Living with chronic pain - a longitudinal study of the interrelations between acceptance, emotions, illness perceptions and health status

Psychological adjustment to chronic pain has been recently explored within three separate frameworks: a behaviour-focused account of chronic pain acceptance within the broader remit of Acceptance and Commitment Therapy; an emotion-focused approach with various research programs investigating the role of anger, fear, depression and also shame and positive emotions in chronic pain; and a cognitionfocused perspective more recently reframed in terms of illness perceptions as part of a wider model of response to health threats, the Self-Regulatory Model. Although these frameworks have broad areas of overlap, limited research has been directed at integrating acceptance, emotions and illness perceptions into a common, comprehensive account of psychological adjustment to chronic pain. Such an account would be beneficial both for providing a parsimonious approach that would guide further research and for developing pain management interventions that would take advantage of existing research from all three domains. The aim of the present thesis was to explore the possibility of integrating these separate areas by studying the relationships between the main concepts (acceptance, emotions, and illness perceptions) in the context of chronic pain. Based on a review of the relevant conceptual and methodological issues of each domain, a theoretical analysis of the similarities and differences between them was developed, with particular emphasis on the potential of existing models to support an integrative account. This analysis provided specific hypotheses regarding each domain and the interrelationships between them, which were investigated in a longitudinal study on a heterogeneous sample of 265 chronic pain patients using the services of the NHS Lothian Pain Clinic and several patient support organisations. Data were collected via postal and online questionnaires at 3 time points, at 41/2-month intervals (21% attrition rate). Validated questionnaires were used to measure the relevant constructs, with additional questions obtaining information regarding health status, medical history and demographics. The confirmatory analysis (employing a variety of statistical procedures, from correlation to multiple regression, factor analysis, cluster analysis and structural equation modeling) largely confirmed the expected relations within and between domains and was also informative regarding the most suitable data reduction methods. A detailed psychometric analysis of the questionnaires used offered a complementary view on the theoretical and methodological issues involved. An additional exploratory analysis focused on identifying the comparative characteristics of acceptance, emotions, and illness perceptions in predicting health status indicators, controlling for contextual factors such as medical history and demographics. Although no significant longitudinal changes were identified in most parameters (confirming the clinical observation of chronic pain as a stable condition), the longitudinal data allowed an analysis of the stability of the concepts and of the magnitude of their relationships in this patient sample. The analysis of intra- and interpersonal variation via hierarchical longitudinal modeling confirmed the stability of the data, highlighted the necessity of studying variation at both levels, and revealed interesting moderation effects, explained via the proposed concept of ‘discrimination ability’ and several alternative mechanisms. These results can be considered as first steps towards an integrative model of psychological adjustment to chronic pain. It is proposed that the behavioural, cognitive and emotional aspects need further conceptual clarification and these future efforts can be supported by the Cognitive-Affective Model of the Interruptive Function of Pain, within the wider framework of the Self-Regulatory Model

Beyond Adherence Thresholds: A Simulation Study of the Optimal Classification of Longitudinal Adherence Trajectories From Medication Refill Histories

Background: The description of adherence based on medication refill histories relies on the estimation of continuous medication availability (CMA) during an observation period. Thresholds to distinguish adherence from non-adherence typically refer to an aggregated value across the entire observation period, disregarding differences in adherence over time. Sliding windows to divide the observation period into smaller portions, estimating adherence for these increments, and classify individuals with similar trajectories into clusters can retain this temporal information. Optimal methods to estimate adherence trajectories to identify underlying patterns have not yet been established. This simulation study aimed to provide guidance for future studies by analyzing the effect of different longitudinal adherence estimates, sliding window parameters, and sample characteristics on the performance of a longitudinal clustering algorithm.Methods: We generated samples of 250–25,000 individuals with one of six longitudinal refill patterns over a 2-year period. We used two longitudinal CMA estimates (LCMA1 and LCMA2) and their dichotomized variants (with a threshold of 80%) to create adherence trajectories. LCMA1 assumes full adherence until the supply ends while LCMA2 assumes constant adherence between refills. We assessed scenarios with different LCMA estimates and sliding window parameters for 350 independent samples. Individual trajectories were clustered with kml, an implementation of k-means for longitudinal data in R. We compared performance between the four LCMA estimates using the adjusted Rand Index (cARI).Results: Cluster analysis with LCMA2 outperformed other estimates in overall performance, correct identification of groups, and classification accuracy, irrespective of sliding window parameters. Pairwise comparison between LCMA estimates showed a relative cARI-advantage of 0.12–0.22 (p < 0.001) for LCMA2. Sample size did not affect overall performance.Conclusion: The choice of LCMA estimate and sliding window parameters has a major impact on the performance of a clustering algorithm to identify distinct longitudinal adherence trajectories. We recommend (a) to assume constant adherence between refills, (b) to avoid dichotomization based on a threshold, and (c) to explore optimal sliding windows parameters in simulation studies or selecting shorter non-overlapping windows for the identification of different adherence patterns from medication refill data

