Perceived self-efficacy and outcome expectancies in coping with chronic low back pain

Life-long music and dance relationships inform impressions of music- and dance-based movement therapies in individuals with and without mild cognitive impairment

Background

No effective therapies exist to prevent degeneration from Mild Cognitive Impairment (MCI) to Alzheimer's disease. Therapies integrating music and/or dance are promising as effective, non-pharmacological options to mitigate cognitive decline.

Objective

To deepen our understanding of individuals' relationships (i.e., histories, experiences and attitudes) with music and dance that are not often incorporated into music- and dance-based therapeutic design, yet may affect therapeutic outcomes.

Methods

Eleven older adults with MCI and five of their care partners/ spouses participated (4M/12F; Black: n=4, White: n=10, Hispanic/ Latino: n=2; Age: 71.4±9.6). We conducted focus groups and administered questionnaires that captured aspects of participants' music and dance relationships. We extracted emergent themes from four major topics, including: (1) experience and history, (2) enjoyment and preferences, (3) confidence and barriers, and (4) impressions of music and dance as therapeutic tools.

Results

Thematic analysis revealed participants' positive impressions of music and dance as potential therapeutic tools, citing perceived neuropsychological, emotional, and physical benefits. Participants viewed music and dance as integral to their lives, histories, and identities within a culture, family, and/ or community. Participants also identified lifelong engagement barriers that, in conjunction with negative feedback, instilled persistent low self-efficacy regarding dancing and active music engagement. Questionnaires verified individuals' moderately-strong music and dance relationships, strongest in passive forms of music engagement (e.g., listening).

Conclusions

Our findings support that individuals' music and dance relationships and the associated perceptions toward music and dance therapy may be valuable considerations in enhancing therapy efficacy, participant engagement and satisfaction for individuals with MCI.

What do patients referred to physical therapy for a musculoskeletal condition expect? A qualitative assessment

BACKGROUND

Patient expectations related to physical therapy outcomes are commonly collected through surveys and close-ended questionnaires. These methods may not optimally capture patients' expectations for physical therapy, especially in the patients' own words. Louis Gifford identified four questions attempting to guide clinicians' understanding of patients' expectations for physical therapy. However, a qualitative assessment mapping the expectations that patients have prior to starting physical therapy appears to be undocumented.

OBJECTIVES

The aim of this study was to determine patient expectations prior to beginning physical therapy for individuals with musculoskeletal conditions.

DESIGN

Qualitative analysis with structured interviews and open-ended participant responses.

METHODS

Twenty-five people (18 female, 7 male; mean age: 47.04 years) were interviewed prior to their initial physical therapy evaluation using a pragmatic approach rooted in phenomenology. Data were transcribed, coded, and thematized using qualitative data analysis software.

RESULTS

Outcome, education, exercise, evaluation, and cause of pain were key themes expressed by participants. Participants appear to want to better understand their symptoms, how they can improve symptoms, what the clinician will do, and how long they will attend physical therapy. Many participants were not certain where physical therapy fit within their overall healthcare plan, and perceptions of manual therapy were vague.

CONCLUSIONS

These identified themes highlight what patients may expect from a physical therapy experience and clinicians should work to identify and satisfy each patient's individual expectations to optimize outcomes.

Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain

OBJECTIVES

The purpose of this study was to evaluate pain self-efficacy (PSE) and coping self-efficacy (CSE) for people with chronic low back pain (CLBP), and to assess whether lower income may be associated with less PSE and CSE in the United States.

METHODS

We conducted a cross-sectional study using survey data collected between June 2016 and February 2017 from n = 1364 patients with CLBP from chiropractic clinics in the United States to measure the relationship between income and both types of self-efficacy. We created 4 multivariate models predicting PSE and CSE scores. We used both a parsimonious set of covariates (age, sex) and a full set (age, sex, education, neck pain comorbidity, catastrophizing, and insurance). We also calculated effect sizes (Cohen's d) for unadjusted differences in PSE and CSE score by income.

