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Health and Quality of Life Outcomes

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Open Access 01-12-2013 | Research

Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain

Authors: Neale R Chumbler, Kurt Kroenke, Samantha Outcalt, Matthew J Bair, Erin Krebs, Jingwei Wu, Zhangsheng Yu

Published in: Health and Quality of Life Outcomes | Issue 1/2013

Abstract

Background

Sense of Coherence (SOC) is a measure of an individual’s capacity to use various coping mechanisms and resources when faced with a stressor. Chronic pain is one of the most prevalent and disabling conditions in clinical practice. This study examines the extent to which a strong SOC is associated with less pain and better health related quality of life (HRQoL) among patients with chronic pain.

Methods

We analyzed data from the Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial which enrolled 250 patients with persistent (3 months or longer) musculoskeletal pain who were receiving care in an United States Department of Veterans Affairs (VA) primary care clinic. The abbreviated three-item SOC scale was used to measure personal coping capability. Participants were categorized into Strong SOC (score 0–1) and Weak SOC (score 2–6). The Brief Pain Inventory (BPI) was used to assess the severity and disability associated with pain. Additionally, pain self-efficacy (ASES) and catastrophizing (CSQ) were assessed. HRQoL was assessed with the 36-item Short-Form Health Survey (SF-36) social functioning, vitality, and general health subscales. Multiple linear regression models were performed to examine whether SOC was independently associated with pain-specific and HRQoL outcomes, after adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities and major depression.

Results

Of the 250 study patients, 61% had a strong SOC whereas 39% had a weak SOC. Multivariable linear regression analysis showed that a strong SOC was significantly associated with better general health, vitality, social functioning and pain self-efficacy as well as less pain catastrophizing. These significant findings were partially attenuated, but remained statistically significant, after controlling for major depression. SOC was not significantly associated with pain severity or pain disability.

Conclusions

A strong SOC is associated with better HRQoL and self-efficacy as well as less catastrophizing in patients with chronic pain. SOC may be an important coping mechanism (strategy) for patients with chronic musculoskeletal pain.

Trial registration

Clinicaltrials.gov Identifier: NCT00926588.

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Kroenke K: Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res 2003, 12: 34–43. 10.1002/mpr.140PubMedCrossRef

National Research Council and the Institute of Medicine: Musculoskeletal disorders and the workplace: low back and upper extremities. Panel on Musculoskeletal Disorders and the Workplace. Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press; 2001. Available from: http://www.nap.edu/books/0309072840/html/

Kroenke K, Krebs E, Wu J, Bair MJ, Damush T, Chumbler N, York T, et al.: Stepped care to optimize pain care effectiveness trial study design and sample characteristics. Contemp Clin Trials 2013, 34: 270–281. 10.1016/j.cct.2012.11.008PubMedCrossRef

Stewart WF, Ricci JA, Chee E, Morganstein D: Lost productive work time costs from health conditions in the United States: results from the American Productivity Audit. J Occup Environ Med 2003,45(12):1234–1246. 10.1097/01.jom.0000099999.27348.78PubMedCrossRef

Turk DC: Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 2002, 18: 355–365. 10.1097/00002508-200211000-00003PubMedCrossRef

Curatolo M, Bogduk N: Pharmacologic pain treatment of musculoskeletal disorders: current perspectives and future prospects. Clin J Pain 2001, 17: 25–32. 10.1097/00002508-200103000-00005PubMedCrossRef

Antonovsky A: Health, Stress, and Coping. San Francisco: Jossey-Bass; 1979.

Gallagher TJ, Wagenfeld MO, Baro F, Haepers K: Sense of coherence, coping and caregiver role overload. Soc Sci Med 1994, 39: 1615–1622. 10.1016/0277-9536(94)90075-2PubMedCrossRef

Antonovsky A: Unravelling the Mystery of Health. San Francisco: Jossey-Bass; 1987.

10.

