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French-Canadian Adaptation of Lifestyle Redesign® for Chronic Pain Management: A Pre-Experimental Pilot Study
Abstract
Date Presented 03/26/20
Lifestyle Redesign is a manualized OT intervention that has shown significant clinical benefits for people with chronic pain. This occupation-based intervention has been translated, adapted in French, and tested with French-Canadian patients in the context of the Canadian healthcare system.
Primary Author and Speaker: Émilie Lagueux
Additional Authors and Speakers: Julie Masse
Contributing Authors: Mélanie Levasseur, Yannick Tousignant-Laflamme, Andréa Dépelteau, Raphaël Pagé, Anne-Marie Pinard, Marie-Hélène Lévesque
Introduction:
Although Lifestyle Redesign® has been shown to be effective in improving older adults' health and well-being, little is known about the feasibility of implementing this programme to develop meaningful and health-promoting routines of community-dwelling older adults in Canada. This study thus aimed to explore the feasibility of implementing a culturally-adapted 6-month version of Lifestyle Redesign® with community-dwelling older French-Canadians with and without disabilities.
Methods:
An exploratory descriptive qualitative clinical research design was used with 17 older adults living at home or in a seniors' residence, divided into two groups participating in Lifestyle Redesign®. Semi-structured interviews were conducted with participants and the occupational therapist who delivered the programme and recorded clinical notes.
Findings:
Participants were aged between 65 and 90; they were mainly women (n = 11; 64.7%), and seven (41.2%) had disabilities. The intervention was tailored to the participants' needs, interests, and capacities in each group (e.g. modules selected, number of individual sessions, and assistance of volunteer). Over the 6-month period, older adults participated in an average of about 25 group sessions with the occupational therapist and in four or five outings with their group (e.g. restaurant, market, and museum) and attended between 5 and 11 individual sessions with the occupational therapist. The most common reasons for missing group sessions were being ill, working, or having another appointment. Personal facilitators and barriers to participation in the intervention were mainly related to abilities, needs, spiritual life, and health. Environmental facilitators were mostly the regularity of the sessions, group, and external support, including human resources to deliver the intervention, whereas barriers were the residence's time restrictions and staff's attitudes, cost of some activities targeted in the programme, and transportation problems.
Conclusion:
Lifestyle Redesign® is a feasible preventive occupational therapy intervention for community-dwelling older French-Canadians. These findings will guide future studies including large-scale clinical trials.
Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management.
The present study aimed to update the literature review on the prevalence of fibromyalgia published in 2006. A bibliographical survey was carried out from 2005 to 2014 in the MEDLINE, Web of Science, Embase, LILACS and SciELO databases and 3274 records were identified. Five researchers selected the studies, following the inclusion criteria: studies that obtained the prevalence of fibromyalgia. Fibromyalgia studies in associated diseases were excluded. When screening by title and abstract, 2073 irrelevant articles were excluded. The full texts of 210 articles were evaluated for eligibility and this review included 39 studies, described in 41 articles. The selected studies were grouped into four categories: (A) prevalence of fibromyalgia in the general population; (B) prevalence of fibromyalgia in women; (C) prevalence of fibromyalgia in rural and urban areas; (D) prevalence of fibromyalgia in special populations. The literature shows values of fibromyalgia prevalence in the general population between 0.2 and 6.6%, in women between 2.4 and 6.8%, in urban areas between 0.7 and 11.4%, in rural areas between 0.1 and 5.2%, and in special populations values between 0.6 and 15%. This literature review update shows a significant increase in fibromyalgia prevalence studies in the world. The new 2010 American College of Rheumatology criteria have not been widely used yet and the COPCORD (Community-oriented program for control of Rheumatic Diseases) methodology has increased the quality of studies on the prevalence of rheumatic diseases in general.
Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.
The Fibromyalgia Impact Questionnaire (FIQ) is a commonly used instrument in the evaluation of fibromyalgia (FM) patients. Over the last 18 years, since the publication of the original FIQ, several deficiencies have become apparent and the cumbersome scoring algorithm has been a barrier to widespread clinical use. The aim of this paper is to describe and validate a revised version of the FIQ: the FIQR.