RESULTS

Lower income was associated with lower PSE and CSE scores across all 4 models. In the full models, the highest-income group had an average of 1 point (1-10 scale) higher PSE score and CSE score compared to the lowest income group. Effect sizes for the unadjusted differences in PSE and CSE scores between the highest and lowest income groups were 0.94 and 0.84, respectively.

CONCLUSIONS

Our findings indicate that people with lower income perceive themselves as less able to manage their pain, and that this relationship exists even after taking into account factors like health insurance and educational attainment. There is a need to further investigate how practitioners and policymakers can best support low-income patients with chronic pain.

Predictor of self-efficacy in individuals with chronic disease: Stress-coping strategies

AIMS AND OBJECTIVES

This study aims to investigate the relationship between stress-coping strategies of individuals with chronic diseases and their self-efficacy.

BACKGROUND

Self-efficacy and coping with stress in chronic diseases affect the course of the disease.

DESIGN

The sample of this methodological study consisted of 178 patients who were hospitalised in a university hospital between November 2017 and November 2018.

METHODS

Data were collected by the face-to-face interview method using a Patient Information Form, Stress-Coping Styles Scale and Self-Efficacy Scale. This study followed STROBE checklist for cross-sectional studies.

RESULTS

The study found that there was a strong relationship between patients' coping strategies and their self-efficacies and that the variables that predict self-efficacy in order of importance were self-confident approach (β = .41), the helpless approach (β = -0.24) and the submissive approach (β = -0.15), respectively. The study also found that the optimistic approach and the seeking social support approach had no significant contribution to the model.

CONCLUSIONS

The most important predictor of self-efficacy in individuals with chronic disease was the self-confident approach, which was one of the problem-oriented coping strategies. Therefore, patients should be taught to use effective methods to cope with stress to increase their self-efficacy, and their self-confidence should be supported.

RELEVANCE TO CLINICAL PRACTICE

In individuals with chronic disease, self-efficacy has an important role to get better psycho-social adaptation. To determine patients' self-efficacy levels and predictors will guide nursing initiatives.

Motivational Non-directive Resonance Breathing as a Treatment for Chronic Widespread Pain

Chronic widespread pain (CWP) is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational non-directive (ND) resonance breathing, as a means of reducing pain and suffering in patients with CWP. Motivational ND resonance breathing provides patients with a noninvasive means of potentially modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life.

The Relationship between Self-Efficacy and Psychosocial Care in Adolescents with Epilepsy

Introduction. Studies about epilepsy are more associated with physiological aspects and drug therapy and far too little attention has been paid to psychological and social care, especially in teens. Hence, the present study aimed to assess relationship between self-efficacy and psychosocial care in adolescents with epilepsy. Methods. A cross-sectional association study was conducted on 74 consecutive adolescents aged 10 to 18 years with general attacks of epilepsy referred to Pediatric Neurology Clinics affiliated with the Tabriz University of Medical Sciences in 2013. Data were collected by interview using multisegment tools including demographic characteristics, self-efficacy scaling in children with epilepsy, and reporting tools for children psychosocial care. Results. Our study showed a significant association of self-efficacy with “information received” (P < 0.02) and also with “need for information or support” (P < 0.01) as well as “concerns and fears” (P < 0.01). The comments of doctor or nurse were directly associated with higher self-efficacy and patients' information needs were inversely associated with higher self-efficacy. Conclusion. For adolescents with epilepsy, providing educational materials such as pamphlets and booklets, designing especial websites, and setting especial meetings with and without parents separately are recommended. Scheduling psychosocial supports and collecting more information about this disorder for adolescents will be helpful.

Patient's Communication Perceived Self-efficacy Scale (PCSS): construction and validation of a new measure in a socio-cognitive perspective

OBJECTIVE

In two studies we constructed and validated the Patient's Communication Perceived Self-efficacy Scale (PCSS) designed to assess patients' beliefs about their capability to successfully manage problematic situations related to communication with doctor.