Chumbler NR, Rittman M, Van Puymbroeck M, Vogel WB, Qin H: 2004. The sense of coherence, burden and depressive symptoms in informal caregivers during the first month after stroke. Int J Geriatr Psychiatry 2004, 19: 944–953. 10.1002/gps.1187PubMedCrossRef

11.

Yang X, Hao Y, George SM, Wang L: Factors associated with health-related quality of life among Chinese caregivers of the older adults living in the community: a cross-sectional study. Health Qual Life Outcomes 2012, 10: 143. 10.1186/1477-7525-10-143PubMedCentralPubMedCrossRef

12.

Anke A, Damsgard E, Roe C: Life satisfaction in subjects with long-term musculoskeletal pain in relation to pain intensity, pain distribution and coping. J Rehabil Med 2013, 45: 277–285. 10.2340/16501977-1102PubMedCrossRef

13.

Blom EC, Serlachius E, Larsson J, Theorell T, Ingvar M: Low sense of coherence (SOC) is a mirror of general anxiety and persistent depressive symptoms in adolescent girls–- a crossectional study of a clinical and non-clinical cohort. Health Qual Life Outcomes 2010, 8: 58. 10.1186/1477-7525-8-58CrossRef

14.

Eriksson M, Lindstrom B: Antonovsky’s sense of coherence scale and the relation with health: a systematic review. J Epidemiol Community Health 2006, 60: 376–381. 10.1136/jech.2005.041616PubMedCentralPubMedCrossRef

15.

Skarsater I, Rayens MK, Peden A, Hall L, Zhang M, Agren H, Prochazka H: Sense of coherence and recovery from major depression: a 4-year follow-up. Arch Psychiatr Nurs 2009, 23: 119–127. 10.1016/j.apnu.2008.04.007PubMedCrossRef

16.

Kroninger-Jungaberle H, Grevenstein D: Development of salutogenetic factors in mental health –- Antonovsky’s sense of coherence and Bandura’s self-efficacy related to Derogatis’ symptom check list (SCL-90-R). Health Qual Life Outcomes 2013, 11: 80. 10.1186/1477-7525-11-80PubMedCentralPubMedCrossRef

17.

Benz T, Angst F, Lehmann S, Aeschlimann A: Association of the sense of coherence with physical and psychosocial health in the rehabilitation of osteoarthritis of the hip and knee: a prospective cohort study. BMC Musculoskelet Disord 2013, 14: 159. 10.1186/1471-2474-14-159PubMedCentralPubMedCrossRef

18.

Lindmark U, Stentstrom U, Warnberg Gerdin E, Hugoson A: The distribution of “sense of coherence” among Swedish adults: a quantitative cross-sectional population study. Scand J Public Health 2010,38(1):1–8. 10.1177/1403494809351654PubMedCrossRef

19.

Sagy S, Antonovsky H: The development of the sense of coherence: a retrospective study of early life experience in the family. Int J Aging Hum Dev 2000,51(2):155–166. 10.2190/765L-K6NV-JK52-UFKTPubMedCrossRef

20.

Urakawa K, Yokoyama K, Itoh H: Sense of coherence in associated with reduced psychological responses to job stressors among Japanese factory workers. BMC Research Notes 2012, 5: 247. 10.1186/1756-0500-5-247PubMedCentralPubMedCrossRef

21.

Cleeland CS: Measurement of pain by subjective report. In Advances in pain research and therapy. Edited by: Chapman CR, Loesner JD. New York: Raven Press; 1989:391–403.

22.

Cleeland CS: Pain assessment in cancer. In Effect of cancer on quality of life. Edited by: Osoba D. Boca Raton, FL: CRC Press; 1991:293–305.

23.

Cleeland CS, Nakamura Y, Mendoza TR, Edwards KR, Douglas J, Serlin RC: Dimensions of the impact of cancer pain in a four country sample: New information from multidimensional scaling. Pain 1996, 67: 267–273. 10.1016/0304-3959(96)03131-4PubMedCrossRef

24.