The FIQR was developed in response to known deficiencies of the FIQ with the help of a patient focus group. The FIQR has the same 3 domains as the FIQ (that is, function, overall impact and symptoms). It differs from the FIQ in having modified function questions and the inclusion of questions on memory, tenderness, balance and environmental sensitivity. All questions are graded on a 0–10 numeric scale. The FIQR was administered online and the results were compared to the same patient's online responses to the 36-Item Short Form Health Survey (SF-36) and the original FIQ.
The FIQR was completed online by 202 FM patients, 51 rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) patients (31 RA and 20 SLE), 11 patients with major depressive disorder (MDD) and 213 healthy controls (HC). The mean total FIQR score was 56.6 ± 19.9 compared to a total FIQ score of 60.6 ± 17.8 (P < 0.03). The total scores of the FIQR and FIQ were closely correlated (r = 0.88, P < 0.001). Each of the 3 domains of the FIQR correlated well with the 3 related FIQ domains (r = 0.69 to 0.88, P < 0.01). The FIQR showed good correlation with comparable domains in the SF-36, with a multiple regression analysis showing that the three FIQR domain scores predicted the 8 SF-36 subscale scores. The FIQR had good discriminant ability between FM and the 3 other groups; total FIQR scores were HC (12.1 ± 11.6), RA/SLE (28.6 ± 21.2) and MDD (17.3 ± 11.8). The patient completion time was 1.3 minutes; scoring took about 1 minute.
The FIQR is an updated version of the FIQ that has good psychometric properties, can be completed in less than 2 minutes and is easy to score. It has scoring characteristics comparable to the original FIQ, making it possible to compare past FIQ results with future FIQR results.
Perceived self-efficacy is a non-negligible outcome when measuring the impact of self-management interventions for chronic pain patients. However, no validated, chronic pain-specific self-efficacy scales exist for studies conducted with French-speaking populations.
OBJECTIVES: To establish the validity of the use of the French-Canadian Chronic Pain Self-efficacy Scale (FC-CPSES) among chronic pain patients.
METHODS: The Chronic Disease Self-Efficacy Scale is a validated 33-item self-administered questionnaire that measures perceived self-efficacy to perform self-management behaviours, manage chronic disease in general and achieve outcomes (a six-item version is also available). This scale was adapted to the context of chronic pain patients following cross-cultural adaptation guidelines. The FC-CPSES was administered to 109 fibromyalgia and 34 chronic low back pain patients (n=143) who participated in an evidence-based self-management intervention (the PASSAGE program) offered in 10 health care centres across the province of Quebec. Cronbach’s alpha coefficients (α) were calculated to determine the internal consistency of the 33- and six-item versions of the FC-CPSES. With regard to convergent construct validity, the association between the FC-CPSES baseline scores and related clinical outcomes was examined. With regard to the scale’s sensitivity to change, pre- and postintervention FC-CPSES scores were compared.
RESULTS: Internal consistency was high for both versions of the FC-CPSES (α=0.86 to α=0.96). Higher self-efficacy was significantly associated with higher mental health-related quality of life and lower pain intensity and catastrophizing (P
<⁄span> Recent neurophysiological evidence attests to the validity of fibromyalgia (FM), a chronic pain condition that affects >2% of the population.
<⁄span> To present the evidence-based guidelines for the diagnosis, management and patient trajectory of individuals with FM.
<⁄span> A needs assessment following consultation with diverse health care professionals identified questions pertinent to various aspects of FM. A literature search identified the evidence available to address these questions; evidence was graded according to the standards of the Oxford Centre for Evidence-Based Medicine. Drafted recommendations were appraised by an advisory panel to reflect meaningful clinical practice.
<⁄span> The present recommendations incorporate the new clinical concepts of FM as a clinical construct without any defining physical abnormality or biological marker, characterized by fluctuating, diffuse body pain and the frequent symptoms of sleep disturbance, fatigue, mood and cognitive changes. In the absence of a defining cause or cure, treatment objectives should be patient-tailored and symptom-based, aimed at reducing global complaints and enhancing function. Healthy lifestyle practices with active patient participation in health care forms the cornerstone of care. Multimodal management may include nonpharmacological and pharmacological strategies, although it must be acknowledged that pharmacological treatments provide only modest benefit. Maintenance of function and retention in the workforce is encouraged.
