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When matching fails: Understanding the process of matching pain-disability treatment to risk profile
Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.ORCID-id: 0000-0001-9429-9012
Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.ORCID-id: 0000-0001-5359-0452
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Purpose A previous study [1] showed that matching people at risk for pain-related disability to an intervention aimed at targeting their psychological problem profile did not, as hypothesized, improve the effect of the intervention. Methodological issues were suggested to explain the lack of differential effect. It was questioned whether the profiles used to allocate people to treatment were adequate. The aim of this study was to investigate if the risk profiles used to determine matching were sufficiently stable and valid by comparing the original profiles withprofiles constructed using other methods.

Methods Ninety-five people suffering musculoskeletal problems were screened, profiled, and matched to workplace based early interventions according to profiles. We studied stability and validity of their psychological risk profiles by investigating their concordance at different time points. People were originally assigned to profiles at inclusion, using a brief screening questionnaire. Then, they were profiled just before treatment start,using the same items. Finally, they were profiled again at treatment start, using extensive questionnaires. Concordance among the three sets of profiles was investigated.

Results Profiles at inclusion were unstable until treatment start. People moved from profiles with more severe elevations in psychological variables, to a profile with moderate elevations. Concordance between the two means of profiling at treatment start was better; the brief screening and the extensive questionnaires assigned people to similar profiles.

Conclusions Risk level may be determined with brief instruments at an early stage of problem development. However, profiles and targets for interventions should be determined immediately prior to treatment start, preferably using full questionnaires.

Nyckelord [en]
Musculoskeletal pain, Occupational Health Services, Disability leave, Risk Assessment, Process Assessment (Health Care)
Nationell ämneskategori
Psykologi
Forskningsämne
Psykologi
Identifikatorer
URN: urn:nbn:se:oru:diva-35184OAI: oai:DiVA.org:oru-35184DiVA, id: diva2:720184
Anmärkning

This research was supported by grants from the Swedish Council for Working Lifeand Social Research

Tillgänglig från: 2014-05-28 Skapad: 2014-05-28 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
Ingår i avhandling
1. Matchmaking in pain practice: challenges and possibilities
Öppna denna publikation i ny flik eller fönster >>Matchmaking in pain practice: challenges and possibilities
2014 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

All people experience pain and for some people, acute pain may over time develop into long-term disabling problems. Already at an early stage, it is possible to identify people at risk for long-term problems and psychologically oriented interventions have been shown to successfully prevent future disability. However, not all people are helped by treatment and there is room for improvement. Moreover, subgroups of people suffering from pain, with different profiles of psychological factors have been identified, indicating that people with pain problems differ. The first aim of this dissertation was to improve the understanding of how people differ. The second aim was to use these individual differences and to match people to psychological treatment based on their psychological profile. The third aim was to explore what happens during treatment that might be important for treatment outcome.

The findings show that people who belonged to subgroups with elevated levels of psychological factors had less favorable outcomes over time, despite treatment, than people with no elevations. Moreover, people with elevations in several psychological factors had even less favorable outcomes. Psychological treatments aimed at preventing future disability performed well, but using profiles to match people to treatment did not improve outcomes further; people who were matched to a treatment and people who were unmatched had similar outcomes. However, the profiles used for matching were unstable over time and there is need to improve the identification of psychological variables used for treatment matching. Finally, a number of psychological factors were shown to be valuable targets for treatment; if the treatments successfully produced change in people’s thoughts and emotions related to pain the treatment outcomes were better. The findings were summarized in a flow chart showing the recommended clinical approach to people seekinghealth care for acute pain problems.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro universitet, 2014. s. 91
Serie
Örebro Studies in Psychology, ISSN 1651-1328 ; 29
Nyckelord
pain, psychological profiles; psychological treatment; early intervention; secondary prevention; treatment matching
Nationell ämneskategori
Psykologi
Forskningsämne
Psykologi
Identifikatorer
urn:nbn:se:oru:diva-33751 (URN)978-91-7529-006-5 (ISBN)
Disputation
2014-03-28, Hörsal L3, Långhuset, Örebro universitet, Fakultetsgatan 1, Örebro, 10:15 (Engelska)
Opponent
Handledare
Tillgänglig från: 2014-02-14 Skapad: 2014-02-14 Senast uppdaterad: 2018-04-17Bibliografiskt granskad

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Bergbom, SofiaBoersma, KatjaLinton, Steven J.

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