METHODS

The 20-item scale was administered to 179 outpatients (study 1). An Exploratory Factor Analysis revealed a three-factor solution. In study 2, the 16-item scale was administered to 890 outpatients.

RESULTS

Exploratory and Confirmatory Factor Analyses supported the 3-factor solution (Provide and Collect information, Express concerns and doubts, Verify information) that showed good psychometric properties and was invariant for gender.

CONCLUSION

PCSS is an easily administered, reliable, and valid test of patients' communication self-efficacy beliefs.

PRACTICE IMPLICATIONS

It can be applied optimally in the empirical study of factors influencing doctor-patient communication and used in training aimed at strengthening patients' communication skills.

Discrepancy between Radiographic Damage and Functional Disability in Elderly People with Osteoarthritis: The Role of Pain Coping Strategies

The aim of this study is twofold. First, to assess the level of agreement between radiographic damage and functional disability in older people with osteoarthritis. And second, to assess the role of coping skills and sensory pain parameters as sources of disagreement between these variables. To achieve this objective we assess, in a sample of 104 older people with osteoarthritis, the following variables: functional capacity, radiographic damage, pain coping strategies, pain intensity, pain frequency and pain duration. The results show a non-linear relationship between radiographic damage and functional disability, modified by the levels of the two variables. There was maximum agreement between low levels of radiographic damage and of functional impairment, whilst agreement decreased for moderate and high levels of radiographic damage. Certain coping strategies may help to explain this disparity.

Individual expectation: an overlooked, but pertinent, factor in the treatment of individuals experiencing musculoskeletal pain

Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice.

Factors that affect functional status in patients with cancer-related pain

Cancer-related pain in outpatient adult populations remains high and has a direct effect on functional status. Factors that affect functional status have been explored separately, but the inter-relatedness of those factors has not been examined. Using a cross-sectional design, the purpose of this study was to examine the relationships between pain level, beliefs about pain, symptom distress, perceived control over pain, and functional status in 304 ambulatory cancer patients who experienced cancer-related pain within the past 2 weeks. Participants completed standardized questionnaires during regularly scheduled clinic visits. Patient's pain level was positively related to increased distress and decreased perceived control over pain and functional status. Structural equation modeling indicated that symptom distress mediated the relation between pain level and functional status. Perceived control over pain had a direct effect on symptom distress and mediated the effect of beliefs about pain and pain level on symptom distress. Patients' perceived control over pain may be an important component in pain management. The direct and mediating effects of perceived control and symptom distress suggest areas of further research. Interventions to increase knowledge and decrease barriers to pain control have the potential for increasing perceived control over pain.

Perseverance by Older People in Their Management of Chronic Pain: A Qualitative Study: Table 1

INTRODUCTION

Many older people suffer from degenerative and chronic diseases resulting in chronic pain. It is important for health professionals and researchers to gain insights into experiences of chronic pain sufferers, so that they may understand the patient's perspective and instigate appropriate treatments.

AIM

This study set out to gain insights into older people's perceptions about the effect of chronic pain on their lives and how they self-manage it.

DESIGN

A qualitative approach to generating data based on Grounded Theory was chosen. Sixty-three people between the ages of 60 and 87 years participated and were interviewed using audiotape. The interviews were transcribed and subsequently analyzed, and the material was coded and collapsed into themes constituting the final grounded theory.

RESULTS

As the data collection progressed, a major theme of perseverance emerged, supported by two subthemes: * keeping occupied, and * a focus on social activities. It became apparent that the participants were determined to get on with their lives. Those with strong social links appeared to have a more positive outlook on life.

CONCLUSIONS

"Keeping going" was a priority for most of the participants. It may be beneficial to identify the ways in which older people persevere despite chronic pain. It is important for health professionals to appreciate the social factors which are important to, and valued by, older people who experience chronic pain.