<⁄span> The new Canadian guidelines for the treatment of FM should provide health professionals with confidence in the complete care of these patients and improve clinical outcomes.
This article describes the development and psychometric testing of the Life Balance Inventory (LBI), an instrument created to measure the construct of life balance as conceptualized in the Life Balance Model. After initial item development based on theory, expert opinion, and feedback from 52 adults, rating and scoring mechanisms were established and two phases of pilot testing were completed. The first (N = 282 adults) and second (N = 458 adults) pilot testing phases used Rasch analysis that showed the items were capturing a range of balance traits and that the items fit intuitively with the model of life balance. The internal consistency of the LBI for both tests was good (Cronbach’s alpha = 0.89 to 0.97). Confirmatory factor analysis for the four subscales of the LBI was inconclusive. The LBI has demonstrated acceptable internal consistency and content validity as a measure for life balance.
BACKGROUND: The aims of this study were to: (1) evaluate the psychometric properties of a French Canadian version of the Hospital Anxiety and Depression Scale (HADS-FC) in a large population of primary care patients in Quebec, Canada; (2) conduct a transcultural validation of the original HADS in a subsample of English-speaking patients; (3) explore HADS properties in subgroups with or without multimorbidity. METHODS: A sample of 14,833 adults recruited in 64 primary care clinics completed the HADS, including 3,382 patients at elevated risk of mental disorders that also completed the Composite International Diagnostic Interview-Simplified (CIDIS). The HADS' internal consistency and discriminant validity were assessed, its factor structure was evaluated, and receiver operating characteristic (ROC) analyses were undertaken to evaluate its case finding abilities. RESULTS: The HADS-FC had good reliability (Cronbach's alphas ranging from 0.79 to 0.89 depending on language version and subscales) and discriminant validity, and a two-factor structure reflecting anxiety and depression factors. Results were similar in patient subgroups with or without multimorbidity. Optimal cut-off values were calculated: HADS: ≥16 (sensitivity 62%, specificity 77%), HADS-A: ≥10 (sensitivity 66%, specificity 73%) and HADS-D:≥7 (sensitivity 65%, specificity 75%). LIMITATIONS: Our cohort selection process and use of the CIDIS as a gold standard may have contributed to the limited case-finding performance of the HADS-FC. CONCLUSIONS: The HADS-FC and English HADS presented good psychometric properties in primary care patients, including patients with and without multimorbidity. However, its performance as a screening instrument in these settings with patients of varying clinical profiles requires more scrutiny.
In recent years quality of life instruments have been featured as primary outcomes in many randomized trials. One of the challenges facing the investigator using such measures is determining the significance of any differences observed, and communicating that significance to clinicians who will be applying the trial results. We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change. Using this approach we have established a plausible range within which the minimal clinically important difference (MCID) falls. In three studies in which instruments measuring dyspnea, fatigue, and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item, when responses were presented on a seven point Likert scale. Furthermore, we have established ranges for changes in questionnaire scores that correspond to moderate and large changes in the domains of interest. This information will be useful in interpreting questionnaire scores, both in individuals and in groups of patients participating in controlled trials, and in the planning of new trials.
Objective:
This study evaluated the measurement characteristics of the Engagement in Meaningful Activities Survey (EMAS) in an age-diverse sample.
Method:
The sample included 154 older adults and 122 college students (age range = 18-100 yr). A Rasch-Andrich rating scale model was used to evaluate the EMAS. Analyses addressed rating scale design, person and item fit, item hierarchy, model unidimensionality, and differential item functioning.
Results:
Category functioning was improved by reducing the EMAS item responses to four categories. Adequate person response validity was established, and all but one EMAS item demonstrated an ideal fit to the Rasch measurement model. After establishing the item hierarchy, I found the EMAS to be a unidimensional measure. Differential item functioning was not detected using Bonferroni-adjusted statistical criteria.
Conclusion:
The results confirm the potential to validly measure subjective qualities of meaningful activity participation. The EMAS can be used to evaluate processes and outcomes central to occupational therapy practice and to aid in the design of therapeutic occupations.
