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Idiographic outcome analyses of the clinical significance of two interventions for patients with musculoskeletal pain
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2006 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 44, no 7, 947-965 p.Article in journal (Refereed) Published
Abstract [en]

This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinically meaningful change. The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain, applying an idiographic outcome measure, The Patient Goal Priority Questionnaire, in combination with the Jacobson and Truax methodology [(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 67 (3), 300–307] for determination of clinical significance. The concurrent validity of the outcome variables behavioral performance, satisfaction with behavioral performance, and fulfilled pre-treatment expectations was also studied. Eighty-two patients, randomized to either individually tailored behavioral medicine treatment (experimental group) or physical exercise therapy (control group) were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals. The experimental intervention had high impact on participants’ performance of their highest ranked everyday life activities, and resulted in larger proportions of clinically significant outcomes compared with controls. The concurrent validity of the outcomes was high for those reporting clinically significant changes, but more generally, there was a moderate agreement across outcome categories. The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct. Further development of idiographic outcome measures is necessary, as is the inclusion in pain intervention research.

Place, publisher, year, edition, pages
2006. Vol. 44, no 7, 947-965 p.
Keyword [en]
treatment outcome; pain; clinical significance; behavioral medicine
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93015DOI: 10.1016/j.brat.2005.07.005ISI: 000238918500003PubMedID: 16181608OAI: oai:DiVA.org:uu-93015DiVA: diva2:166362
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2016-08-24Bibliographically approved
In thesis
1. Individually Tailored Treatment in the Management of Musculoskeletal Pain: Development and Evaluation of a Behavioural Medicine Intervention in Primary Health Care
Open this publication in new window or tab >>Individually Tailored Treatment in the Management of Musculoskeletal Pain: Development and Evaluation of a Behavioural Medicine Intervention in Primary Health Care
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis deals with clinical pain intervention research from a behavioural medicine perspective. The general aim was to develop and evaluate an individually tailored treatment protocol focused on pain management in everyday life in people who experience persistent musculoskeletal pain. Another aim was to develop and incorporate an idiographic outcome measure for behavioural goal assessment in the formal evaluation of the clinical significance of treatment outcomes.

The studies were conducted in a primary health care setting demonstrating a contribution from physical therapists in the field of behavioural medicine. Two separate samples of patients with musculoskeletal pain with a duration exceeding one month, n = 197 (Study I, descriptive and correlational design), and n = 97/82 (Study III/IV, randomized group-study) were included. In addition, four women were recruited for a series of experimental single-case studies (Study II).

The treatment protocol that was individually tailored to each participant’s behavioural treatment goals and assumed determinants of pain-related disability was more effective in reducing pain-related disability, pain intensity, fear-avoidance, and in increasing pain control when compared to an intervention including physical exercises. The individually tailored treatment was generally more beneficial for resumption of everyday life activity, increasing satisfaction, fulfilling pre-treatment expectations, and in preparing individuals for self-management of pain. The Patient Goal Priority Questionnaire that was elaborated over the course of the project can be used to a) identify and assess behavioural treatment goals, b) elaborate individual functional behavioural analyses relevant for everyday life functioning, and c) determine the clinical significance of treatment outcomes – that is, whether interventions produce outcomes of relevance for each individual’s everyday life. The inclusion of idiographic outcome measures in clinical pain intervention research is necessary and improves the ecological validity of the evaluation of clinical significance.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 94 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 35
Keyword
Caring sciences, behavioural medicine, goal assessment, tailored treatment, chronic pain, physical therapy, primary health care, Vårdvetenskap
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-5781 (URN)91-554-6240-5 (ISBN)
Public defence
2005-05-20, Sal X, Universitetshuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-04-27 Created: 2005-04-27Bibliographically approved

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Åsenlöf, PernillaLindberg, Per

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