Brief cognitive-behavioral audiotape interventions for cancer-related pain: Immediate but not long-term effectiveness

BACKGROUND

Few studies have evaluated cognitive-behavioral interventions as an adjunct treatment for chronic cancer-related pain. A randomized clinical trial was performed evaluating the efficacy of 3 brief cognitive-behavioral techniques: relaxation, distraction, and positive mood interventions.

METHODS

Fifty-seven patients with chronic cancer-related pain taking opioid medications were randomly assigned to either the relaxation, distraction, positive mood, or waiting-list control group. The patients in the 3 intervention groups received audiotapes of the cognitive-behavioral technique and were asked to practice regularly at home. The tapes were supplemented with written instructions and follow-up telephone calls.

RESULTS

Patients in the relaxation and distraction groups reported significantly reduced pain intensity immediately after listening to the tapes. The pain reduction was not maintained, however. At the 2-week follow-up assessment, no significant differences in pain intensity or interference were found among the treatment groups. The groups also did not differ with regard to secondary outcome measures assessing quality of life, mood, self-efficacy, and other symptoms. The results of qualitative interviews indicated that patients often had difficulty focusing on the audiotapes and preferred their own methods of pain reduction.

CONCLUSIONS

Brief relaxation and distraction audiotape interventions produced immediate pain reductions but not longer-term pain relief. Additional research with a more individualized intervention is needed to evaluate cognitive-behavioral interventions for cancer pain control.

Chronic disease self-management program for low back pain in the elderly

OBJECTIVE

To evaluate the effectiveness of Stanford's Chronic Disease Self-Management Program (CDSMP) for chronic low back pain (LBP) in older Americans.

DESIGN

Randomized controlled trial.

SETTING

Community-based program offered at 12 locations.

SUBJECTS

Community-dwelling seniors (n = 109) aged 60 and older with chronic LBP of mechanical origin.

METHODS

Patients were randomly allocated to the CDSMP or to a 6-month, wait-list control group. The program included one 2.5-hour session per week for 6 weeks. Outcomes evaluated at 6 months included 100-point modified Von Korff pain and disability scales; days with pain and disability; SF-36 general health, energy-fatigue, and emotional well-being scales; 2 scales from the Arthritis Self-Efficacy Scale, self-care attitudes/behaviors, and health services utilization.

RESULTS

For pain at 6 months, the primary outcome, the adjusted mean difference between the program and control, was -1.0 (P = .835). There was a sizable advantage for the program in disability averaged over the course of the entire 6-month study (-9.2, P = .027), but not at the 6-month follow-up (-5.8, P = .278). There was an interaction between intervention and baseline disability days favoring the program for higher baseline values (P = .007). The CDSMP affected emotional well-being (7.6, P = .037) and energy-fatigue (5.1, P = .274). There were no differences for self-efficacy, pain days, and general health.

CONCLUSION

There was no advantage for the CDSMP over a wait-list control for improving pain, general health, self-efficacy, and self-care attitudes in older Americans with chronic LBP. A benefit was suggested for emotional well-being, fatigue, functional disability, and days with disability.

Migraine et migraine transformée avec abus médicamenteux : quelles différences en termes de handicap, de détresse émotionnelle et de stratégies de coping ?

LITERATURE FINDINGS

Twelve percent of general population is estimated to suffer from migraine (Henryet al., 2002), which represent in France 6 to 7 millions of individuals. Transformed migraine (TM) with medication overuse is a complication of migraine characterized by an increase of crisis frequency and by a parallel increase of medication intake. French prevalence of TM with analgesic overuse seems to reach up to 3% of general population (Lanteri-Minet, 2003). TM is associated with an increased disability (concerning housework, leisure, job and social activities). Moreover TM is associated with a bad emotional adjustment, which can lead to anxiety and depressive disorders. Those disorders have been founded to be more frequent in TM than in simple migraine (Radatet al., 1999). As a consequence, TM patients's quality of life is severely impaired. The use of dysfunctional coping strategies against pain should explain bad emotional adjustment in those patients. One study have found a statistical relationship between dysfunctional coping strategies such as nd depressive disorders in migraineurs (Materazzo et al., 2000).