ABSTRACT:
Fibromyalgia is a chronic syndrome with no cure. A thorough understanding of the illness experience is therefore key in the palliative care of patients with this condition. In search for supportive treatments fibromyalgia patients often attend a chiropractor or other manual therapist. Knowledge of the meaning and reality of living with this condition to the patient could be considered essential to any health care practitioner playing a role in the management. This study aimed to gain a better understanding of the subjective experience of fibromyalgia, focusing on the personal, occupational and social impact of the condition on patients' lives. This included exploring the patients' views about the future.
This study employed descriptive phenomenology and adopted Husserl's concept of transcendental subjectivity or "bracketing". This qualitative study involved semi-structured interviews and was undertaken to obtain rich data that reflected the essence of the participants' experience. Participants consisted of six female volunteers, diagnosed with fibromyalgia by the University Hospital Gent, Belgium. Data were analysed using a thematic framework.
Fibromyalgia pervaded all aspects of life. Four main themes arose from data analysis, namely; the impact of fibromyalgia on patients' occupational and personal life, the impact on their future and aspects of social interaction. Nearly all participants had stopped working, giving rise to feelings of uselessness and loss of identity. Leisure activities were also greatly affected. Fibromyalgia was said to alter family bonds, some of which were reinforced, others were broken. The diagnosis was seen as a relief, marking an end to a period of uncertainty. Participants reported ambivalence in interaction. Despite some positive encounters, frustration arising from perceived incomprehension dominated. Consequently patients preferred not to share their experiences.
The study revealed the negative impact of fibromyalgia on patients' lives as comprising of great complexity and individuality. Several implications for health care practitioners can be extrapolated, including the need of a more efficient diagnostic process and increased education about the fibromyalgia experience. Further studies are required to better clarify the multifaceted nature of living with the condition.
Background:
Although insomnia is a prevalent complaint with significant morbidity, it often remains unrecognized and untreated. Brief and valid instruments are needed both for screening and outcome assessment. This study examined psychometric indices of the Insomnia Severity Index (ISI) to detect cases of insomnia in a population-based sample and to evaluate treatment response in a clinical sample.
Methods:
Participants were 959 individuals selected from the community for an epidemiological study of insomnia (Community sample) and 183 individuals evaluated for insomnia treatment and 62 controls without insomnia (Clinical sample). They completed the ISI and several measures of sleep quality, fatigue, psychological symptoms, and quality of life; those in the Clinical sample also completed sleep diaries, polysomnography, and interviews to validate their insomnia/good sleep status and assess treatment response. In addition to standard psychometric indices of reliability and validity, item response theory analyses were computed to examine ISI item response patterns. Receiver operating curves were used to derive optimal cutoff scores for case identification and to quantify the minimally important changes in relation to global improvement ratings obtained by an independent assessor.
Results:
ISI internal consistency was excellent for both samples (Cronbach α of 0.90 and 0.91). Item response analyses revealed adequate discriminatory capacity for 5 of the 7 items. Convergent validity was supported by significant correlations between total ISI score and measures of fatigue, quality of life, anxiety, and depression. A cutoff score of 10 was optimal (86.1% sensitivity and 87.7% specificity) for detecting insomnia cases in the community sample. In the clinical sample, a change score of -8.4 points (95% CI: -7.1, -9.4) was associated with moderate improvement as rated by an independent assessor after treatment.
Conclusion:
These findings provide further evidence that the ISI is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.
Preventive health programs may mitigate against the health risks of older adulthood.
To evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults. Design.-A randomized controlled trial.
Two government subsidized apartment complexes for independent-living older adults.
A total of 361 culturally diverse volunteers aged 60 years or older.
An OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months.
A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms.
Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Questionnaire (P=.03), Life Satisfaction Index-Z (P=.03), Medical Outcomes Study Health Perception Survey (P=.05), and for 7 of 8 scales on the RAND 36-Item Health Status Survey, Short Form: bodily pain (P=.03), physical functioning (P=.008), role limitations attributable to health problems (P=.02), vitality (P=.004), social functioning (P=.05), role limitations attributable to emotional problems (P=.05), and general mental health (P=.02).
Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains. Because the control groups tended to decline over the study interval, our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood.
Importance:
Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign® is a well-known cost-effective preventive occupational therapy intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown.
Objective:
To explore the influence of Lifestyle Redesign on older French-Canadians' health, social participation, leisure, and mobility.
Design:
A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids.
Setting:
Community.
