Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Experiences of occupational therapists within an ACT-based interdisciplinary pain management program

BACKGROUND

Acceptance and Commitment Therapy (ACT)-based interdisciplinary pain rehabilitation programs have shown effective results. While occupational therapy within these programs has made a unique contribution to pain management because of its focus on occupation and use of group activities, little is known about occupational therapists' own experiences of it.

AIM

The aim of this study was to describe the occupational therapists' experiences of working in a manual-based interdisciplinary pain management program grounded in ACT.

MATERIAL AND METHODS

Six occupational therapists at a pain rehabilitation clinic were interviewed. Data were analysed using Braun and Clark's thematic analysis.

RESULTS

The occupational therapists experienced that ACT and occupational therapy complement each other and that ACT facilitated comprehension of occupational therapy interventions. With ACT, the team gained a common language, which made teamwork and patient comprehension more efficient. A behavioural analysis (SORC) served as a link between occupational therapy and ACT.

CONCLUSIONS

Manual-based occupational therapy activity group interventions with elements of ACT were felt to enhance the patient's understanding of their rehabilitation and supported teamwork.

SIGNIFICANCE

This study provides further support for use of ACT in occupational therapy within interdisciplinary pain management programs. Occupational therapists' use of SORC is an area of development.

Exploring communication in families affected by parental chronic pain: An occupational perspective

BACKGROUND

Family communication about pain is an important therapeutic target when a parent lives with chronic pain. Occupational therapy literature about communication in families affected by parental chronic pain is currently lacking.

AIMS/OBJECTIVES

To bring an occupational perspective to communication within families affected by parental chronic pain, to generate insights for practice.

MATERIALS AND METHODS

Five families (total n = 19 family members) were recruited into this collective case study. The gathered data included interviews, observations, and personal documents/artefacts. A cross-case analysis of similarities and differences between families was conducted to distil insights about the relationship between occupation and communication about parental pain.

RESULTS

Each family develops its own style of communicating about a parent's pain. On a day-to-day basis, pain-related communication is prompted by experienced, observed and/or anticipated occupational disruption brought about by parental pain.

CONCLUSIONS

Occupational disruption and occupational responses need to be components of interest, when designing assessments and interventions targeted at communication in families affected by parental chronic pain.

SIGNIFICANCE

The findings from this study point to the importance of communication through occupation in families affected by parental chronic pain and suggest novel targets for occupational therapy intervention.

Occupational therapists' perspectives on current practice in chronic pain and sleep disturbances

Background

Chronic pain and sleep disturbances are often co-morbid. Sleep disturbances can negatively affect self-care occupations, cognition, mood, emotional functioning and physical wellbeing.

Aim

To explore occupational therapists' experience working with clients with chronic pain and sleep difficulties.

Method

Semi-structured interviews were conducted with 11 occupational therapists with experience working with clients with sleep disturbances and chronic pain.

Findings

The relationship between sleep disturbances and chronic pain was described as being complex and multifaceted. Participants believed they were uniquely placed to work with clients experiencing these two conditions. They felt inadequately equipped to treat sleep disturbances and chronic pain. Participants indicated that best practice required multiple interventions and a team-based approach. Finally, the participants noted that sleep disturbances and chronic pain are a growing area of practice.

Conclusion

The findings suggest that occupational therapists tailor their intervention strategies to be early, multi-pronged and individualised. Institutional barriers need to be addressed to further develop occupational therapists' skill set when working in the areas of sleep and chronic pain. Further research to support the interventions currently used in practice to treat these two conditions is needed.

"I Still Suffer Every Second of Every Day": A Qualitative Analysis of the Challenges of Living with Chronic Orofacial Pain

Objective

Chronic orofacial pain is prevalent and debilitating. Psychological and social factors place a heavy burden on this population but are often overlooked. Here, we offer the first comprehensive qualitative conceptualization of the challenges of living with chronic orofacial pain through a biopsychosocial perspective to inform multifaceted care for this population.

Design

We employed a qualitative thematic analysis of open text responses using a hybrid inductive-deductive approach and a biopsychosocial framework.

Methods

Two hundred and sixty participants with chronic orofacial pain responded to an open-ended question: "What is the biggest challenge you face in managing your condition?" by typing their responses into a text box as part of an online survey. We mapped responses onto biomedical, psychological, and social themes (deductive) and concurrently identified findings within each theme that emerged directly from the data (inductive).

Results

Subthemes within the biomedical theme included challenges with biomedical pain management, medication side effects, sensory triggers, physical symptoms of stress/tension, and biological functions and related activities of daily living. Subthemes within the psychological theme included anxiety, depression, emotional symptoms of stress, unpredictability/uncertainty of pain, and psychological and cognitive aspects of medication management. Subthemes within the social theme included social relational, experience with providers, socioeconomics and access to care, and roles and responsibilities.

