The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Participants
2.3. Interview Script
2.4. Data Collection
2.5. Data Analysis
3. Results
3.1. Participants
3.2. Themes
“…It’s good. I’m pleased. I’m happy, more than happy.”(Male, 72)
“…It did help me, and it helped me mentally as well.”(Female, 69)
“…Overall, I’m ecstatic about how the program went.”(Male, 26)
“Everything made sense…”(Male, 72)
“I can walk without pain. It’s a miracle that program.”(Male, 72)
“I’ve spoken about the program to quite a lot of people & I would recommend it hands-down.”(Female, 60)
“I was surprised. I didn’t expect it to be as good as it was.”(Female, 51)
“But with their help, I was able to see that there is a future providing I’m in the right mindset”(Male, 26)
“…It just didn’t really work for me. I was like, I was always in pain.”(Male, 63)
“My body is more flexible than before. But pain is not gone away...”(Male, 47)
“The specialist even said that nothing can be done…”(Male, 47)
“I went to my neurosurgeon and he said that ‘you’ve got a bulging disc’. He said, ‘I’ll see you back for another op’ and as soon as you hear that you get scared…”(Female, 51)
“It was good for me being a person who likes the information, to have that as background knowledge to understanding why I’m in pain and how to go about managing it. It really helped me.”(Male, 26)
“My pain was completely different to other people’s pain and what I suffered was something different and that other people had different pain. But I could share and understand other people’s views. We shared a lot of things in common.”(Female, 55)
“I can understand where they’re coming from, … but that hasn’t proven to be true in my case. I’ve had to have more medical intervention.”(Female, 60)
“There were a couple of things I found really, really helpful & that was the easily adapted stretching & exercise regime each day.”(Female, 60)
“I have a routine that helps me sleep at night, involving an hour of stretching that I adapted from the stretching part of the program. I do it every night before bed...”(Male, 70)
“The meditation, separated from the context of some sort of religious spirituality, but just in terms of calming the nerves, is extremely important.”(Male, 70)
“Start doing a little bit and increase more and more and more… You get a little bit of pain but don’t get put off, just keep going…”(Male, 72)
“I could really see from the paperwork that we were filling out, how in black & white, I was progressing.”(Female, 60)
“I thought J and T were both great. I thought J was inspirational. His energy and his passion and his belief in the program resonated not just with me, but everyone in our group.”(Female, 51)
“It became possible to relate to the other individuals participating in the program. The small number of people, I got to know them almost every single one, personally.”(Male, 70)
“[Outside of the group] Because we don’t look physically unwell, we haven’t got a broken leg with a cast on it, we’re not showing it & we’re not being believed.”(Female, 60)
“… Some of them obviously had more injuries than others… You can see by the end of that program how much they had progressed.”(Male, 26)
“The program is good in that you can make it custom made to yourself.”(Female, 60)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Rice, A.S.; Smith, B.H.; Blyth, F.M. Pain and the global burden of disease. Pain 2016, 157, 791–796. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Reid, K.J.; Harker, J.; Bala, M.M.; Truyers, C.; Kellen, E.; Bekkering, G.E.; Kleijnen, J. Epidemiology of chronic non-cancer pain in Europe: Narrative review of prevalence, pain treatments and pain impact. Curr. Med. Res. Opin. 2011, 27, 449–462. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Froud, R.; Patterson, S.; Eldridge, S.; Seale, C.; Pincus, T.; Rajendran, D.; Fossum, C.; Underwood, M. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet. Disord. 2014, 15, 50. [Google Scholar] [CrossRef] [Green Version]
- Wynne-Jones, G.; Cowen, J.; Jordan, J.L.; Uthman, O.; Main, C.J.; Glozier, N.; van der Windt, D. Absence from work and return to work in people with back pain: A systematic review and meta-analysis. Occup. Environ. Med. 2014, 71, 448–456. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Deloitte Access Economics. The Cost of Pain in Australia. Available online: https://www2.deloitte.com/au/en/pages/economics/articles/cost-pain-australia.html (accessed on 29 October 2020).