Participants:
Sixteen volunteers (10 women) aged 65-90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking.
Intervention:
French-Canadian 6-mo version of Lifestyle Redesign.
Outcomes and measures:
Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide.
Results:
The French-Canadian Lifestyle Redesign had a beneficial effect on participants' mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect.
Conclusion and relevance:
The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians.
What this article adds:
This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults' health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.
Introduction
It is theorized that occupational therapy practice is underpinned by the construct of occupational engagement, with a focus on examining the subjective meaning of occupation. The theoretical definition of occupational engagement presents significant challenges to its use, evaluation, and measurement within evidence-based contemporary occupational therapy practice.
Method
A scoping review was conducted to examine how occupational engagement is defined within occupational therapy literature and how occupational engagement is evaluated.
Results
Twenty-six journal articles were identified. Definitions were fragmented and inconsistent across studies. Key themes relating to definitions of occupational engagement included active involvement in occupation, finding value and meaning, balanced engagement, subjective experience of engagement, developing identity through occupation, and social and environmental interactions. Measures seeking to understand occupational engagement were varied across studies, with a consistent measure applied only in the area of mental health.
Conclusion
The lack of consistency in definitions and measurement of occupational engagement presents significant issues for occupational therapy practice and evaluation. There is a need for a common definition of occupational engagement to be applied in the literature. Outcome measures seeking to understand occupational engagement are also required; however, these rely on a clearly defined construct.
OBJECTIVE. Our objective was to determine the efficacy of a Lifestyle Redesign® intervention for people living with chronic pain on quality of life (QOL), function, self-efficacy, and pain levels.
METHOD. Clinical outcomes were collected from 45 patients who completed an individual outpatient Lifestyle Redesign occupational therapy program for chronic pain as part of their usual plan of medical care. Outcome measures included the Canadian Occupational Performance Measure, the 36-Item Short-Form Survey, the Brief Pain Inventory, and the Pain Self-Efficacy Questionnaire. We analyzed scores using paired-samples t tests.
RESULTS. Significant changes were observed in occupational performance and satisfaction scores, physical and social functioning, role limitations due to physical and emotional problems, energy and fatigue, general health, and pain self-efficacy.
CONCLUSION. Lifestyle Redesign interventions, when integrated into a patient’s medical plan of care, can improve patient functioning, self-efficacy, and QOL.
Objectives: Patient Global Rating of Change (GRC) scales are commonly used in routine clinical care given their ease of use, availability and short completion time. This analysis aimed at assessing the validity of Patient Global Impression of Change (PGIC), a GRC scale commonly used in fibromyalgia, in a Canadian real-life setting. Methods: 167 fibromyalgia patients with available PGIC data were recruited in 2005-2013 from a Canadian tertiary-care multidisciplinary clinic. In addition to PGIC, disease severity was assessed with: pain visual analogue scale (VAS); Patient Global Assessment (PGA); Fibromyalgia Impact Questionnaire (FIQ); Health Assessment Questionnaire (HAQ); McGill Pain Questionnaire; body map. Multivariate linear regression assessed the PGIC relationship with disease parameter improvement while adjusting for follow-up duration and baseline parameter levels. The Spearman's rank coefficient assessed parameter correlation. Results: Higher PGIC scores were significantly (p<0.001) associated with greater improvement in pain, PGA, FIQ, HAQ and the body map. A statistically significant moderate positive correlation was observed between PGIC and FIQ improvement (r=0.423; p<0.001); correlation with all remaining disease severity measures was weak. Regression analysis confirmed a significant (p<0.001) positive association between improvement in all disease severity measures and PGIC. Baseline disease severity and follow-up duration were identified as significant independent predictors of PGIC rating. Conclusions: Despite that only a weak correlation was identified between PGIC and standard fibromyalgia outcomes improvement, in the absence of objective outcomes, PGIC remains a clinically relevant tool to assess perceived impact of disease management. However, our analysis suggests that outcome measures data should not be considered in isolation but, within the global clinical context.
Objective:
This systematic review addresses the effectiveness of occupational therapy-related interventions for adults with fibromyalgia.
Method:
We examined the literature published between January 2000 and June 2014. A total of 322 abstracts from five databases were reviewed. Forty-two Level I studies met the inclusion criteria. Studies were evaluated primarily with regard to the following outcomes: daily activities, pain, depressive symptoms, fatigue, and sleep.