Krebs EE, Lorenz KA, Bair MJ, Damush TM, Wu J, Sutherland JM, Asch SM, Kroenke K: Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med 2009, 24: 733–738. 10.1007/s11606-009-0981-1PubMedCentralPubMedCrossRef

25.

Lorig K, Seleznick M, Lubeck D, Ung E, Chastain RL, Holman HR: The beneficial outcomes of the arthritis self-management course are not adequately explained by behavior change. Arthritis Rheum 1989,32(1):91–95. 10.1002/anr.1780320116PubMedCrossRef

26.

Robinson ME, Riley JL III, Myers CD, Sadler IJ, Kvaal SA, Geisser ME, et al.: The coping strategies questionnaire: a large sample, item level factor analysis. Clin J Pain 1997, 13: 43–49. 10.1097/00002508-199703000-00007PubMedCrossRef

27.

Harland NJ, Georgieff K: Development of the coping strategies questionnaire: a clinically utilitarian version of the coping strategies questionnaire. Rehabil Psychol 2003, 48: 296–300.CrossRef

28.

Ware JE, Sherbourne CD: The MOS-36 item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992, 30: 473–483. 10.1097/00005650-199206000-00002PubMedCrossRef

29.

Ware JE, Kosinski M, Keller SD: A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996, 34: 220–233. 10.1097/00005650-199603000-00003PubMedCrossRef

30.

Lundberg O, Nystrom M: A simplified way of measuring sense of coherence: experiences from a population survey in Sweden. Eur J Public Health 1995, 5: 56–69. 10.1093/eurpub/5.1.56CrossRef

31.

Surtees P, Wainwright N, Luben R, Khaw K, Day N: Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom prospective cohort study. Am J Epidemiol 2003, 158: 1202–1209. 10.1093/aje/kwg272PubMedCrossRef

32.

Kroenke K, Theobald D, Wu J, Norton K, Morrison G, Carpenter J, et al.: Effect of telecare management on pain and depression in patients with cancer: a randomized trial. JAMA 2010, 304: 163–171. 10.1001/jama.2010.944PubMedCentralPubMedCrossRef

33.

Kroenke K, Spitzer RL, Williams JB, Lowe B: The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010, 32: 345–359. 10.1016/j.genhosppsych.2010.03.006PubMedCrossRef

34.

Kroenke K, Spitzer RL, Williams JBW: The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001, 16: 606–613. 10.1046/j.1525-1497.2001.016009606.xPubMedCentralPubMedCrossRef

35.

Eriksson M, Lindstrom B: Antonovsky’s sense of coherence scale and its relation with quality of life: a systematic review. J Epidemiol Community Health 2007, 61: 938–944. 10.1136/jech.2006.056028PubMedCentralPubMedCrossRef

36.

Silarova B, Nagyova I, Rosenberger J, Studencan M, Ondusova D, Reijneveld SA, van Dijk JP: Sense of coherence as an independent predictor of health-related quality of life among coronary heart disease patients. Qual Life Res 2012,21(10):1863–1871. 10.1007/s11136-011-0106-2PubMedCrossRef

37.

Benyamini Y, Roziner I, Goldbourt U, Drory Y, Gerber Y, for the Israel Study Group on First Acute Myocardial Infarction: Depression and anxiety following myocardial infarction and their inverse associations with future health behaviors and quality of life. Ann Behav Med 2013,46(3):310–321. 10.1007/s12160-013-9509-3PubMedCrossRef

38.

Drageset J, Nygaard HA, Eide GE, Bondevik M, Nortvedt MW, Natvig GK: Sense of coherence as a resource in relation to health-related quality of life among mentally intact nursing home residents–-a questionnaire study. Health Qual Life Outcomes 2008, 6: 85. 10.1186/1477-7525-6-85PubMedCentralPubMedCrossRef

39.