Inhaler Technique Questionnaire (InTeQ) in pediatric patients with asthma

Inhaler; Pediatric patients; AsthmaInhalador; Pacients pediàtrics; AsmaInhalador; Pacientes pediátricos; AsmaFinancial support for this study was provided through Grants by the Instituto de Salud Carlos III FEDER: Fondo Europeo de Desarrollo Regional (PI15/00449) and Generalitat de Catalunya (AGAUR 2021 SGR 00624, 2017 SGR 452). The following researchers have worked on this manuscript while funded by Grants: CLB (University of Costa Rica OAICE-85-2019), KM (Instituto de Salud Carlos III FEDER: Fondo Europeo de Desarrollo Regional FI16/00071), and ALD (Miguel Servet research contract from the Instituto de Salud Carlos III CP21/00062)

Unapređenje prakse i upotrebe tehnologija za unapređenje adherence

Medication non-adherence is recognized as a global problem associated with financial burden for patients and healthcare funds. At the European level, different Medication Adherence Technologies (MATech) are in use. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) was launched to: 1) identify current practices for Medication Adherence (MA) support by healthcare professionals; 2) create a structure for the repository of existing MATech that could be used by different stakeholders; and to 3) prepare guidance for sustainable implementation of MATech across European healthcare settings. ENABLE gathered different healthcare professionals and academics from 39 countries, to achieve the set of goals during a four-year period. Several cross-European studies were conducted employing stakeholder consultation (Delphi) and survey methods, including analysis of current practices for assessing and supporting MA in routine care, as well as barriers and facilitators to managing MA, work on medication management during COVID pandemic, reimbursement pathways of adherence interventions and protocols to identify the best practices and technologies. The MATech repository was designed by ENABLE members, and consultation of different stakeholders is currently in progress. The repository structure includes information about the MATech product and provider, goals and content related to managing MA, and information about the scientific evaluation and implementation. A cross-European expert survey identified a limited number of MA enhancing interventions that are currently subject to reimbursement. ENABLE identified the need for collaboration, infrastructure, and reimbursement to enhance the uptake of MATech in daily practice.Neadherenca pacijenata prema terapiji prepoznata je kao globalni problem udružen sa finansijskim opterećenjem pojedinaca i zdravstvenih sistema. Na nivou Evrope koriste se različite tehnologije za unapređenje adherence (Medication Adherence Technologies - MATech). Evropska mreža za razvoj najboljih praksi i tehnologija za unapređenje adherence (ENABLE, COST Action 19132) pokrenuta je sa ciljem da se: 1) identifikuju trenutne prakse unapređenja adherence (medication adhrerence – MA) od strane zdravstvenih profesionalaca; 2) kreira struktura repozitorijuma postojećih MATech koju mogu da koriste različiti stejkholderi; 3) da se pripreme vodiči za održivu implementaciju MATech širom Evrope. ENABLE okuplja zdravstvene profesionalce različitih profesija iz 39 zemalja kako bi se postigli ciljevi tokom četvorogodišnjeg perioda. Nekoliko studija u više zemalja Evrope pokrenuto je kako bi se izvršilo ispitivanje 1) stavova različitih stejkholdera delfi metodom i upitnicima, uključujući analizu trenutnih praksi u vezi analize i podrške MA u rutinskoj praksi, kao i barijere i facilitatore koji utiču na MA, 2) menadžment lekovima tokom COVID pandemije, 3) načine refundacije intervencija u vezi sa MA i 4) protokola koji identifikuju nabolje prakse i tehnologije. Kreirana je struktura MATech repozitorijuma, dok je usaglašavanje sa različitim stejkholderima u toku. Struktura repozitorijuma zasniva se na informacijama o MATech, ciljevima i sadržajima u vezi MA, i informacijama o naučnim procenama i implementaciji MATech. Na području Evrope istraživanje je identifikovalo ograničeni broj intervencija za unapređenje MA koje podležu refundaciji. ENABLE ukazuje na potrebu za kolaboracijom, razvojem infrastrukture i politike refundacije kako bi se unapredila upotreba MATech u rutinskoj praksi.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra

