Winteler BR1, Widmer Leu C1, Heigl F2, Villiger PM2, Gantschnig BE2,3
1Inselspital, Bern University Hospital, Institute of Physiotherapy, Bern, Switzerland, 2Inselspital, Bern University Hospital, Department of Rheumatology, Immunology, Allergology, Bern, Switzerland, 3ZHAW Zurich University of Applied Sciences, Institute of Occupational Therapy, School of Health Professions, Winterthur, Switzerland
Background: Psychosocial distress and disability are both evident in patients with chronic back pain. However, it is still unclear, which impact the two dimensions have on one's pain experience.
Purpose: Since we belief that disability evocates burden of suffering, we investigated the correlation between the perceived burden of suffering measured by the Pictorial Representation of Illness and Self Measure (PRISM) and the self-reported disability measured by the Roland Morris Disability Questionnaire (RMDQ) in patients with chronic back pain of our Bern ambulatory inter-professional rehabilitation programme (BAI-reha).
Methods: For this cross-sectional cohort study we included consecutive patients enrolled in the BAI-reha from March 2013 to March 2015 for whom back pain was the major complaint (n = 47). All patients had to give written informed consent for data evaluation prior to the study. Patients were excluded if they had a primary mental disorder, declined to participate in an interprofessional outpatient rehabilitation programme, had too limited language skills to actively participate at group discussions held in German, or were involved in an ongoing court proceeding or insurance coverage dispute. Complete data sets (n = 46) were used to calculate correlation coefficients. The homogeneity of variances between groups was evaluated by Levene's test.
Results: Of the 47 patients with chronic back pain, 29 (62%) were female and 18 (38%) male with a mean age of 44 years and 46 years, respectively. Levene's test showed skewed data distribution for the PRISM values, while the RMDQ data were normally distributed. We therefore chose Spearman's rho to calculate correlation coefficients which resulted in a very weak negative relationship between the variables of the two instruments (rs = −0.1; p = 0.5).
Conclusion(s): Although the RMDQ and the PRISM seem to cover similar dimensions of pain, the results of our study do not support this. Experience of disability in everyday life and burden of suffering due to chronic back pain appeared as two different constructs. We hypothesize that suffering mainly represents the overall emotional impact of pain whereas disability, although in this case experienced due to chronic back pain as well, might been conceptualized differently.
Implications: Based on our results, we suggest using both, the RMDQ and the PRISM to evaluate the multiple dimensions of chronic back pain and understand the complexity of patients' pain experiences. Furthermore, longitudinal studies are necessary comparing the effectiveness of treatment regimens, which focus on disability reduction to those on reducing suffering.
Keywords: physical therapy, interprofessional, rehabilitation
Funding acknowledgements: The work was unfunded.
Purpose: Since we belief that disability evocates burden of suffering, we investigated the correlation between the perceived burden of suffering measured by the Pictorial Representation of Illness and Self Measure (PRISM) and the self-reported disability measured by the Roland Morris Disability Questionnaire (RMDQ) in patients with chronic back pain of our Bern ambulatory inter-professional rehabilitation programme (BAI-reha).
Methods: For this cross-sectional cohort study we included consecutive patients enrolled in the BAI-reha from March 2013 to March 2015 for whom back pain was the major complaint (n = 47). All patients had to give written informed consent for data evaluation prior to the study. Patients were excluded if they had a primary mental disorder, declined to participate in an interprofessional outpatient rehabilitation programme, had too limited language skills to actively participate at group discussions held in German, or were involved in an ongoing court proceeding or insurance coverage dispute. Complete data sets (n = 46) were used to calculate correlation coefficients. The homogeneity of variances between groups was evaluated by Levene's test.
Results: Of the 47 patients with chronic back pain, 29 (62%) were female and 18 (38%) male with a mean age of 44 years and 46 years, respectively. Levene's test showed skewed data distribution for the PRISM values, while the RMDQ data were normally distributed. We therefore chose Spearman's rho to calculate correlation coefficients which resulted in a very weak negative relationship between the variables of the two instruments (rs = −0.1; p = 0.5).
Conclusion(s): Although the RMDQ and the PRISM seem to cover similar dimensions of pain, the results of our study do not support this. Experience of disability in everyday life and burden of suffering due to chronic back pain appeared as two different constructs. We hypothesize that suffering mainly represents the overall emotional impact of pain whereas disability, although in this case experienced due to chronic back pain as well, might been conceptualized differently.
Implications: Based on our results, we suggest using both, the RMDQ and the PRISM to evaluate the multiple dimensions of chronic back pain and understand the complexity of patients' pain experiences. Furthermore, longitudinal studies are necessary comparing the effectiveness of treatment regimens, which focus on disability reduction to those on reducing suffering.
Keywords: physical therapy, interprofessional, rehabilitation
Funding acknowledgements: The work was unfunded.
Topic: Musculoskeletal: spine; Pain & pain management; Disability & rehabilitation
Ethics approval required: Yes
Institution: The Ethical Review Board Bern
Ethics committee: Kantonale Ethikkommission für die Forschung
Ethics number: 2017_02088
All authors, affiliations and abstracts have been published as submitted.