METHOD

The aim of this study was to compare 30 simple migraineurs (SM) to 32 transformed migraineurs with medication overuse (TM) for impairment, emotional adjustment and coping strategies. Patients have been assessed with Pain Disability Inventory (PDI) (Pollard et al., 1984), Hospital Anxiety Depression scale (HAD) (Zigmond and Snaith, 1983) and Coping Strategies Questionnaire (CSQ) (Rosentiel and Keefe, 1983).

RESULTS

Principal Component Analysis (SPSS Software) confirms the good psychometric properties of PDI and HAD in headache patients. Statistical analysis shows higher emotional distress scores (HAD mean score = 32,2 +/- 10,9) in TM than in SM (24, 1 +/- 7,3) (p < 0,001). Both groups didn't use the same coping strategies against pain. TM were characterized by the use of "dramatisation", "distraction" and "pray", which are considered as dysfunctional coping strategies, although SM used "reinterpretation" which is associated with a better adjustment in term of disability and emotional distress (Riley et al., 1999).

CONCLUSION

These results suggest that dysfunctional coping strategies in TM should explained the increased prevalence of emotional distress in this population. It should be of an utmost interest to assess temporal evolution of coping strategies after medication withdrawal. Withdrawal is the main therapeutical measure proposed to TM patients. It should also be supposed that behavioural changes related to medication with drawal evolve in parallel with changes in the use of coping strategies against pain.

Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study

Low back pain (LBP) is a major problem of public health. Chronic pain is the most difficult to treat and the most expensive. The way patients cope with their pain may influence its outcome.

AIM

To identify coping strategies of LBP patients, and their influence on LBP evolution.

METHODS

Ninety nine patients were assessed just after an acute LBP episode and one year later. Assessment tools included medical and social reports, scales of anxiety, depression, quality of life, locus of control (LOC), social support and coping strategies.

RESULTS

One year after the initial episode, 67% of patients have improved and 33% had a chronic pain. A principal components analysis showed that two main dimensions might be identified inside the outcome: functional and emotional non-adjustment. Functional non-adjustment was predicted by male gender, reduction of activity, and history of trauma over one year. Emotional non-adjustment was only predicted by trait-depression. Reactions to pain were structured in four factors: distraction-praying, helplessness-hopelessness, cognitive restructuration and perceived control. Two of these factors predicted adjustment one year later: distraction-praying had a direct effect on functional non-adjustment, and helplessness-hopelessness on emotional issue.

CONCLUSIONS

Besides somatic factors, psychosocial predictors of LBP chronic evolution may be identified. Both aspects must be taken into account in order to prevent chronic pain. Perhaps cognitive-behavior therapy may help LBP patients to cope with pain in a better way.

Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement

OBJECTIVE

To examine whether a routine multidisciplinary inpatient rehabilitation program can increase patient self-efficacy, and to investigate the effects of high self-efficacy at admission, and increases in self-efficacy, on health changes in patients who undergo such rehabilitation after hip joint replacement.

METHODS

Participants in this longitudinal study were 1,065 patients who underwent inpatient rehabilitation after hip joint replacement. Questionnaires were administered at admission, discharge, and 6-month followup. The main outcome variables were disability, pain, depressive symptomatology, and self-efficacy to cope with disability and pain.

RESULTS

Significant improvements from admission to discharge from the inpatient rehabilitation program in disability, pain, depressive symptoms, and self-efficacy were found. In addition, higher levels of self-efficacy at admission and larger increases in self-efficacy over the course of the program predicted larger health changes (i.e., greater decreases in disability, pain, and depressive symptoms). Results were generally similar for health changes from discharge to 6-month followup.

CONCLUSION

A routine multidisciplinary inpatient rehabilitation program after hip joint replacement can result in enhanced self-efficacy.