- O’Connell, N.E.; Cook, C.E.; Wand, B.M.; Ward, S.P. Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best Pract. Res. Clin. Rheumatol. 2016, 30, 968–980. [Google Scholar] [CrossRef] [Green Version]
- Kamper, S.J.; Apeldoorn, A.T.; Chiarotto, A.; Smeets, R.J.; Ostelo, R.W.; Guzman, J.; van Tulder, M.W. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015, 350, h444. [Google Scholar] [CrossRef] [Green Version]
- Chou, R.; Deyo, R.; Friedly, J.; Skelly, A.; Hashimoto, R.; Weimer, M.; Fu, R.; Dana, T.; Kraegel, P.; Griffin, J.; et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann. Intern. Med. 2017, 166, 493–505. [Google Scholar] [CrossRef] [Green Version]
- Groot, D.; van Hooff, M.L.; Kroeze, R.J.; Monshouwer, M.; O’Dowd, J.; Horsting, P.; Spruit, M. Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: A concise report of an extended cohort with a minimum of 5-year follow-up. Eur. Spine J. 2019, 28, 1579–1585. [Google Scholar] [CrossRef] [Green Version]
- Tardif, H.; Arnold, C.; Hayes, C.; Eagar, K. Establishment of the Australasian Electronic Persistent Pain Outcomes Collaboration. Pain Med. 2016, 18, 1007–1018. [Google Scholar] [CrossRef] [Green Version]
- Hogg, M.N.; Kavanagh, A.; Farrell, M.J.; Burke, A.L.J. Waiting in Pain II: An Updated Review of the Provision of Persistent Pain Services in Australia. Pain Med. 2020, pnaa374. [Google Scholar] [CrossRef]
- Agency for Clinical Innovation Pain Management Network. Pain Management Programs–Which Patient for Which Program? Agency for Clinical Innovation, 2017. Available online: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0015/205071/ACI13-015-pain-programs-2017-web.pdf (accessed on 17 April 2019).
- Haldorsen, E.M.H.; Grasdal, A.L.; Skouen, J.S.; Risa, A.E.; Kronholm, K.; Ursin, H. Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain 2002, 95, 49–63. [Google Scholar] [PubMed]
- Skouen, J.S.; Grasdal, A.L.; Haldorsen, E.M.; Ursin, H. Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: Randomized controlled study. Spine 2002, 27, 901–909. [Google Scholar] [CrossRef] [PubMed]
- Skouen, J.S.; Kvåle, A. Different outcomes in subgroups of patients with long-term musculoskeletal pain. Nor. Epidemiol. 2006, 16. [Google Scholar] [CrossRef]
- Egan, A.; Lennon, O.; Power, C.K.; Fullen, B.M. “I’ve Actually Changed How I Live”—Patients’ Long-Term Perceptions of a Cognitive Behavioral Pain Management Program. Pain Med. 2016, 18, 220–227. [Google Scholar] [CrossRef]
- Bair, M.J.; Matthias, M.S.; Nyland, K.A.; Huffman, M.A.; Stubbs, D.L.; Kroenke, K.; Damush, T.M. Barriers and facilitators to chronic pain self-management: A qualitative study of primary care patients with comorbid musculoskeletal pain and depression. Pain Med. 2009, 10, 1280–1290. [Google Scholar] [CrossRef]
- Lansbury, G. Chronic pain management: A qualitative study of elderly people’s preferred coping strategies and barriers to management. Disabil. Rehabil. 2000, 22, 2–14. [Google Scholar] [CrossRef]
- Penney, L.S.; Haro, E. Qualitative evaluation of an interdisciplinary chronic pain intervention: Outcomes and barriers and facilitators to ongoing pain management. J. Pain Res. 2019, 12, 865–878. [Google Scholar] [CrossRef] [Green Version]
- Gustafsson, M.; Ekholm, J.; Ohman, A. From shame to respect: Musculoskeletal pain patients’ experience of a rehabilitation programme, a qualitative study. J. Rehabil. Med. 2004, 36, 97–103. [Google Scholar] [CrossRef]
