the South East England region. We used the Delphi technique with a total of three rounds to reach professionals’ agreement. Discussion: The prescribing guidelines were agreed and will be reviewed and updated depending on new research evidence and technical advances. Clinical relevance This project is highly useful for professionals in a clinic setting to aid in appropriate patient selection and to justify the cost of prescribing microprocessor-controlled prosthetic knees.

What psychological and physical changes predict patients’ attainment of personally meaningful goals six months following a CBT based pain management intervention?

Abstract Purpose: To examine the influence of demographic measures, and changes in physical ability, pain, self-efficacy and emotional distress on Goal Attainment Scaling (GAS) scores, after a 15-day CBT based pain management programme. Method: Chronic pain patients (N = 257) were referred; 225 (88%) completed the programme and were invited for follow up six months later. One hundred and sixty-two (63%), (mean age 47.7, 71% female) completed the reassessment procedures. GAS scores (which were also repeated at the end the programme), an 11-point Pain Numerical Rating Scale, Pain Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, distance walked in 5 mins, number of sit/stand repetitions in 1 min and number of stairs climbed in 1 min were measured on the first day and six months following the programme. Results: At six months post discharge, changes in goal attainment, physical measures, pain intensity, depression and self-efficacy were observed. Hierarchical regression showed change in GAS was predicted by improvement in walking tolerance and self-efficacy. Conclusions: The achievement of personally important goals was most significantly associated with change in walking ability and self-efficacy, while controlling for the influence of change in pain. Implications for Rehabilitation Chronic pain can reduce psychological and physical functioning, leading to a reduction in meaningful activities. Achievement of personally important activities as measured by Goal Attainment Scaling can be a more sensitive measure of programme outcome than that captured by many other standard measures. Self-efficacy is an important predictor of attainment of patient preferred goals following a CBT based pain management programme, and could be emphasized during treatment along with improved walking ability, to enhance patients’ goal achievement.

The effect of electromagnetic shielding on phantom limb pain: A placebo-controlled double-blind crossover trial.

Background: Environmental electromagnetic fields influence biological systems. Evidence suggests these have a role in the experience of phantom limb pain in patients with amputations. Objectives: This article followed a previous study to investigate the effect of electromagnetic field shielding with a specially designed prosthetic liner. Study design: Randomised placebo-controlled double-blind crossover trial. Methods: Twenty suitable participants with transtibial amputations, phantom pain at least 1 year with no other treatable cause or pathology were requested to record daily pain, well-being, activity and hours of prosthetic use on pre-printed diary sheets. These were issued for three 2-week periods (baseline, electromagnetic shielding (verum) and visually identical placebo liners – randomly allocated). Results: Thirty-three per cent of the recruited participants were unable to complete the trial. The resulting N was therefore smaller than was necessary for adequate power. The remaining data showed that maximum pain and well-being were improved from baseline under verum but not placebo. More participants improved on all variables with verum than placebo. Conclusion: Electromagnetic field shielding produced beneficial effects in those participants who could tolerate the liner. It is suggested that this might be due to protection of vulnerable nerve endings from nociceptive effects of environmental electromagnetic fields. Clinical relevance Electromagnetic field shielding with a suitable limb/prosthesis interface can be considered a useful technique to improve pain and well-being in patients with phantom limb pain.

Phantom Pain—Psychological Conceptualization and Treatment: A Case Report

This paper describes a case concentrating on the psychological conceptualization and treatment of phantom pain. A single session of cognitive work, teaching an “attention diversion’ strategy, was effectively utilized for the treatment of below knee phantom pain in an elderly lady. A follow-up, approximately one year later, revealed that the treatment gains had been maintained. Although a review of the literature (Sherman, Sherman and Gall, 1980) presents a rather murky picture as regards treatment prospects, the results nevertheless illustrate how a very simple cognitive strategy was successfully employed to alleviate a long standing debilitating phantom pain.