Dosage of pain rehabilitation programmes for patients with chronic musculoskeletal pain:a non-inferiority randomised controlled trial

PURPOSE: To analyse the effects of interdisciplinary pain rehabilitation programmes with different dosages; care as usual versus short form. METHODS: A single blinded, two armed, randomised controlled trial, with non-inferiority design was performed. All patients with chronic musculoskeletal pain referred to an outpatient multidisciplinary pain rehabilitation programme were eligible for this study. Only dosage differed, content was similar. The difference on Pain Disability Index was the primary outcome measure. Four points difference on Pain Disability Index was applied as a non-inferiority margin. Treatment effects within groups were expressed in standardised mean difference and effect sizes were calculated between the groups. RESULTS: Because care as usual was frequently extended, the difference in dosage between groups was limited. The study was stopped prematurely because of an a-priori stopping rule. Interim analyses are presented. Both groups (care as usual n = 58, short form n = 54) improved significantly (mean Pain Disability Index change care as usual: -10.8; short form: -8.3). Mean difference between groups was 2.5 points (95% confidence interval was -2.2 to 7.3). Effect size between groups was 0.2. CONCLUSIONS: The 95% confidence interval for the difference in mean pain disability reduction exceeded the upper limit of the non-inferiority margin. The results of the primary analyses of this trial are, therefore, inconclusive. Ancillary analyses revealed that programme dosage was not associated with differences in the disability outcomes. Implications for rehabilitation Optimum dosage of interdisciplinary pain rehabilitation programs is unknown and scarcely studied. This study is the first to analyse dosage as primary aim. Although results are inconclusive, they also suggest that differences in dosage may not automatically lead to differences in effects. Further research is needed to analyse what dosage works for whom; to detect optimum effective and cost-effective dosage of pain rehabilitation programmes

Including personal boundaries scale: development and psychometric properties of a measurement for nurses' self-efficacy toward intimate and sexual behavior in dementia care

BackgroundPerson-centered nursing home care recognizes the intimate and sexual needs of residents with dementia but lacks guidance for nurses to address them while effectively respecting their personal boundaries. The Including Personal Boundaries (IPB) scale was developed to complement clinical and scientific efforts to support both nurse and resident wellbeing.MethodsThrough a co-creative process, theoretical principles, day-to-day experiences, and expert knowledge were integrated into an initial nineteen-item version of the IPB scale. The pilot sample comprised 297 Dutch (vocational) nurses in dementia nursing care.ResultsAfter Principal Component Analysis, nine items with strong factor loadings (>0.6) were retained. Internal reliability measures supported the item selection, such as high internal consistency (α = 0.866) and adequate corrected item-total correlations (0.532–0.781).ConclusionThe presented IPB scale, a nine-item scale, is a short, robust measure to assess nurses' self-efficacy in their capabilities to include personal boundaries (physical and emotional) when confronted with the intimate and sexual behaviors of residents with dementia. Further validation is recommended. The IPB scale could provide valuable insights for research, clinical practice, and education

Marketing (as) Rhetoric: paradigms, provocations, and perspectives

In this collection of short, invited essays on the topic of marketing (as) rhetoric we deal with a variety of issues that demonstrate the centrality of rhetoric and rhetorical considerations to the pursuit of marketing scholarship, research and practice. Stephen Brown examines the enduring rhetorical power of the 4Ps; Chris Hackley argues for the critical power of rhetorical orientations in marketing scholarship but cautions us on the need to work harder in conceptually connecting rhetorical theory and modern marketing frameworks; Shelby Hunt explains how rhetorical processes are incorporated in his inductive realist model of theory generation, using one of his most successful publications as an illustration; Charles Marsh demonstrates what Isocrates’ broad rhetorical project has to teach us about the importance of reputation cultivation in modern marketing; Nicholas O’Shaughnessy uses an analysis of Trump’s discourse to argue that political marketing as it is currently conceived is ill-equipped to engage effectively with the rhetorical force of Trump’s ‘unmarketing’; Barbara Phillips uses Vygotsky’s work on imagination to investigate the important of pleasure and play in advertising rhetoric; and finally, David Tonks, who in many ways started it all, reiterates the need for marketers to recognise the strength of the relationship between marketing and persuasion

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges