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Screening to identify patients at risk: profiles of psychological risk factors for early intervention
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-9429-9012
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-5359-0452
2005 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 21, no 1, p. 38-43Article in journal (Refereed) Published
Abstract [en]

There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.

Place, publisher, year, edition, pages
2005. Vol. 21, no 1, p. 38-43
National Category
Social Sciences Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-2814PubMedID: 15599130OAI: oai:DiVA.org:oru-2814DiVA, id: diva2:134639
Note
Discussion p. 69-72Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention
Open this publication in new window or tab >>Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Betydelsen av rädsla och undvikande i utvecklingen av ett långvarigt smärtproblem : implikationer för sekundär prevention
Abstract [en]

This dissertation focused on the role of fear and avoidance in the development of a persistent back pain problem. The first aim of this dissertation was to study when and how cognitive, affective and behavioral factors influence one another in the development of persistent pain and disability. The moderating role of pain duration on the relationship between psychological risk factors and dysfunction was studied, as well as the interrelationships between psychological risk factors within individuals.

The results suggest that pain duration may moderate the relationship between some of the psychological risk factors and function. In study two, depression and function were interrelated independent of stages of chronicity while the strength of the relationship between fear of movement and function increased across the stages. Further, the results suggest that there may be individual variability in the importance of psychological risk factors and in how these factors are interrelated within individuals. In study one and three profiles of psychological functioning emerged that were characterized by pain-related fear with and without depressed mood, by depressed mood only, and by low pain-related fear and no depressed mood. These profiles were meaningfully related to future disability.

The second aim of this dissertation was to test a new treatment that is designed to match patients with high levels of fear and avoidance. The results of study four show that this exposure treatment can produce significant decreases in fear and increases in function.

The results of the studies in this dissertation suggest that we need to assign a key role to psychological processes such as pain-related fear, depressed mood, and avoidance in our efforts to understand the development of persistent back pain disability. The results highlight that there may be several roads towards a persistent back pain problem and that the relationship between psychological factors and disability is not static but appears to change as a function of pain duration. This suggests that we need to know more about the process of development of persistent back pain disability and that future research should incorporate the role of time, as well as take into consideration that there may be individual variability in the importance of factors and their interactions. Lastly, the results suggest that secondary prevention of persistent back pain disability could be enhanced by addressing psychological processes at a much earlier time point than is currently practiced and by customizing interventions to the characteristics of the individual patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek, 2005. p. 71
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 5
Keyword
Psychology, pain-related fear, fear-avoidance model, back pain, disability, development, exposure, Psykologi
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-110 (URN)91-7668-433-4 (ISBN)
Public defence
2005-05-20, Aulan, B-huset, Universitetssjukhuset, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-10-18Bibliographically approved

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Boersma, KatjaLinton, Steven J.

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