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Patients' needs regarding chronic pain rehabilitation and management
Mälardalen University, School of Health, Care and Social Welfare.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2010.
Identifiers
URN: urn:nbn:se:mdh:diva-11890ISBN: 978-91-7457-147-9 (print)OAI: oai:DiVA.org:mdh-11890DiVA, id: diva2:400739
Public defence
2010-12-10, Danderyds Sjukhus, Stockholm, 11:11 (Swedish)
Opponent
Supervisors
Available from: 2011-02-28 Created: 2011-02-28 Last updated: 2014-01-10Bibliographically approved
List of papers
1. Indicators of need for occupational therapy in patients with chronic pain: occupational therapists' focus groups.
Open this publication in new window or tab >>Indicators of need for occupational therapy in patients with chronic pain: occupational therapists' focus groups.
2010 (English)In: Occupational therapy international, ISSN 0966-7903, Vol. 17, no 2, p. 93-103Article in journal (Refereed) Published
Abstract [en]

This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings. Copyright (c) 2009 John Wiley & Sons, Ltd.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-7624 (URN)10.1002/oti.282 (DOI)000289427900005 ()19653210 (PubMedID)2-s2.0-77954566064 (Scopus ID)
Available from: 2010-10-25 Created: 2009-12-02 Last updated: 2014-06-17Bibliographically approved
2. Exploring indicators for pain rehabilitation: A Delphi study using a multidisciplinary expert panel
Open this publication in new window or tab >>Exploring indicators for pain rehabilitation: A Delphi study using a multidisciplinary expert panel
2009 (English)In: Musculoskeltal Care, ISSN 1478-2189, Vol. 7, no 4, p. 227-242Article in journal (Refereed) Published
Abstract [en]

 Objective: Lack of referral guidelines can cause delayed or even nonexistent rehabilitation for chronic pain patients. Indicators signalling the need for interventions could counteract this delay for pain rehabilitation and thereby prevent deteriorating patient health. This study aimed to explore the indicators of need for pain rehabilitation using a multidisciplinary expert panel working with pain rehabilitation. 

Methods: A three-round Delphi study was conducted with a multidisciplinary expert panel (n=23), each representing one pain rehabilitation unit in Sweden. The expert panel produced indicators, which were then ranked using a four-point Likert scale. 

Results: Twenty multifaceted indicators for pain rehabilitation were identified. A major part concerned patient problems with activity level, catastrophizing, coping, existential problems, fear avoidance, high pain rating, medication, mental health, motivation, no pain relief, pain spread/increase, psychosocial problems combined with activity problems, psychosocial problems, recovery, and reduced physical function. Furthermore, indicators concerned demographic factors, sick leave, situation in primary health care, and work. Finally, tacit knowledge was pointed out as an indicator. The results support previous research but also bring out less quantifiable indicators, such as relying on tacit knowledge while assessing a patient’s need for rehabilitation.

Conclusion: The indicators for pain rehabilitation were comprehensive, pointing out that needs assessment is complex. Despite reaching consensus on 19 out of 20 indicators, further research is needed to deepen knowledge in this area and to secure a fair assessment of a patient’s need for pain rehabilitation.

 

Place, publisher, year, edition, pages
John Wiley & Sons, 2009
Keywords
Chronic pain, Delphi, assessment, pain rehabilitation
National Category
Nursing
Identifiers
urn:nbn:se:mdh:diva-5800 (URN)10.1002/msc.154 (DOI)2-s2.0-70849095969 (Scopus ID)
Available from: 2009-05-04 Created: 2009-05-04 Last updated: 2014-01-10Bibliographically approved
3. Adapt, discover, and engage: a qualitative interview study with patients living with chronic pain
Open this publication in new window or tab >>Adapt, discover, and engage: a qualitative interview study with patients living with chronic pain
2010 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 2, no 4, p. 254-261Article in journal (Refereed) Published
Abstract [en]

Aim.  This paper reports a study that aimed to advance the understanding of needs related to chronic pain management by describing these needs as they are experienced by people living with chronic pain.

Methods.  Data during 2008 were collected by interviews with ten Swedish adults living with musculoskeletal chronic pain and analysed using thematic content analysis.

Findings.  Three themes were found: Need to handle the painful body and the eager mind, need for transformation of self-image, and need for affirmation through communion and enjoyment. The first theme describes how the body and mind are in conflict with each other and how participants constantly have to weigh the consequences of their actions. The second highlights the need to let go of a former self and to discover a new self. The third illustrates the participants’ needs for social engagement and for performance of valued occupations that provide hope and support.

Conclusions.  Findings show that participants experience internal needs, and they also have needs that can only be met through interaction with the surrounding context. Furthermore, findings show that some of the experienced needs can create inner conflict because they can be contradictory.

Relevance to clinical practice.  Findings from this study provide health care professionals with information about how patients with chronic pain experience needs. In turn, this can constitute a base that to enable evaluation of how closely the patients’ experiences of need correspond to the interventions that health care in general provides this group of patients. Patients should be supported to manage their possibly incompatible needs and to prioritise occupations that generate energy and satisfaction.

Keywords
needs assessment; pain management; qualitative research; rehabilitation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-10515 (URN)10.1111/j.1752-9824.2010.01066.x (DOI)
Available from: 2010-10-25 Created: 2010-10-25 Last updated: 2017-12-12Bibliographically approved
4. Improving occupational performance: a single case study of patients with chronic pain
Open this publication in new window or tab >>Improving occupational performance: a single case study of patients with chronic pain
(English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:mdh:diva-8176 (URN)
Available from: 2010-02-12 Created: 2010-02-12 Last updated: 2018-03-16Bibliographically approved

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