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| 2. |
- Boersma, Katja, 1973-, et al.
(author)
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Lowering fear-avoidance and enhancing function through exposure in vivo : a multiple baseline study across six patients with back pain
- 2004
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In: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 108:1-2, s. 8-16
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Journal article (peer-reviewed)abstract
- This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.
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| 3. |
- Buer, Nina, 1960-, et al.
(author)
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Fear-avoidance beliefs and catastrophizing : occurrence and risk factor in back pain and ADL in the general population
- 2002
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In: Pain. - 0304-3959 .- 1872-6623. ; 99:3, s. 485-491
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Journal article (peer-reviewed)abstract
- Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain.The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL).The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.
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| 5. |
- Linton, Steven J, 1952-, et al.
(author)
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Early identification of patients at risk of developing a persistent back problem : The predictive validity of the Örebro musculoskeletal pain questionnaire
- 2003
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In: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 19:2, s. 80-86
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Journal article (peer-reviewed)abstract
- Objective: To test the predictive utility of the Orebro Musculoskeletal Pain Screening Questionnaire in identifying patients at risk for developing persistent back pain problems. Design: Prospective, where participants completed the questionnaire and their cases were followed for 6 months to assess outcome with regard to pain, function, and absenteeism due to sickness. Participants: One hundred seven patients, recruited from seven primary care units. Results: Discriminant analyses showed that the items on the questionnaire were significantly related to future problems. For absenteeism due to sickness, 68% of the patients were correctly classified into one of three groups, whereas an even distribution would have produced 33%. The analyses for function correctly classified 81%, and for pain 71%, into one of two groups, compared with a chance level of 50%. A total score analysis demonstrated that a cutoff score of 90 points had a sensitivity of 89% and a specificity of 65% for absenteeism due to sickness, and a sensitivity of 74% and a specificity of 79% for functional ability. Conclusions: The results underscore that psychological variables are related to outcome 6 months later, and they replicate and extend earlier findings indicating that the Örebro Screening Questionnaire is a clinically reliable and valid instrument. The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain. The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors.
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| 7. |
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| 8. |
- Marhold, Charlotta, et al.
(author)
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A cognitive-behavioral return-to-work program : Effects on pain patients with a history of long-term versus short-term sick leave
- 2001
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In: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 91:1-2, s. 155-163
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Journal article (peer-reviewed)abstract
- A cognitive-behavioral return-to-work focused program was evaluated in a randomized controlled design, and the effects were compared between two groups of women with musculoskeletal pain. One group of patients (n=36) had a history of long-term sick leave (>12 months) at the start of the program and the other (n=36) had a history of short-term sick leave (2-6 months). The outpatient treatment program, conducted by a psychologist, included 12 sessions with the primary aim to help the patients return-to-work. The treatment first included teaching of coping strategies such as applied relaxation, stress management, graded activity training and pacing. Thereafter the patients were taught how to manage difficulties at their return-to-work and how to generalize coping strategies to different risk factors at their work places. The control condition received treatment-as-usual. The results showed that the cognitive-behavioral return-to-work program was more effective than the treatment-as-usual control condition in reducing the number of days on sick leave for patients on short-term sick leave, but not for patients on long-term sick leave. The treatment program also helped the patients on short-term sick leave to increase their ability to control and decrease pain and to increase their general activity level compared to the control condition. These results underscore the need for an early return-to-work focused rehabilitation to prevent long-term sick leave and disability.
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| 9. |
- Marhold, Charlotta, et al.
(author)
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Identification of obstacles for chronic pain patients to return to work : Evaluation of a questionnaire
- 2002
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In: Journal of occupational rehabilitation. - : Springer. - 1053-0487 .- 1573-3688. ; 12:2, s. 65-75
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Journal article (peer-reviewed)abstract
- The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named "Depression," "Pain intensity," "Difficulties at work return," "Physical workload and harmfulness," "Social support at work," "Worry due to sick leave," "Work satisfaction," "Family situation and support," and "Perceived prognosis of work return." The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales "Perceived prognosis of work return," "Social support at work," "Physical workload and harmfulness," "Depression," and "Pain intensity" could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery.
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| 10. |
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New avenues for the prevention of chronic musculoskeletal pain and disability
- 2002. - 1
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Editorial collection (peer-reviewed)abstract
- Starting with the introduction readers are shown the dire need for prevention and the peculiarities of preventing a problem that is typically recurrent. In the second section risk factors and mechanisms are examined that provide a unique and in-depth understanding of how disability develops and thereby how it might be prevented. Chapters are dedicated to major risk factors such as stress ergonomics and fear-avoidance as well as to the overriding question of why acute pain sometimes develops into a chronic problem. The major challenge facing the field today is developing effective preventive interventions. Section three provides detailed information on a number of approaches to the prevention of debilitating chronic pain. The section starts with the early identification of patients who based on the information in section two on risk factors will likely develop persistent pain and disability. Clinical and workplace oriented prevention strategies are highlighted. Readers are introduced to the problems and solutions in developing effective preventive programs. Several successful methods are described in terms of program delivery and scientific value. This book will provide the state of the art on how to understand and effectively deal with this costly and devastating problem.
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