Results:
Strong evidence was found for interventions categorized for this review as cognitive-behavioral interventions; relaxation and stress management; emotional disclosure; physical activity; and multidisciplinary interventions for improving daily living, pain, depressive symptoms, and fatigue. There was limited to no evidence for self-management, and few interventions resulted in better sleep.
Conclusion:
Although the evidence supports interventions within the scope of occupational therapy practice for people with fibromyalgia, few interventions were occupation based.
Description:
Malgré l'intérêt que le concept de l'équilibre de vie suscite, aucun questionnaire n'est actuellement disponible en français pour bien le mesurer. BUT: Cette étude visait à traduire le Life Balance Inventory (objectif 1) et à vérifier la validité convergente de cette version française (objectif 2). MÉTHODOLOGIE: Une validation transculturelle a d'abord été réalisée, suivie d'une étude descriptive transversale auprès de 152 adultes âgés de 40 ans et plus, avec ou sans incapacité physique. Des questionnaires ont permis de mesurer les variables suivantes : équilibre de vie, stress, santé et qualité de vie. RÉSULTATS: Un meilleur équilibre de vie est associé à un degré inférieur de stress (r = -0,36; p < 0,01), ainsi qu'à une santé physique (r = 0,42; p = 0,01), une santé mentale (r = 0,36; p = 0,01) et une qualité de vie (r = 0,54; p < 0,01) supérieures. CONSÉQUENCES: L'Inventaire de l'équilibre de vie est un questionnaire valide pour aider les ergothérapeutes à évaluer l'emploi du temps de leurs clients.
Individuals with chronic pain show a greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The current study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of PROMIS Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress appears to be disruption of social relationships, rather than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.
This book provides statisticians and researchers with the statistical tools - equations, formulae and numerical tables - to design and plan clinical studies and carry out accurate, reliable and reproducible analysis of the data so obtained. There is no way around this as incorrect procedure in clinical studies means that the researcher's paper will not be accepted by a peer-reviewed journal. Planning and analysing clinical studies is a very complicated business and this book provides indispensible factual information.
Importance
Fibromyalgia is present in as much as 2% to 8% of the population, is characterized by widespread pain, and is often accompanied by fatigue, memory problems, and sleep disturbances.Objective
To review the epidemiology, pathophysiology, diagnosis, and treatment of fibromyalgia.Evidence Review
The medical literature on fibromyalgia was reviewed from 1955 to March 2014 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on meta-analyses and contemporary evidence-based treatment guidelines. Treatment recommendations are based on the most recent evidence-based guidelines from the Canadian Pain Society and graded from 1 to 5 based on the level of available evidence.Findings
Numerous treatments are available for managing fibromyalgia that are supported by high-quality evidence. These include nonpharmacological therapies (education, exercise, cognitive behavioral therapy) and pharmacological therapies (tricyclics, serotonin norepinephrine reuptake inhibitors, and gabapentinoids).Conclusions and Relevance
Fibromyalgia and other “centralized” pain states are much better understood now than ever before. Fibromyalgia may be considered as a discrete diagnosis or as a constellation of symptoms characterized by central nervous system pain amplification with concomitant fatigue, memory problems, and sleep and mood disturbances. Effective treatment for fibromyalgia is now possible.
The social environment comprising communities, families, neighbourhoods,
work teams, and various other forms of social group is not simply an external
feature of the world that provides a context for individual behaviour. Instead
these groups impact on the psychology of individuals through their capacity to
be internalised as part of a person’s social identity. If groups provide individuals
with a sense of meaning, purpose, and belonging (i.e. a positive sense of social
identity) they tend to have positive psychological consequences. The impact
of these identity processes on health and well-being is explored in the
contributions to this special issue. In this editorial, we discuss these contributions
in light of five central themes that have emerged from research to date.
These themes address the relationship between social identity and (a) symptom
appraisal and response, (b) health-related norms and behaviour, (c) social
support, (d) coping, and (e) clinical outcomes. The special issue as a whole
points to the capacity for a social identity approach to enrich academic
understanding in these areas and to play a key role in shaping health-related
policy and practice.
To date, there are no systematic reviews of epidemiological studies of chronic pain in the developing world.
