None listed
Conditions
Brief summary
Primary aim: - To determine whether the performance and satisfaction within meaningful occupations for adults with Chronic Pain improves in response to a Leaned Pacing intervention in comparison to Waitlist Control conditions. Hypotheses: - The Learned Pacing intervention group will have greater occupational performance and satisfaction in comparison to the Waitlist Control group Proposal research design: - Pilot Randomised Controlled Trial Two Group Pretest- Posttest Design. Methods: - Potential participants will be identified from a Community Based Rehabilitation Centre Multidisciplinary Pain Service waitlist and potential participants who consent to participating in the research project will be screened for eligibility based on inclusion/ exclusion criteria, - Eligible participants will be randomly assigned to either the Learned Pacing intervention or Waitlist Control - The experimental group intervention is a Learned Pacing intervention and will be provided over three separate sessions lasting between 60- 90 minutes, which will be provided over three consecutive weeks by a qualified Occupational Therapist. Participants allocated to this group will receive usual care subsequently with a current wait list time of approximately 3 months. - The Waitlist Control group will not receive the experimental intervention, however participants allocated to this group will receive usual care subsequently with a current wait list time of approximately 3 months. - The Canadian Occupational Performance Measure and the Brief Pain Inventory will be used as the outcome measures to record data, pre and post intervention, according to participant's occupational performance and satisfaction, as well as pain severity and interference.
Interventions
A common intervention used to treat Chronic Pain in clinical practice is ‘pacing’. A key pain management strategy, pacing aims to enable individuals with Chronic Pain to reduce pain severity and to improve ability to participate in chosen occupations. Pacing involves preplanning, alternating between participating in an occupation, and taking a break, before pain escalates to a flare up (Sternbach, 1978). Pacing can be used over time to gradually build up tolerances in occupational participation
A common intervention used to treat Chronic Pain in clinical practice is ‘pacing’. A key pain management strategy, pacing aims to enable individuals with Chronic Pain to reduce pain severity and to improve ability to participate in chosen occupations. Pacing involves preplanning, alternating between participating in an occupation, and taking a break, before pain escalates to a flare up (Sternbach, 1978). Pacing can be used over time to gradually build up tolerances in occupational participation (Nielson, Jensen, Karsdorp, & Vlaeyen, 2013) within existing or reintroduced occupations. Pacing as a learned strategy significantly differs from how individuals naturally pace (Andrews, Strong, & Meredith, 2012). For example, Murphy, Smith, and Alexander (2008) found that the way women with osteoarthritis naturally pace their occupations might be a reaction to exacerbating pain and fatigue severity. The intervention group will receive a Learned Pacing intervention which will be provided individually and face to face by associate researcher Lauren Guy, over three separate sessions lasting between 60- 90 minutes, which will be provided over three consecutive weeks. All intervention sessions will take place at the Community Based Rehabilitation Center at Sunshine Hospital. All resources provided within the intervention are based on the book ‘Explain Pain’ by Butler and Moseley (2013). Objectives for intervention session 1: - To understand the background and rationale for pacing, see pg. 106 & 107 (Butler & Moseley, 2013), for information for which the education will be based on) - To understand what pacing is, see pg. 116- 119 (Butler & Moseley, 2013), for information for which the education will be based on) - To understand the proposed benefits of pacing, see pg. 116- 119 (Butler & Moseley, 2013), for information for which the education will be based on) - To understand how to implement pacing into daily occupations, including the identification of baseline times, see pg. 116- 119 (Butler & Moseley, 2013), for information for which the education will be based on. - To understand the concept of pacing up occupational tolerances over time, see pg. 116- 119 (Butler & Moseley, 2013), for information for which the education will be based on. - To receive a homework task which will enable participants to log their pacing implementation into daily occupations and to identify pacing baseline times. - To provide pages 106 & 107, 116- 119 (Butler & Moseley, 2013) for clients to take home to read - To identify a meaningful occupation/s to practically implement pacing into in the following session Objectives for intervention session 2: - To reflect on the implementation of pacing into daily occupations. - To discuss identification of pacing baseline times. - To troubleshoot barriers to the implementation of pacing into daily occupations. - To practically implement pacing into an occupation (identified in the previous session). - To receive homework to continue to log implementation of pacing into daily occupations and to begin pacing up to improve occupational tolerances. Objectives for intervention session 3: - To reflect on the implementation of pacing into daily occupations. - To reflect on the pacing up of occupational tolerances. - To troubleshoot barriers to the implementation of pacing into daily occupations and increasing occupational tolerances. - To practically implement pacing into the occupation practiced in the previous session, with increased tolerances. - To be encouraged to continue implementation of pacing into daily occupations and increasing occupational tolerances. Intervention adherence will be monitored through the use of a pacing log sheet (as mentioned above). Reference Butler, D., & Moseley, L. (2013). Explain Pain (Second ed., pp. 106-107, 116- 119). Adelaide City West, Australia Noigroup Publications.
Sponsors
Community Based Rehabilitation, Sunshine Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Participants with Chronic Pain as diagnosed by a medical practitioner. The study will include participants with Chronic Pain, which has originated from any source. Using a broad inclusion criterion will support the aim that the participants are representative of the population of interest (Pocock, 1983). - Pain has persisted for greater than or equal to 3 months. Pain, which has persisted for greater than or equal to 3 months, is considered Chronic Pain, as opposed to Acute Pain. - Aged greater than or equal to 18 years old, secondary to the intervention being targeted to an adult level of health literacy. - Participants must be able to attend 5 visits to the Community Rehabilitation Center where the study is being conducted. - Participants are happy to be randomly assigned.
Exclusion criteria
- Surgery within the last (less than or equal to) 3 months secondary to post surgical pain being treated as Acute Pain, which differs from the treatment of Chronic Pain. - Participants, who are unable to read, write or understand English secondary to the outcome measures and intervention being provided in English. The funding of interpreters is not feasible given insufficient funds. - Past or current treatment with a multidisciplinary Pain Management Service, given the possible affects of the Learned Pacing intervention may be diminished (Pocock, 1983). - Participants who are unable to collaboratively complete the primary outcome measure with the researcher (e.g. develop goals, score goals). This will only be able to be confirmed once the outcome measure is attempted with the client. - Participants who are due to commence usual care within the following 5 weeks - Participants with any cognitive impairment. If a participant’s medical history includes cognitive impairment they will be excluded to ensure participants are able to provide informed consent to participate in the research project. - Participants who are pregnant.
Outcome results
None listed