This article aims to show how a discourse and communication based approach in the context of the care of the elderly provides a basis for reflecting on pain. Based on six hours of data from talk encounters between care professionals and elderly clients, an activity analysis of institutional settings and categorization of interactional discourse was undertaken. The focus was: (a) how elderly people initiated painful accounts, and (b) how the professionals oriented to such accounts. It is found that pain-talks are governed by the institutional practice of different phases:framing; mapping troubles and symptoms; clients' self presentations; counseling, and concluding. This phase structure exemplifies knowledge of communicative activities and is part of practical knowledge which the party, or at least the professional, is expected to become acquainted with. A thematic interactional map of critical moments related to pain as (a) social death and hope, and (b) presentation of self as past and self as present emerges. The caring aspect is to support hope and to change the focus from social death to life and recovering. In foregrounding health, it is important for the elderly people to affirm their identity of themselves as being good and honest persons.
The call to the Emergency Medical Dispatch Centre is often a person's first contact with the health-care system in cases of acute illness or injury and acute chest pain is a common reason for calling. The aim was to illuminate how spouses to persons with acute chest pain experienced the alarm situation, the emergency call and the prehospital emergency care. Interviews were conducted with nineteen spouses. A phenomenological-hermeneutic approach was used for the analyses. The themes responsibility and uneasiness emerged as well as an overall theme of aloneness. Being a spouse to a person in need of acute medical and nursing assistance was interpreted as "Being responsible and trying to preserve life" and "Being able to manage the uneasiness and having trust in an uncertain situation." When their partners' life was at risk the spouses were in an escalating spiral of worry, uncertainty, stress, fear of loss, feeling of loneliness and desperation. They had to manage emotional distress and felt compelled to act to preserve life, a challenging situation.
OBJECTIVE: This study evaluated the effects of a group learning program on patients with chronic musculoskeletal pain and high absenteeism and investigates what characterizes those patients who may benefit from such a program. The learning program was based on personal construct theory. The theory included the following: (1) participation in an educational program is related to a favorable outcome across the outcome measures (pain, pain coping, management of daily life, absenteeism, and use of health care), (2) patients with high agency orientation (i.e., inner-directed) cope with their pain and manage daily life in a better manner than do patients with low agency orientation (i.e., outer-directed), and (3) patients with high personal control, measured in terms of agency orientation, in terms of health locus of control, or in both terms, will benefit more from the educational program than will patients with low personal control. DESIGN: The study was a randomized controlled study. PATIENTS: One hundred and sixteen patients with chronic musculoskeletal pain and high absenteeism answered a questionnaire before and after the intervention program. The intervention group (n = 61) consisted of nine subgroups geographically spread through the eastern part of Norway and met for four hours every 2 weeks from February 1997 to October 1997. A total of 12 meetings were held. RESULTS: The intervention group reported a significantly higher score for the variable "management of everyday life" (p
The aim of this study was to investigate the influence of specific components of Andersen's behavioural model on adult individuals' perceived oral treatment need.
A questionnaire was sent to a randomly selected sample of 9,690 individuals, 20 to 89 years old, living in Skåne, Sweden. The 58 questions, some with follow-up questions, were answered by 6,123 individuals; a 63% response rate. Selected for inclusion in the multivariate logistic regression analysis were those questions relating to Andersen's behavioural model, phase five. Responses to "How do you rate your oral treatment need today?" were used as a dependent variable. The 62 questions chosen as independent variables represented the components: individual characteristics, health behaviour and outcomes in the model.
Of the independent variables, 24 were significant at the p
To assess the content of newspaper articles in 2 provinces in Canada to determine if rest or avoidance of activity is being recommended for back pain.
Inaccurate back pain beliefs in the general public may arise due to messages in the mass media. One persisting belief in Canada is that rest or activity avoidance is needed until back pain resolves.
We searched newspapers in 2 Canadian provinces via an electronic database for articles discussing back pain. Two trained raters used an article review template to indicate whether the article's main recommendation was to stay active, rest, was neutral (indicating a balance between rest and activity), or did not provide advice on level of activity during an episode of back pain.
One hundred 29 articles were identified. The primary advice provided related to level of activity during an episode of back pain was stay active in 24% of articles, whereas no articles primarily recommended rest or avoidance of activity. Sixteen percent of articles were rated as neutral, indicating the authors suggested a balance between rest and activity.
Back-pain-related newspaper articles do not carry messages that advocate rest or avoidance of activity, but rather highlight the importance of staying active during an episode or participating in exercise.