- Wideman, T.H.; Boom, A.; Dell’Elce, J.; Bergeron, K.; Fugère, J.; Lu, X.; Bostick, G.; Lambert, H.C. Change Narratives That Elude Quantification: A Mixed-Methods Analysis of How People with Chronic Pain Perceive Pain Rehabilitation. Pain Res. Manag. 2016, 2016, 9570581. [Google Scholar] [CrossRef] [Green Version]
- Bremander, A.; Bergman, S.; Arvidsson, B. Perception of multimodal cognitive treatment for people with chronic widespread pain—Changing one’s life plan. Disabil. Rehabil. 2009, 31, 1996–2004. [Google Scholar] [CrossRef]
- Driscoll, M.A.; Knobf, M.T.; Higgins, D.M.; Heapy, A.; Lee, A.; Haskell, S. Patient Experiences Navigating Chronic Pain Management in an Integrated Health Care System: A Qualitative Investigation of Women and Men. Pain Med. 2018, 19, S19–S29. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gjesdal, K.; Dysvik, E.; Furnes, B. Mind the Gaps: A Qualitative Study Combining Patients’ and Nurses’ Reflections on Pain Care. SAGE Open Nurs. 2019, 5, 2377960819868865. [Google Scholar] [CrossRef] [Green Version]
- Holtrop, J.S.; Fisher, M.; Martinez, D.E.; Simpson, M.; Awadallah, N.S.; Nease, D.E., Jr.; Zittleman, L.; Westfall, J.M. What Works for Managing Chronic Pain: An Appreciative Inquiry Qualitative Analysis. J. Prim. Care Community Health 2019, 10, 2150132719885286. [Google Scholar] [CrossRef]
- Penney, L.S.; Ritenbaugh, C.; DeBar, L.L.; Elder, C.; Deyo, R.A. Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: A qualitative study. BMC Fam. Pract. 2017, 17, 164. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Al Achkar, M.; Revere, D.; Dennis, B.; MacKie, P.; Gupta, S.; Grannis, S. Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: A qualitative study in Indiana. BMJ Open 2017, 7, e015083. [Google Scholar] [CrossRef]
- Larsson, B.; Gard, G.; Karlsson, L.; Persson, A.L. Patient expectations for a multimodal pain rehabilitation programme: Active participation and coping skills. A qualitative study. Disabil. Rehabil. 2016, 38, 2135–2143. [Google Scholar] [CrossRef]
- Nielsen, S.; Campbell, G.; Peacock, A.; Smith, K.; Bruno, R.; Hall, W.; Cohen, M.; Degenhardt, L. Health service utilisation by people living with chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. Aust. Health Rev. 2016, 40, 490–499. [Google Scholar] [CrossRef] [Green Version]
- Watson, J.A.; Ryan, C.G.; Cooper, L.; Ellington, D.; Whittle, R.; Lavender, M.; Dixon, J.; Atkinson, G.; Cooper, K.; Martin, D.J. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J. Pain 2019, 20, 1140.e1–1140.e22. [Google Scholar] [CrossRef]
- Wood, L.; Hendrick, P.A. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur. J. Pain 2019, 23, 234–249. [Google Scholar] [CrossRef]
- Harrison, L.E.; Pate, J.W.; Richardson, P.A.; Ickmans, K.; Wicksell, R.K.; Simons, L.E. Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain. J. Clin. Med. 2019, 8, 1267. [Google Scholar] [CrossRef] [Green Version]
- Moseley, G.L.; Butler, D.S. Fifteen Years of Explaining Pain: The Past, Present and Future. J. Pain 2015, 16, 807–813. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- O’Brien, E.M.; Staud, R.M.; Hassinger, A.D.; McCulloch, R.C.; Craggs, J.G.; Atchison, J.W.; Price, D.D.; Robinson, M.E. Patient-centered perspective on treatment outcomes in chronic pain. Pain Med. 2010, 11, 6–15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Moseley, G.L.; Butler, D.S. Explain Pain Supercharged; NOI Group: Adelaide, Australia, 2017. [Google Scholar]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Glaser, B.G.; Strauss, A.L. Discovery of Grounded Theory: Strategies for Qualitative Research; Routledge: Abington, UK, 2017. [Google Scholar]
