Date Presented 04/22/2023
Individuals experiencing chronic pain (CP) often report difficulties with sleep and exhaustion, decreased physical abilities, poor social relations, and a decreased ability to perform meaningful activities, such as work and leisure. Because CP negatively effects occupational performance, there is a need for OT to become a more integral part of CP management. This presentation will cover the research and development of a virtual self-management intervention for CP.
Primary Author and Speaker: Elizabeth Gibbs
Contributing Authors: Emily K. Simpson, Kurt Heinking
PURPOSE: Chronic Pain (CP) negatively impacts individuals’ physiological, psychological, and social well-being, including difficulties with sleep/exhaustion, decreased physical abilities, poor social relations, and a decreased ability to perform meaningful activities (Elzahaf et al., 2012). As a result, individuals experiencing chronic pain report having a poor quality of life and decreased self-efficacy (Miller et al. 2020; Nost et al., 2016). Because CP negatively impacts individuals’ occupational performance and satisfaction, occupational therapy practitioners (OTPs) are uniquely positioned to provide occupation-based CP interventions and help improve individuals’ quality of life and self-efficacy. Preliminary research suggests that OT CP interventions can improve individuals’ quality of life, increase their self-efficacy, and engagement in meaningful occupations (Lagueux et al., 2021; Simon & Collins, 2017). This study aimed to investigate the effectiveness of a virtual 6-session occupational therapy self-management intervention (OTSM) when compared to standard osteopathic manipulation treatments for individuals experiencing CP. Outcomes measured were self-efficacy, pain levels, quality of life, and perceived occupational performance.
METHOD: A two group pre-/posttest quasi-experimental research design was used, including participants in the treatment group (n = 13) and the care-as-usual group (n = 8), which consisted of bi-weekly/monthly osteopathic manipulation treatments, or OMTs. Individuals who qualified for the study were experiencing CP for at least 3 months, were over the age of 18 years old, and receiving treatment at Midwestern University’s Multi-Specialty Clinic. Participants in both groups completed a battery of assessments before and after the intervention, including the Canadian Occupational Performance Measure (COPM), which measured perceived occupational performance and satisfaction; the Pain, Enjoyment, General Activity Scale (PEG), World Health Organization Quality of Life (WHO-QOL BREF), which measured quality of life, and the West Haven Yale Multidimensional Pain Inventory (WHYMPI), both of which measured dimensions of the pain experience; and the General Self-Efficacy Scale (GSES), which measured self-efficacy. The intervention included education, action planning, and individualized practice opportunities related to exercise and movement, stress management, routine management, and adapting occupations. Wilcoxon signed-rank tests were used to compare pre- and post- variables in both groups and Mann-Whitney tests were performed to compare intervention and care-as-usual groups, where p < 0.05 was considered statistically significant. Two focus groups (n = 5) were additionally conducted, and content analysis was applied to the transcripts.
RESULTS: The intervention had a positive effect on participants’ perceived occupational performance (0.012) and satisfaction (0.002), pain severity (0.036), pain and activity (0.043), pain and enjoyment (0.016), and self-efficacy (0.011). Qualitative findings indicated that the intervention allowed participants to participate in new and past occupations, increasing their self-efficacy, positively impacting their attitudes, and minimizing their pain experiences.
CONCLUSION: Findings demonstrate the potential for occupational therapy to be part of a holistic care approach to CP management. Participants found the intervention beneficial in managing their CP and enabling them to participate in meaningful occupations. Future research should consider the inclusion of group sessions, adding creative modes and multiple platforms for program implementation, an increased focus on mental health, and more intentional collaboration between interprofessional team members.
References
Lagueux, Masse, J., Levasseur, M., Pagé, R., Dépelteau, A., Lévesque, M. H., Tousignant-Laflamme, Y., & Pinard, A. M. (2021). Pilot Study of French-Canadian Lifestyle Redesign® for Chronic Pain Management. OTJR Occupation, Participation and Health, 41(2), 80–89. https://doi.org/10.1177/1539449220982908
Miller, J., MacDermid, J. C., Walton, D. M., & Richardson, J. (2020). Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 101(5), 750–761. https://doi.org/10.1016/j.apmr.2019.12.016
Simon, A. U., & Collins, C. E. (2017). Lifestyle Redesign® for chronic pain management: A retrospective clinical efficacy study. American Journal of Occupational Therapy, 71, 7104190040. https://doi.org/10.5014/ ajot.2017.025502
Louw, A., Schmidt, S., Zimney, K., & Puentedura, E. J. (2019). Treat the patient, not the label. Journal of Women’s Health Physical Therapy, 43(2), 89–97. https://doi.org/10.1097/jwh.0000000000000121