Beliefs about the controllability of pain: congruence between older adults with cancer and their family caregivers

Family dyadic beliefs about pain controllability were examined to determine what influence they had on patient symptom distress and subjective caregiver burden. The Calgary Family Assessment and Intervention Models and Illness Beliefs Model guided this investigation. Self-report questionnaires were administered to a sample of 81 family dyads that consisted of ambulatory cancer care older adult outpatients and their family caregivers. Inferential statistics indicated that family dyads were congruent in their beliefs about pain controllability. Descriptive statistics showed that family dyads with beliefs that the pain was controllable had less symptom distress and caregiver burden than dyads with beliefs that pain was not controllable. Results suggest that family dyadic beliefs that cancer-related pain is controllable have a positive influence on family pain control outcomes. Findings also support the need for nurses to include family members when developing pain management interventions for older adults.

Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey

Background

Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits.

Methods

During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period.

Results

Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year) at baseline with an odds ratios of 0.55 (95% CI: 0.33–0.90). This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2–3.0, for the highest educated group), but not of the consequences (leg pain and exemption from duty), whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1–0.8 for exemption from duty in the group with highest IQ). Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1–10.8), leg pain (OR: 3.3;1.3–8.3) and exemption from duty during service (OR: 5.9;2.4–14.8).

Conclusion

Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the duration of low back pain prior to service and IQ-level are the most important factors.

Further validation of the chronic pain coping inventory

Multidisciplinary treatment programs for chronic pain typically emphasize the importance of decreasing maladaptive and encouraging adaptive coping responses. The Chronic Pain Coping Inventory (CPCI), developed to assess coping strategies targeted for change in multidisciplinary pain treatment, is a 64-item instrument that contains 8 subscales: Guarding, Resting, Asking for Assistance, Relaxation, Task Persistence, Exercising/Stretching, Coping Self-Statements, and Seeking Social Support. A previous validation study with 210 patients in a Canadian academic hospital setting supported an 8-factor structure for the CPCI. The current study was undertaken to validate the CPCI among 564 veterans with a more extended history of chronic pain. Patients completed the study questionnaires before multidisciplinary treatment. A confirmatory factor analysis was used to examine the factor structure of the 64-item CPCI. A series of hierarchical multiple regression analyses were performed with depression, pain interference, general activity level, disability, and pain severity as the criterion variables and the 8 CPCI factors as the predictor variables, controlling for pain severity and demographic variables. The confirmatory factor analysis results strongly supported an 8-factor model, and the regression analyses supported the predictive validity of the CPCI scales, as indicated by their association with measures of patient adjustment to chronic pain.

PERSPECTIVE

This article validated the 8-factor structure of the CPCI by using a confirmatory factor analysis and a series of linear regressions. The results support the applicability and utility of the CPCI in a heterogeneous population of veterans with severe chronic pain treated in a tertiary teaching hospital. The CPCI provides an important clinical and research tool for the assessment of behavioral pain coping strategies that might have an impact on patient outcomes.

Exploratory analysis to identify factors impacting return-to-work outcomes in cases of cumulative trauma disorder

Current findings suggest that cumulative trauma disorders are multifaceted and have less predictable outcomes than trauma cases. The purpose of this study was to attempt to identify emerging patterns and predictive relationships in this diagnostic group that might be worthy of eventual prospective research. The data source was a comprehensive electronic database containing clinical information collected at point of care over a four-year period. A retrospective analysis was performed on 459 workers' compensation cases with upper extremity cumulative trauma disorders and a subset of 312 with carpal tunnel syndrome. The outcome criterion was return to work as a dichotomous variable. Only two significant correlations with return to work were found: the therapist's estimate of rehabilitation potential and the patient's outcome expectation of the ability to work. Further investigation of the role of beliefs and expectations in the therapeutic process would be a productive area for prospective study.