- Kvale, S. InterViews; Sage: Thousands Oaks, CA, USA, 1996. [Google Scholar]
- Liamputtong, P. Qualitative Research Methods, 3rd ed.; Oxford University Press: Victoria, Australia, 2009. [Google Scholar]
- Varpio, L.; Ajjawi, R.; Monrouxe, L.V.; O’Brien, B.C.; Rees, C.E. Shedding the cobra effect: Problematising thematic emergence, triangulation, saturation and member checking. Med. Educ. 2017, 51, 40–50. [Google Scholar] [CrossRef] [PubMed]
- Malterud, K.; Siersma, V.; Dorrit Guassora, A. Sample size in qualitative interview studies guided by information power. Qual. Health Res. 2016, 26, 1753–1760. [Google Scholar] [CrossRef] [PubMed]
- Boeije, H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual. Quant. 2002, 36, 391–409. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Thematic analysis. In APA Handbook of Research Methods in Psychology, Vol. 2: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological, 1st ed.; Cooper, H., Camic, P.M., Long, D.L., Panter, A.T., Rindskopf, D., Sher, K.J., Eds.; American Psychological Association: Washington, DC, USA.
- Tan, G.; Jensen, M.P.; Thornby, J.I.; Shanti, B.F. Validation of the Brief Pain Inventory for chronic nonmalignant pain. J. Pain 2004, 5, 133–137. [Google Scholar] [CrossRef]
- Nicholas, M.K. The pain self-efficacy questionnaire: Taking pain into account. Eur. J. Pain 2007, 11, 153–163. [Google Scholar]
- Sullivan, M.J.; Bishop, S.R.; Pivik, J. The pain catastrophizing scale: Development and validation. Psychol. Assess. 1995, 7, 524. [Google Scholar]
- Toye, F.; Seers, K.; Hannink, E.; Barker, K. A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Med. Res. Methodol. 2017, 17, 116. [Google Scholar] [CrossRef]
- Manary, M.P.; Boulding, W.; Staelin, R.; Glickman, S.W. The patient experience and health outcomes. N. Engl. J. Med. 2013, 368, 201–203. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Verbeek, J.; Sengers, M.J.; Riemens, L.; Haafkens, J. Patient expectations of treatment for back pain: A systematic review of qualitative and quantitative studies. Spine 2004, 29, 2309–2318. [Google Scholar] [CrossRef] [PubMed]
- Matthias, M.S.; Kukla, M.; McGuire, A.B.; Bair, M.J. How do patients with chronic pain benefit from a peer-supported pain self-management intervention? A qualitative investigation. Pain Med. 2016, 17, 2247–2255. [Google Scholar] [CrossRef] [PubMed]
- Rosenstock, I.M. The health belief model and preventive health behavior. Health Educ. Monogr. 1974, 2, 354–386. [Google Scholar] [CrossRef]
- Gifford, L. Pain, the tissues and the nervous system: A conceptual model. Physiotherapy 1998, 84, 27–36. [Google Scholar] [CrossRef]
- Engel, G.L. The clinical application of the biopsychosocial model. Am. J. Psychiatry 1980, 137, 535–544. [Google Scholar] [CrossRef] [PubMed]
- Harding, G.; Campbell, J.; Parsons, S.; Rahman, A.; Underwood, M. British pain clinic practitioners’ recognition and use of the bio-psychosocial pain management model for patients when physical interventions are ineffective or inappropriate: Results of a qualitative study. BMC Musculoskelet. Disord. 2010, 11, 51. [Google Scholar] [CrossRef]