Living with chronic pain : a longitudinal study of the interrelations between acceptance, emotions, illness perceptions and health status

Psychological adjustment to chronic pain has been recently explored within three separate frameworks: a behaviour-focused account of chronic pain acceptance within the broader remit of Acceptance and Commitment Therapy; an emotion-focused approach with various research programs investigating the role of anger, fear, depression and also shame and positive emotions in chronic pain; and a cognitionfocused perspective more recently reframed in terms of illness perceptions as part of a wider model of response to health threats, the Self-Regulatory Model. Although these frameworks have broad areas of overlap, limited research has been directed at integrating acceptance, emotions and illness perceptions into a common, comprehensive account of psychological adjustment to chronic pain. Such an account would be beneficial both for providing a parsimonious approach that would guide further research and for developing pain management interventions that would take advantage of existing research from all three domains. The aim of the present thesis was to explore the possibility of integrating these separate areas by studying the relationships between the main concepts (acceptance, emotions, and illness perceptions) in the context of chronic pain. Based on a review of the relevant conceptual and methodological issues of each domain, a theoretical analysis of the similarities and differences between them was developed, with particular emphasis on the potential of existing models to support an integrative account. This analysis provided specific hypotheses regarding each domain and the interrelationships between them, which were investigated in a longitudinal study on a heterogeneous sample of 265 chronic pain patients using the services of the NHS Lothian Pain Clinic and several patient support organisations. Data were collected via postal and online questionnaires at 3 time points, at 41/2-month intervals (21% attrition rate). Validated questionnaires were used to measure the relevant constructs, with additional questions obtaining information regarding health status, medical history and demographics. The confirmatory analysis (employing a variety of statistical procedures, from correlation to multiple regression, factor analysis, cluster analysis and structural equation modeling) largely confirmed the expected relations within and between domains and was also informative regarding the most suitable data reduction methods. A detailed psychometric analysis of the questionnaires used offered a complementary view on the theoretical and methodological issues involved. An additional exploratory analysis focused on identifying the comparative characteristics of acceptance, emotions, and illness perceptions in predicting health status indicators, controlling for contextual factors such as medical history and demographics. Although no significant longitudinal changes were identified in most parameters (confirming the clinical observation of chronic pain as a stable condition), the longitudinal data allowed an analysis of the stability of the concepts and of the magnitude of their relationships in this patient sample. The analysis of intra- and interpersonal variation via hierarchical longitudinal modeling confirmed the stability of the data, highlighted the necessity of studying variation at both levels, and revealed interesting moderation effects, explained via the proposed concept of ‘discrimination ability’ and several alternative mechanisms. These results can be considered as first steps towards an integrative model of psychological adjustment to chronic pain. It is proposed that the behavioural, cognitive and emotional aspects need further conceptual clarification and these future efforts can be supported by the Cognitive-Affective Model of the Interruptive Function of Pain, within the wider framework of the Self-Regulatory Model.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Screenshot of interactive plotting session for patient 76.

<p>Screenshot of interactive plotting session for patient 76.</p

Performance (single and four-threaded) computing CMAs for a very large dataset (500000 patients with 4058110 events) on a mid/high range desktop computer.

<p>Performance (single and four-threaded) computing CMAs for a very large dataset (500000 patients with 4058110 events) on a mid/high range desktop computer.</p

Performance (single and two-threaded) computing CMAs for a large dataset (13922 patients with 112983 events) on a consumer-grade laptop.

<p>Performance (single and two-threaded) computing CMAs for a large dataset (13922 patients with 112983 events) on a consumer-grade laptop.</p

Publication-quality plotting for simple, per-episode, and sliding-window CMA 9 for patient 76.

<p>Publication-quality plotting for simple, per-episode, and sliding-window CMA 9 for patient 76.</p

Treatment episodes for two example patients under three different scenarios.

<p>Treatment episodes for two example patients under three different scenarios.</p