Toward the development of a motivational model of pain self-management

Adaptive management of chronic pain depends to a large degree on how patients choose to cope with pain and its impact. Consequently, patient motivation is an important factor in determining how well patients learn to manage pain. However, the role of patient motivation in altering coping behavior and maintaining those changes is seldom discussed, and theoretically based research on motivation for pain treatment is lacking. This article reviews theories that have a direct application to understanding motivational issues in pain coping and presents a preliminary motivational model of pain self-management. The implications of this model for enhancing engagement in and adherence to chronic pain treatment programs are then discussed. The article ends with a call for research to better understand motivation as it applies to chronic pain self-management. In particular, there is a need to determine whether (and which) motivation enhancement interventions increase active participation in self-management treatment programs for chronic pain.

Comprehensive analysis and management of chronic pain

Given the pervasive effect of chronic pain, a comprehensive approach to nursing care is needed. Addressing the physical effects of persistent pain on multiple systems and bodily functions requires combining (drug and nondrug) interventions to reduce pain and improve functioning. Targeting anxiety, depression and anger effectively can halt or even reverse the escalation of pain attributed to emotions. Recognizing belief patterns associated with distress and disability, while challenging patients to rethink the truthfulness of their perceptions is an important step in helping patients think, feel, and do better. Eliciting self-reflective narratives about the context of pain in their lives taps into the spiritual domain and initiates processes of grieving, forgiveness, and acceptance that are needed to transcend perceived limits and find new meaning in their lives. By attending to social interactions, including therapeutic relationships, chronic pain patients can become more independent and involved in family or socially meaningful activities. Combined, nurses can help patients restore joy, functioning, and a sense of purpose despite the devastating toll persistent pain has taken.

The relationship of perceived control to outcomes in older women undergoing surgery for fractured neck of femur

This paper examines the relationship between internal locus of control and recovery from surgery for fractured neck of femur in women over the age of 65 years, in order to inform strategies for nursing care. Structured interviews were carried out at 5 and 30 days postsurgery with 112 women (mean age 78.6 years) in five general hospitals in the North of England. Locus of control was assessed as a factor associated with the outcomes of physical disability (measured as dependence in activities of daily living) and psychological distress (measured using the Hospital Anxiety and Depression Scale). Internal locus of control was significantly related to less physical disability, but no association was found between locus of control and depression and anxiety at 30 days postsurgery when age, 5-day measures and other 30-day outcome measures were controlled. The findings suggest that nursing interventions that enhance perceived internal control by patients during rehabilitation may result in better physical outcomes. Further work is required to explore the relationship of control to psychological outcomes.

Ways of coping with asthma in everyday life: validation of the Asthma Specific Coping Scale

OBJECTIVE

This study examines the validity of the Asthma Specific Coping Scale.

METHODS

Study samples were comprised of persons with drug-treated asthma (n=3464) drawn from the Drug Reimbursement Registry and asthma rehabilitation participants [brief (n=278) and comprehensive (n=316) intervention]. Data were collected by questionnaires.

RESULTS

The expected structure of the six subscales (restricted lifestyle, hiding asthma, positive reappraisal, information seeking, ignoring asthma, and asthma worry) was supported. The Cronbach's alpha reliabilities of the subscales ranged from .63 to .84. Concurrent validity was supported by meaningful correlations between asthma coping scales and psychosocial resources, health-related quality of life, and general coping. The asthma coping scales discriminated between the intervention participants and the population-based sample. Four out of six subscales also showed sensitivity to change after rehabilitation.

CONCLUSION

Though further longitudinal studies are needed, this scale seems to be a promising instrument to be used in surveys and outcome studies.

Measuring control appraisals in chronic pain

Research has established a positive association between appraisals of control over pain and indexes of adaptive psychologic and physical functioning among persons with chronic pain. A number of measures of control appraisals have been used in the research literature. The current study sought to determine the number of factors or dimensions embedded in these commonly used measures of pain control appraisal. The study also sought to determine the association between the control appraisal construct(s) and measures of patient functioning. Two hundred fifty-two persons with chronic pain completed a questionnaire packet that included multiple measures of control appraisals. A factor analysis resulted in 6 factors: 1 factor representing beliefs about control over life in general, 1 representing perceived control over the effects of pain on one's life, and remaining 4 factors that appear to be more closely tied to perceived control over pain itself. Consistent with previous research, control appraisals made a significant contribution to the prediction of functioning (depression, disability, and pain interference). Most importantly, perceived control over the effects of pain on one's life and perceived control over life in general were more strongly associated with functioning than perceptions of control over pain itself.

