| 1. |
- Denison, Eva, et al.
(författare)
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Musculoskeletal pain in primary health care : subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables
- 2007
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Ingår i: Journal of Pain. - : Elsevier BV. - 1526-5900 .- 1528-8447. ; 8:1, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to identify and describe subgroup profiles based on self-reported pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing in patients with musculoskeletal pain. Two primary health care samples (n = 215 and n = 161) were used. Self-report questionnaires were completed at the start of physical therapy treatment. Cluster analysis was used to generate subgroups. Three subgroups were identified in sample 1 and replicated in sample 2. These were labeled "High self-efficacy-Low fear-avoidance," "Low self-efficacy-Low fear-avoidance," and "Low self-efficacy-High fear-avoidance." The subgroups differed significantly in work-status in both samples (P < .001), but not in age, gender, or duration of pain. The results show the presence of subgroups based on pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing. The profile patterns suggest that different management strategies may be relevant in each subgroup. Perspective This article presents subgroups of patients with musculoskeletal pain with different profiles in pain intensity, disability, and psychosocial variables possible to modify by physical therapy management. The results could potentially aid clinicians in tailoring assessment and treatment approaches to each subgroup.
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| 2. |
- Sandborgh, Maria, et al.
(författare)
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Pain belief screening instrument : development and preliminary validation of a screening instrument for disabling persistent pain
- 2007
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:6, s. 461-466
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 3. |
- Sandborgh, Maria, 1955-
(författare)
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Screening, Targeting, Tailoring, and Implementation in Primary Health Care : An integrated physical therapy and behavioural medicine approach to persons with persistent musculoskeletal pain
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis deals with a behavioural medicine approach to the management of patients with persistent musculoskeletal pain in primary health care physical therapy. The main aims of the thesis were; to develop, and evaluate the psychometric properties of, a screening instrument for risk of disability and; to evaluate the implementation and effects of a targeted and tailored treatment.The studies comprise four samples of patients with musculoskeletal pain exceeding one month. All subjects were recruited when consulting physical therapists in Swedish primary health care settings. For development and evaluation of the Pain Belief Screening Instrument (PBSI) four samples were used; two samples (n1 = 215 and n2 = 93) in Study I, one sample (n = 168) in Study II, and one sample (n = 45) in Study III. For evaluation of implementation and effects of targeted and tailored treatment the 32 patients who completed treatment in Study III were used. In Study IV treatment documents of 18 patient cases from Study III were studied to evaluate treatment integrity.The concurrent and predictive validity of the PBSI was good, and the instrument was therefore used to define subgroups with either a high or low risk for disability. A low treatment dosage of a tailored treatment for low risk patients was tried and found equally efficient as a longer treatment focusing physical exercise. Subjects who received a treatment tailored to individual patient characteristics perceived a better global outcome of treatment compared to subjects in the control group. However, no between-group differences in the disability measures were found. The evaluation of treatment integrity displayed low therapist adherence to the treatment rationale for the tailored treatment.The studies demonstrate ways to systematically integrate a behavioural medicine approach and physical therapy. The results indicate efficiency in managing patients with persistent musculoskeletal pain in primary health care.
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| 4. |
- Sandborgh, Maria, et al.
(författare)
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The Pain Belief Screening Instrument (PBSI) : Predictive validity for disability status in persistent musculoskeletal pain
- 2008
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 30:15, s. 1123-1130
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To evaluate the predictive validity of a screening instrument measuring disability, self-efficacy, fear of movement and catastrophizing, for disability status in patients with musculoskeletal pain in primary health care physical therapy. Development over time of pain-related disability, pain intensity, self-reported work capacity and overall daily function for subgroups of patients was also investigated. Method. Prospective and correlational study, where patients (n = 168) with a pain-duration of 4 weeks or more completed the questionnaires and their cases were followed for 8 months to assess the variables of interest. For predictive validity of the screening instrument discriminant analyses were conducted. The development over time for subgroups was analysed by comparing scores at the first and second measurement. Results. The PBSI correctly classified 72% of the subjects as High-disabled (n = 33) or Low-disabled (n = 110), as measured with the Pain Disability Index (Wilks' lambda = 0.848, p < 0.005). For pain intensity, self-reported changes in work capacity and overall daily function the discriminant analyses were not significant. The High-disability group had increased disability, unchanged pain intensity and decreased work capacity and daily function after 8 months. Conclusion. The predictive validity of the PBSI for disability was confirmed. In clinical use the PBSI could serve as a mean to obtain supplementary and clinically useful information.
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