To estimate the prevalence of chronic pain worldwide paying particular attention to data from countries with a Human Development Index (HDI) of less than 0.9.
A literature search was conducted for cross-sectional surveys of chronic pain (≥3 months) in the adult general population using Medline, Embase, CINAHL, SportDiscus, Sciencedirect, CAS ILLUMINA, Academic search complete, PsycINFO and AMED. Forty-eight studies were identified and 29 of these were excluded because they surveyed children, the elderly or were longitudinal studies.
Weighted mean ± SD prevalence of chronic pain worldwide was 30.3% ± 11.7% (19 studies, 65 surveys, 34 countries, 182,019 respondents). There was no correlation between HDI and prevalence. In countries with a HDI < 0.9 prevalence was 33.9% ± 14.5% and significantly higher than prevalence in countries with a HDI of ≥0.9 (29.9% ± 12.7%), although removal of a large study that may have included a sample of individuals with comorbidities reduced the worldwide estimate to 28.0% ± 11.8% (47 surveys, 33 countries, 139,770 participants). Interestingly, the estimate of countries with a HDI < 0.9 to 24.8% ± 8.9% (7 surveys, 7 countries, 6122 participants) became significantly lower than the estimate of countries with a HDI ≥ 0.9 which was 28.1% ± 11.6% (40 surveys, 21 countries, 133,648 participants).
The review provides further evidence that the prevalence of chronic pain in the general population is high. However, there was insufficient reliable data to estimate with any certainty the prevalence of chronic pain in countries with an HDI < 0.9 with variability in estimates between surveys being of concern. Subtle differences in review and survey methodology appeared to impact markedly on estimates. There is a need for epidemiological studies that estimate the prevalence of chronic pain in developing countries to determine the scale of the problem.
Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.
A broad range of literature is reviewed and analysed using causal layered analysis, a post-structural critical futures methodology. This layered analysis moves through four layers of analysis; the litany layer, the social causes layer, the worldview analysis layer and the grand myth and metaphor layer.
This layered analysis revealed three significant factors shaping the future development of occupational therapy services for people with chronic pain: the influence of the biopsycho-social model within health-care services for people with chronic pain, occupational therapy philosophy and the social construction of people with chronic pain. Recommendations for future research and practice derived from this analysis include the need to research the effectiveness of occupation-based interventions for people with chronic pain, the significance of client-centred occupational therapy and valuing of clients' narratives to avoid pervasive negative social constructions of people with chronic pain influencing occupational therapy practice.
This critical analysis has made occupational therapy services for people with chronic pain problematic in order to generate reflection, discussion and new insights. This analysis deconstructs contemporary occupational therapy philosophy and practice and therefore provides a new perspective on occupational therapy for people with chronic pain.
To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =9).
This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
To validate a translated and adapted version of the Fibromyalgia Impact Questionnaire (FIQ) for use in French-speaking populations.
The FIQ was translated into French by 2 independent translators and then back-translated into English to assess the conceptual equivalence. The translated version was tested and adapted by an expert committee to obtain the Questionnaire de mesure d'Impact de la Fibromyalgie (QIF), the French version of the FIQ. We administered the QIF to 102 women with fibromyalgia (FM): 71 women who consulted once, and 31 women who were follow for 3 visits (D0, M1, and M3). The patients were also asked to answer 4 other questionnaires: the McGill Pain Questionnaire, the Medical Outcome Study Short Form-36 (SF-36), the short form of the Arthritis Impact Measurement Scale 2 (AIMS2), and the General Health Questionnaire (GHQ) (for psychiatric assessment). To ensure test-retest reliability, the patients were asked to complete the QIF 7 days after the first visit and to send it back to the investigators by mail. During each visit, all patients were asked about pain intensity. A tender point count was obtained by thumb palpation and the tenderness threshold of each specific point was assessed by a 4-point scale score to determine the global tender point index.
No major cultural adaptation was needed to obtain the French version of the FIQ. Test-retest reliability coefficients (intraclass correlation coefficient) for each question ranged from 0.04 to 0.84. Two items from the QIF (number of days when the patient felt good and visual analog scale stiffness) did not reach significant levels of test-retest reliability. Internal validity was good. The QIF score correlated well with the SF-36 and AIMS2 scores. The psychological aspects of the QIF were well correlated with those of GHQ-28. None of the items from the McGill Pain Questionnaire was correlated with QIF items. Similarly the clinical data concerning pain assessment were not correlated with QIF items.