Chronic Pain and Self-efficacy: The Effects of Age, Sex, and Chronicity

Higher self-efficacy (SE) is associated with lower pain ratings in chronic pain patients, although longer experience with chronic pain leads to lower SE scores. Self-efficacy in pain patients does not appear to be clearly related to sex or age, however. This study investigated the effects of gender, age, length of pain experience (chronicity) on SE and pain ratings. Archival data from the records of 187 patient's charts were evaluated for demographic information, chronicity, pain ratings and SE. Analyses found a significant inverse relationship between SE and pain ratings (r = -.22) and lower SE for young adult patients. Results support the conclusion that enhanced SE is an important psychosocial intervention in the treatment of chronic pain patients.

A descriptive study of medical and chiropractic patients with chronic low back pain and sciatica: management by physicians (practice activities) and patients (self-management)

BACKGROUND

A practice-based study of ambulatory patients with low back pain noted a long-term outcome advantage for self-referred chiropractic (DC) patients over medical (MD) patients within a subgroup of patients with chronic low back pain and radiating pain below the knee. The frequency of self-care education by physicians in both provider cohorts coupled with current thinking on management of chronic low back pain led to an exploration and description of physicians' noncore practice activities and patients' self-management attitudes and behaviors.

METHODS

A longitudinal, practice-based, observational study was undertaken in 14 general practice and 51 chiropractic community-based clinics. We enrolled 2945 consecutive patients with ambulatory low back pain of mechanical origin; of these, 268 comprised the subgroup of patients with chronic low back pain and radiating pain below the knee. The patients' low back status was followed for 1 year. Data on physicians' practice activities were obtained from doctor questionnaires completed at each patient visit and from chart abstraction. Patient data obtained from self-administered questionnaires at enrollment included sociodemographics, complaint characteristics, health status, and health encounter preferences. Questionnaires mailed at 2 weeks, 1 month, 3 months, 6 months, and 12 months collected data on low back complaint status and satisfaction with treatment. At 1 to 3 years follow-up, mailed questionnaires collected data on patients' self-management attitudes and behaviors.

RESULTS

Physicians' core practice activities were as expected. Exercise plans and self-care education (>55%) were conspicuous in the frequency of their use in the DC cohort. MD patients appeared to rely more on family and friends for support during periods of back trouble. DC patients were characterized by greater self-efficacy motivation (P = .000). Both groups showed evidence of self-care activities during and between bouts of back pain, although MD patients were far more likely to choose bed rest (P = .007).

CONCLUSIONS

The chiropractic encounter may have enhanced patients' self-efficacy motivation, leading to better coping abilities and better pain and disability outcomes. Understanding, respecting, and capitalizing on the role and influence of psychosocial factors can help all physicians become more effective healers and counselors for their patients with back pain.

Reliability and validity of a self-efficacy instrument specific to sickle cell disease

The psychometric properties of a new, 9-item scale measuring disease-specific perceptions of self-efficacy were investigated in a community-based sample of adults (N = 83) with sickle cell disease (SCD). The Sickle Cell Self-Efficacy Scale (SCSES) was comprised of nine questions relating to participants' perceptions of their ability to function on a day-to-day basis and to manage SCD symptomatology (e.g. episodes of pain). The SCSES demonstrated good internal consistency, discriminant validity, and convergent and predictive validity, both with previously validated measures of related constructs as well as with reported SCD symptomatology. Overall, the instrument appears to be reliable and valid for assessing clients' self-efficacy for engaging successfully in day-to-day activities despite having SCD. Future investigators may wish to examine temporal and causal links between alterations in self-efficacy and changes in adjustment to sickle cell disease; the SCSES provides a psychometrically sound tool with which to investigate these phenomena.