The influence of 'significant others' on persistent back
pain and work participation: a qualitative exploration of illness
perceptions.
McCluskey S, Brooks J, King N, Burton K. The influence of
'significant others' on persistent back pain and work
participation: a qualitative exploration of illness perceptions.
BMC Musculoskeletal Disorders 2011, 12:236
doi:10.1186/1471-2474-12-236
http://www.biomedcentral.com/1471-2474/12/236
ABSTRACT
Background
Individual illness perceptions have been highlighted as
important influences on clinical outcomes for back pain. However,
the illness perceptions of 'significant others'
(spouse/partner/close family member) are rarely explored,
particularly in relation to persistent back pain and work
participation. The aim of this study was to initiate qualitative
research in this area in order to further understand these wider
influences on outcome.
Methods
Semi-structured interviews based on the chronic pain version of
the Illness Perceptions Questionnaire-Revised were conducted with a
convenience sample of UK disability benefit claimants, along with
their significant others (n=5 dyads). Data were analysed using
template analysis.
Results
Significant others shared, and perhaps further reinforced,
claimants' unhelpful illness beliefs including fear of
pain/re-injury associated with certain types of work and activity,
and pessimism about the likelihood of return to work. In some
cases, significant others appeared more resigned to the permanence
and negative inevitable consequences of the claimant's back pain
condition on work participation, and were more sceptical about the
availability of suitable work and sympathy from employers. In their
pursuit of authenticity, claimants were keen to stress their desire
to work whilst emphasising how the severity and physical
limitations of their condition prevented them from doing so. In
this vein, and seemingly based on their perceptions of what makes a
'good' significant other, significant others acted as a 'witness to
pain', supporting claimants' self-limiting behaviour and statements
of incapacity, often responding with empathy and assistance. The
beliefs and responses of significant others may also have been
influenced by their own experience of chronic illness, thus
participants lives were often intertwined and defined by
illness.
Conclusions
The findings from this exploratory study reveal how others and
wider social circumstances might contribute both to the propensity
of persistent back pain and to its consequences. This is an area
that has received little attention to date, and wider support of
these findings may usefully inform the design of future
intervention programmes aimed at restoring work participation.
Activity Increase Despite Arthritis (AÏDA): phase II
randomised controlled trial of an active management booklet for hip
and knee osteoarthritis in primary care.
Williams NH, Amoakwa E, Belcher J, Edwards RT, Hassani H, Hendry
M, Burton K, Lewis R, Hood K, Jones J, Bennett P, Linck P, Neal RD,
Wilkinson C. Activity Increase Despite Arthritis (AÏDA): phase II
randomised controlled trial of an active management booklet for hip
and knee osteoarthritis in primary care. Br J Gen Pract
2011;61:452-458
Abstract
Background
The Hip & Knee Book: Helping you cope with osteoarthritis was
developed to change disadvantageous beliefs and encourage physical
activity in people with hip or knee osteoarthritis.
Aim
To assess the feasibility of conducting a definitive randomised
controlled trial (RCT) of this evidence-based booklet in people
with hip or knee osteoarthritis.
Design
Phase II feasibility randomised controlled trial
(RCT).
Method
Computerised searches of patients' record databases identified
people with osteoarthritis of the hip or knee, who were invited to
participate in the RCT comparing the new booklet with a control
booklet. Outcomes were measured at baseline, 1month, and 3months,
and included: beliefs about hip and knee pain,
exercise, and fear avoidance; level of physical activity; and
health service use.
Results
The trialmethods were feasible in terms of recruitment,
randomisation, and follow-up, but most participants recruited had
longstanding established symptoms. After one and 3months, there was
a small relative improvement in illness, exercise, and
fear-avoidance beliefs and physical activity level in The Hip &
Knee Book group (n = 59) compared with the control group (n = 60),
which provides some proof of principle for using these outcomes in
future trials.
Conclusion
This feasibility study provided proof of principle for testing The
Hip & Knee Book in a larger definitive RCT.