The purpose of this study was to document the impact of waiting for first-time elective coronary angiography (CA) on patients' anxiety and health-related quality of life (HRQL).
A prospective, observational inception cohort pretest and posttest design was used.
The study was conducted in a tertiary community cardiac center in Toronto, Canada.
Disease-specific HRQL was measured using the Seattle Angina Questionnaire at baseline (Time 1 [T1]) and 1 week before CA (Time 2 [T2]). The association between time on the waiting list and subjects' perceived anxiety was analyzed.
Paired-sample t tests comparing mean anxiety levels at T1 and T2 indicated a statistically significant increase in anxiety levels at T2 that did not seem to be related to the waiting time for CA (P =.000). Comparison of mean Seattle Angina Questionnaire scores at T1 and T2 indicated a trend toward deterioration in HRQL over time.
Waiting for elective CA may have a negative impact on patients' psychologic status and HRQL. Nursing and clinical interventions to reduce anxiety and improve HRQL are indicated for this population.
OBJECTIVES: Appraisals and coping play important roles in musculoskeletal disorders, but how these aspects develop over time remains unknown. The aim of the current study was to examine the development of pain-related appraisals, coping and well behaviours among chronic low back pain (CLBP) patients. METHODS: Twenty-two outpatients (15 women, 7 men) of working age were interviewed about past and present experiences of CLBP. The interviews were analysed using Grounded theory. RESULTS: The majority of the participants used disregarding processes in response to CLBP. The disregarding process developed from a psychological defence into a conscious coping strategy, the transition mediated by a crisis. This defence seemed to protect the participants' self-concept and reduce emotional discomfort, although it did not promote rehabilitation. The disregarding strategy was usually employed in later phases of the disorder and was consistent with active attempts at changing pain-related behaviours. Study limitation: Most of the participants had experienced CLBP for several years, thus the risk of memory bias cannot be ruled out. Furthermore, the sample was composed of relatively healthy subjects, thus the findings may not apply to chronic low back patients in general. CONCLUSION: Acceptance of CLBP favoured rehabilitation and helped participants change pain-related behaviours.
The aim was to test aspects of reliability and validity of a Swedish version of the Self-Efficacy for Exercise Scale (SEE-SV) for older people. Floor and ceiling effects, item-total correlation, internal consistency, test--retest reliability, content and construct validity were tested on 39 older people, mean age 72 years (SD 3.3). Content validity was also tested on five physical therapists. The results showed no floor and ceiling effects. The ICC for the total score was 0.79 (95% CI 0.61-0.89). The median weighted kappa coefficients square for the individual items was 0.63. Item-to-total correlation varied between 0.64 and 0.86 and Cronbach's Alpha for all items was >0.92. The correlations between SEE-SV and the SF-36 Mental Health and Bodily Pain subscales were r(s)?=?0.50 and r(s)?=?0.30 (ns), respectively. The correlation between SEE-SV and self-assessed physical activity was r(s)?=?0.13 (ns). Eighty-nine percent responded that the items were relevant and 92% that no item should be excluded. All physical therapists considered the items relevant, but the written instructions could be improved. In conclusion, SEE-SV has good item-to-total correlation, satisfactory internal consistence and substantial test--retest reliability. Our results show satisfactory content validity; however, studies are needed to further evaluate construct validity and to evaluate other aspects such as predicitve validity and responsiveness.
A symposium was held in Toronto, 2008, in which research progress regarding the biobehavioural dimension of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was presented. An extended workshop was held in April 2009 in which further recommendations were made from an expert panel, using the 2008 symposium material as a base. This paper is a summary of the 2008 symposium proceedings with elaborations based on further developments. Seven studies were conducted between 2001 and 2008, in which the following were investigated: (i) basic properties of Axis II instruments, (ii) reliability and criterion validity of Axis II instruments, (iii) expansion of predictors, (iv) metric equivalence of the depression and non-specific physical symptoms subscales in the RDC/TMD, (v) laboratory investigation of oral behaviours, (vi) field data collection of oral behaviours, and (vii) functional limitation of the jaw. Methods and results for each of these studies are described. Based on the results of these studies that have been published, as well as the direction of interim results from the few studies that await completion and publication, the biobehavioural domain of the RDC/TMD, as published in 1992, is reliable and valid. These results also provide strong evidence supporting the future growth of the biobehavioural domain as the RDC/TMD matures into subsequent protocols for both clinical and research applications.