- Robinson, V.; King, R.; Ryan, C.G.; Martin, D.J. A qualitative exploration of people’s experiences of pain neurophysiological education for chronic pain: The importance of relevance for the individual. Man Ther. 2016, 22, 56–61. [Google Scholar] [CrossRef] [Green Version]
- King, R.; Robinson, V.; Elliott-Button, H.L.; Watson, J.A.; Ryan, C.G.; Martin, D.J. Pain reconceptualisation after pain neurophysiology education in adults with chronic low back pain: A qualitative study. Pain Res. Manag. 2018, 2018. [Google Scholar] [CrossRef] [Green Version]
- Denk, F.; McMahon, S.B. Neurobiological basis for pain vulnerability: Why me? Pain 2017, 158, S108–S114. [Google Scholar] [CrossRef]
- Novick, G. Is there a bias against telephone interviews in qualitative research? Res. Nurs. Health 2008, 31, 391–398. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Krefting, L. Rigor in qualitative research: The assessment of trustworthiness. Am. J. Occup. Ther. 1991, 45, 214–222. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Demographic and clinical information: |
|
Open ended questions: |
|
Categorical Variables | n (%) |
---|---|
Gender | |
Male | 5 (45) |
Female | 6 (55) |
Pain duration | |
3 to 12 months | 1 (9) |
1 to 2 years | 3 (27) |
2 to 5 years | 2 (18) |
More than 5 years | 5 (45) |
Main pain site | |
Back | 5 (45) |
Hip | 2 (18) |
Neck | 1 (9) |
Head | 1 (9) |
Shoulder | 1 (9) |
Knee | 1 (9) |
Work status | |
Unemployed due to pain | 8 (73) |
Not working by choice (retired) | 3 (27) |
Compensation claim status | |
Yes | 2 (18) |
No | 9 (82) |
Continuous Variables | Mean (SD) |
Age in years, range, median | 55 (14), 26 to 72, 55 |
Number of pain sites, range | 5.7 (2.5), 2 to 11 |
BPI Severity /10 | 6.5 (2.0) “Moderate” |
BPI Interference /10 | 6.8 (2.0) “Moderate” |
DASS Depression /42 | 23.4 (9.5) “Severe” |
DASS Anxiety /42 | 16.0 (11.5) “Severe” |
DASS Stress /42 | 24.0 (9.8) “Moderate” |
PCS /52 | 29.7 (14.2) “High” |
PSEQ /60 | 19.3 (14.6) “Severe” |
Subthemes | Themes |
---|---|
Overall very positive | The program overall was positive, but… |
Exceeded expectations | |
Recommend to others | |
Motivating, provided a sense of hope | |
Logical and made sense | |
Transformative, life changing | |
I still have pain | |
It didn’t apply to me | |
Inconsistent with specialists | |
Total acceptance of key messages | I valued my improved knowledge and understanding of pain, but… |
Partial or conditional acceptance of key messages | |
Rejection of key messages | |
Stretches | I valued the stretching/relaxation/pacing/activity monitoring |
Relaxation | |
Pacing and activity monitoring | |
Staff support | I valued being part of a supportive and understanding group |
Peer support | |
Validation, being believed | |
Benchmarking | |
Being treated as an individual |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Pate, J.W.; Tran, E.; Radhakrishnan, S.; Leaver, A.M. The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program. Medicina 2021, 57, 46. https://doi.org/10.3390/medicina57010046
Pate JW, Tran E, Radhakrishnan S, Leaver AM. The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program. Medicina. 2021; 57(1):46. https://doi.org/10.3390/medicina57010046
Chicago/Turabian StylePate, Joshua W., Elizabeth Tran, Seema Radhakrishnan, and Andrew M. Leaver. 2021. "The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program" Medicina 57, no. 1: 46. https://doi.org/10.3390/medicina57010046