QIF is a valid instrument for measuring functional disability and health status in French women with FM. Some of the items were of a limited reliability, perhaps due to the variability of the multiple aspects of this syndrome.
Although pain is a significant clinical problem in individuals suffering from post-traumatic stress disorder (PTSD), reliable and valid measures of pain for this population are lacking. The goal of this study was to validate the Brief Pain Inventory (BPI) in French-speaking veterans suffering from PTSD (n=130). We administered the BPI, as well as measures of PTSD, health status, quality of life, and social desirability, to veterans being assessed or treated for PTSD at a Veterans Affairs Canada clinic. The BPI showed strong internal consistency, as evidenced by Cronbach's alphas of 0.90 and 0.92 for the severity and interference subscales, respectively. Similar to previous findings, a two-factor structure (pain severity and pain interference) was found using an exploratory factor analysis. The two factors explained nearly 73% of the variance of the instrument. The BPI was also strongly correlated with health status and quality of life in the physical domain. In this veteran sample, nearly 87% of the veterans suffered from significant current pain. Veterans in our sample reported rates of pain severity that were similar to or higher than most of those reported by cancer patients and others with significant physical disability/illness. Overall, the French version of the BPI is a reliable, valid measure of pain in PTSD-suffering populations. Pain is a major issue in veterans with PTSD, and should be screened for with instruments such as the BPI.
Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomised Controlled Trial
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- J Jackson
- M Carlson
- C.-P Chuo
- B J Cherry
- M Jordan-Marsh
- B G Knight
- D Mandel
- J Blanchard
- D A Granger
- R R Wilcox
- M Y Lai
- B White
- C Lam
- A Marterella
- S P Azen
Clark, F. A., Jackson, J., Carlson, M., Chuo, C.-P., Cherry, B. J.,
Jordan-Marsh, M., Knight, B. G., Mandel, D., Blanchard, J.,
Granger, D. A., Wilcox, R. R., Lai, M. Y., White, B., Lam,
C., Marterella, A., & Azen, S. P. (2012). Effectiveness of a
lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2
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Pain assessment: Global use of the Brief Pain Inventory
- C S Cleeland
- K M Ryan
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use of the Brief Pain Inventory. Annals of the Academy of
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Model of human occupation: Theory and application
- G Kielhofner
Kielhofner, G. (2008). Model of human occupation: Theory and
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Translation and validation of the Engagement in Meaningful Activities Survey
- P.-A Lacroix
- A.-J Pelletier
- M.-P Blondin
- A Dugal
- C Langlois
- M Levasseur
- N Larivière
Lacroix, P.-A., Pelletier, A.-J., Blondin, M.-P., Dugal, A., Langlois,
C., Levasseur, M., & Larivière, N. (2018). Translation and
validation of the Engagement in Meaningful Activities Survey.
Canadian Journal of Occupational Therapy, 85(1), 11-20.
https://doi.org/10.1177/0008417417702925
Effects of Lifestyle Redesign on older adults: A systematic review
- M.-H Lévesque
- J Trépanier
- M.-J Sirois
- M Levasseur
Lévesque, M.-H., Trépanier, J., Sirois, M.-J., & Levasseur, M.
(2019). Effects of Lifestyle Redesign on older adults: A systematic review. Canadian Journal of Occupational Therapy,
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Occupational sciences for occupational therapy
- D E Pierce
Pierce, D. E. (2014). Occupational sciences for occupational therapy. Slack Incorporated.
Chronic pain: The occupational therapist's perspective
- J Strong
Strong, J. (1996). Chronic pain: The occupational therapist's perspective. Churchill Livingstone.
Enabling occupation II: Advancing an occupational therapy vision for health, wellbeing, & justice through occupation
- E Townsend
- H J Polatajko
Townsend, E., & Polatajko, H. J. (2007). Enabling occupation II:
Advancing an occupational therapy vision for health, wellbeing, & justice through occupation. Canadian Association of
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A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity
- J Ware
- M Kosinski
- S Keller
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World Health Organization supports global effort to relieve chronic pain
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