Meaningful contributions of rehabilitation for people with persistent pain; a reflexive thematic analysis

Purpose: This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain. Materials and methods: A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses. Results: Participants included three men and ten women, age ranging from 22–69 years, pain duration was 2–30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants’ perspective. Conclusions: The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.</p

Patient-centeredness in physiotherapy : What does it entail? A systematic review of qualitative studies

PURPOSE: The literature review is aimed at examining and summarizing themes related to patient-centeredness identified in qualitative research from the perspectives of patients and physiotherapists. Following the review, a secondary aim was to synthesize the themes to construct a proposed conceptual framework for utilization within physiotherapy. METHODS: A systematic search of qualitative studies was conducted including all articles up to 2015 September. Methodological quality was examined with a checklist. The studies were examined for themes suggestive of the practice of patient centeredness from perspective of the therapists and/or the patients. Data were extracted using a data extraction form and analyzed following "thematic synthesis." RESULTS: Fourteen articles were included. Methodological quality was high in five studies. Eight major descriptive themes and four subthemes (ST) were identified. The descriptive themes were: individuality (ST "Getting to know the patient" and ST "Individualized treatment"), education, communication (ST "Non-verbal communication"), goal setting, support (ST "Empowerment"), social characteristics of a patient-centered physiotherapist, a confident physiotherapist, and knowledge and skills of a patient-centered physiotherapist. CONCLUSIONS: Patient-centeredness in physiotherapy entails the characteristics of offering an individualized treatment, continuous communication (verbal and non-verbal), education during all aspects of treatment, working with patient-defined goals in a treatment in which the patient is supported and empowered with a physiotherapist having social skills, being confident and showing specific knowledge

Patient-centeredness in physiotherapy : What does it entail? A systematic review of qualitative studies

PURPOSE: The literature review is aimed at examining and summarizing themes related to patient-centeredness identified in qualitative research from the perspectives of patients and physiotherapists. Following the review, a secondary aim was to synthesize the themes to construct a proposed conceptual framework for utilization within physiotherapy. METHODS: A systematic search of qualitative studies was conducted including all articles up to 2015 September. Methodological quality was examined with a checklist. The studies were examined for themes suggestive of the practice of patient centeredness from perspective of the therapists and/or the patients. Data were extracted using a data extraction form and analyzed following "thematic synthesis." RESULTS: Fourteen articles were included. Methodological quality was high in five studies. Eight major descriptive themes and four subthemes (ST) were identified. The descriptive themes were: individuality (ST "Getting to know the patient" and ST "Individualized treatment"), education, communication (ST "Non-verbal communication"), goal setting, support (ST "Empowerment"), social characteristics of a patient-centered physiotherapist, a confident physiotherapist, and knowledge and skills of a patient-centered physiotherapist. CONCLUSIONS: Patient-centeredness in physiotherapy entails the characteristics of offering an individualized treatment, continuous communication (verbal and non-verbal), education during all aspects of treatment, working with patient-defined goals in a treatment in which the patient is supported and empowered with a physiotherapist having social skills, being confident and showing specific knowledge

Teaching patients about pain: the emergence of Pain Science Education, its learning frameworks and delivery strategies

Since it emerged in the early 2000’s, intensive education about ‘how pain works’, widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences to the original have led the PETAL collaboration to call the current iteration ‘Pain Science Education’. This review presents a brief historical context for PSE, the clinical trial, consumer perspective and real-world clinical data that have pushed the field to update both content and method. We describe the key role of educational psychology in driving this change, the central role of constructivism and the constructivist learning frameworks around which PSE is now planned and delivered. We integrate terminology and concepts from the learning frameworks currently being used across the PETAL collaboration in both research and practice – the Interactive, Constructive, Active, Passive (ICAP) framework, transformative learning theory, dynamic model of conceptual change. We then discuss strategies that are being used to enhance learning within clinical encounters, which focus on the skill, will and thrill of learning. Finally, we provide practical examples of these strategies so as to assist the reader to drive their own patient pain education offerings towards more effective learnin

Teaching patients about pain : the emergence of pain science education, its learning frameworks and delivery strategies

Abstract: Since it emerged in the early 2000's, intensive education about \u2018how pain works\u2019, widely known as pain neuroscience education or explaining pain, has evolved into a new educational approach, with new content and new strategies. The substantial differences from the original have led the PETAL collaboration to call the current iteration \u2018Pain Science Education\u2019. This review presents a brief historical context for Pain Science Education, the clinical trials, consumer perspective, and real-world clinical data that have pushed the field to update both content and method. We describe the key role of educational psychology in driving this change, the central role of constructivism, and the constructivist learning frameworks around which Pain Science Education is now planned and delivered. We integrate terminology and concepts from the learning frameworks currently being used across the PETAL collaboration in both research and practice\u2014the Interactive, Constructive, Active, Passive framework, transformative learning theory, and dynamic model of conceptual change. We then discuss strategies that are being used to enhance learning within clinical encounters, which focus on the skill, will, and thrill of learning. Finally, we provide practical examples of these strategies so as to assist the reader to drive their own patient pain education offerings towards more effective learning

Considering Precision and Utility When we Talk About Pain. Comment on Cohen et al

Graham L. Moseley, Neil Pearson, Roland Reezigt, Victoria J. Madden, Mark R. Hutchinson, Martin Dunbar, Anneke J. Beetsma, Hayley B. Leake, Pete Moore, Laura Simons, Lauren Heathcote, Cormac Ryan, Carolyn Berryman, Amelia K. Mardon, Benedict M. Wan

Considering Precision and Utility When we Talk About Pain.: Comment on Cohen et al

We applaud many of the sentiments put forward by Cohen et al in their critique of language and logic in pain medicine. 8 Pleas to avoid conflation between nociception and pain are not new - “The mislabelling of nociceptors as pain fibres was not an elegant simplification but a most unfortunate trivialisation of pain”29 ; “.. we don't actually have ‘pain receptors’, or ‘pain nerves’ or ‘pain pathways’ or ‘pain centres.’”4 We are among those who see such conflation as contrasting with contemporary understandings of ‘how pain works’ and undermining evidence-based treatment approaches