Conclusion

Chronic orofacial pain is associated with multifaceted challenges. Consideration of individuals' experiences of biomedical, psychological, and social challenges in the assessment, referral, and treatment of chronic orofacial pain holds the potential to promote more comprehensive, patient-centered care for this population.

The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis

Background

Healthy lifestyle is important to decrease health risks in individuals living with chronic pain. From an occupational therapy perspective, human health and lifestyle are linked to occupational engagement in meaningful everyday activities. This study is aimed at investigating the effect of including occupational engagement in chronic pain interventions on lifestyle.

Methods

In this systematic review (PROSPERO reg. CRD42020159279), we included randomized controlled trials (RCTs) on interventions involving occupational engagement (i.e., occupational performance based on involvement, choice, positive meaning, and commitment) and assessing modifiable lifestyle factors: physical activity, body anthropometrics, alcohol consumption, smoking, stress, and sleep. We sought the databases Ovid MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Scopus, Web of Science, OTseeker, ClinicalTrials.gov, OpenGrey, and the web engine Google Scholar and citations and references of relevant publications. We evaluated methodological quality with the Cochrane risk-of-bias tool 2.0, determined the overall evidence certainty using the GRADE methodology, and performed meta-analysis when two or more trials reported on the outcomes.

Results

Of the 9526 items identified, 286 were full text screened. We included twelve articles with eleven RCTs comprising 995 adults and assessing physical activity, sleep quality, stress, and Body Mass Index. Sufficient data for meta-analysis was only available for physical activity and sleep quality. The meta-analysis suggested a moderate increase in physical activity after behavioral interventions for fibromyalgia and musculoskeletal pain (SMD = 0.69 (0.29; 1.09)) and a small increase in sleep quality up to 6 months after multidisciplinary self-management of fibromyalgia (SMD = 0.35 (95% CI 0.08; 0.61)). The overall certainty of the evidence was deemed low.

Conclusion

Including occupational engagement in chronic pain interventions may increase short-term physical activity and long-term sleep quality. Due to the few available RCTs including occupational engagement in chronic pain treatment for adults living with chronic pain, further high-quality RCTs are needed and will likely change the conclusion.

Exploring perceived occupational balance in women with fibromyalgia. A descriptive study

BACKGROUND

People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation.

OBJECTIVE

To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms.

METHODS

A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure.

RESULTS

One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance.

CONCLUSION

Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance.

SIGNIFICANCE

Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.

Occupational Therapy's Unique Contribution to Chronic Pain Management: A Scoping Review

Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.

Facilitators and barriers to green exercise in chronic pain

BACKGROUND

Green exercise, defined as exercising in nature, demonstrates mental and physical health benefits. There is limited literature on green exercise as part of the treatment for chronic pain. Our objective was to investigate chronic pain patients' perceptions of green exercise and the possible barriers that may arise in employing it as part of their treatment regimes.

METHODS

After institutional ethics committee approval, a convenience sample of 113 adult patients, who attended a chronic pain clinic, were included. Participants completed a questionnaire that included a variety of questions with responses reported using a Likert scale.

RESULTS

The most frequent patient age was 50-70 years in 49% of respondents and the most frequent pain complaint was back pain (62%). Ninety-four percent of participants reported that nature improves their mood. Seventy percent of participants reported that green spaces were easily accessible to them on a regular basis. However, up to 38% reported that they would not be able to commit to three times a week of a green exercise regime. The majority (62% of participants) reported that they would like healthcare practitioners to discuss green exercise with them.

CONCLUSION

Patients who suffer from chronic pain may be interested in green exercise as part of their treatment regime. Barriers that were identified included proximity to outdoor locations, time availability, and personal appraisal of the benefits of exercise for their condition. Green exercise should be considered as a part of a chronic pain treatment plan, and future studies should be directed to evaluating its efficacy in chronic pain.

Mindfulness Training for Occupational Therapy Students

Introduction:

This article describes the experiences of occupational therapy students over the course of three mindfulness programmes, designed to support them in managing stress in their personal and professional lives.

Method:

Hermeneutic phenomenology was used to explore the experiences and perceptions of 20 students undertaking these introductory programmes of mindfulness. Data were collected through interviews, questionnaires and emails.

Findings:

Five themes are presented to demonstrate the effects of mindfulness on students' personal lives, academic work and practice placements. Obstacles to mindfulness practice were found, alongside evidence of benefits in enhanced self-awareness and insight into habitual thought patterns. Techniques for managing stressful situations were used successfully.

Conclusion:

Implications arising from the study are discussed, including the potential for the future inclusion of mindfulness training within the occupational therapy curriculum.