Nilsson E, Kristenson M: Psychological factors related to physical, social, and mental dimensions of the SF-36: a population-based study of middle-aged women and men. Patient Related Outcome Measures 2010, 1: 153–162.PubMedCentralPubMedCrossRef

40.

Barthelsson C, Nordstrom G, Norberg A: Sense of coherence and other predictors of pain and health following laparoscopic cholecystectomy. Scand J Caring Sci 2011, 25: 143–150. 10.1111/j.1471-6712.2010.00804.xPubMedCrossRef

41.

Schrier M, Amital D, Arnson Y, Rubinow A, Altaman A, Nissenabaum B, Amital H: Association of fibromyalgia characteristics in patients with non-metastatic breast cancer and the protective role of resilience. Rheumatol Int 2012, 32: 3017–3023. 10.1007/s00296-011-2104-7PubMedCrossRef

42.

Erim Y, Morawa E, Atay H, Aygun S, Gokalp P, Senf W: Sense of coherence and depression in the framework of immigration: Turkish patients in Germany and in Turkey. Int Rev Psychiatry 2011, 23: 542–549. 10.3109/09540261.2011.637908PubMedCrossRef

43.

Geyer S: Some conceptual considerations on the sense of coherence. Soc Sci Med 1997, 44: 1771–1779. 10.1016/S0277-9536(96)00286-9PubMedCrossRef

44.

Haukkala A, Konttinen H, Lehto E, Uutela A, Kawachi I, Laatikainen T: Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality. Psychosom Med 2013, 75: 429–435. 10.1097/PSY.0b013e31828c3fa4PubMedCrossRef

45.

Togari T, Yamazaki Y, Nakayama K, Shimizu J: Development of a short version of the sense of coherence scale for population survey. J Epidemiol Community Health 2007, 61: 921–922. 10.1136/jech.2006.056697PubMedCentralPubMedCrossRef

46.

Eriksson M, Lindstrom B: Validity of Antonovsky’s sense of coherence scale: a systematic review. J Epidemiol Community Health 2005, 59: 460–466. 10.1136/jech.2003.018085PubMedCentralPubMedCrossRef

47.

Kivimaki M, Feldt T, Vahtera J, Nurmi JE: Sense of coherence and health: evidence from two cross-lagged longitudinal samples. Soc Sci Med 2000, 50: 583–597. 10.1016/S0277-9536(99)00326-3PubMedCrossRef

48.

Lindstrom B, Eriksson M: Salutongenesis. J Epidemiol Community Health 2005, 59: 440–442. 10.1136/jech.2005.034777PubMedCentralPubMedCrossRef

49.

Suominen S, Helenius H, Blomberg H, Uutela A, Koskenvuo : Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults. J Psychosomatic Research 2001, 50: 77–86. 10.1016/S0022-3999(00)00216-6CrossRef

50.

Chumbler NR, Rittman MR, Wu SS: Associations in sense of coherence and depression in caregivers of stroke survivors across 2 years. J Behav Health Serv Res 2008, 35: 226–234. 10.1007/s11414-007-9083-1PubMedCrossRef

51.

Volanen SM, Suominen S, Lahelma E, Koskenvuo M, Silventoinen K: Negative life events and stability of sense of coherence: a five-year follow-up study of Finnish women and men. Scand J Psychol 2007, 48: 433–441. 10.1111/j.1467-9450.2007.00598.xPubMedCrossRef

52.

Schumann A, Hapke U, Meyer C, et al.: Measuring sense of coherence with only three items: a useful tool for population surveys. Br J Health Psychol 2003, 8: 409–421. 10.1348/135910703770238275PubMedCrossRef

Title: Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain
Authors: Neale R Chumbler
Kurt Kroenke
Samantha Outcalt
Matthew J Bair
Erin Krebs
Jingwei Wu
Zhangsheng Yu
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Health and Quality of Life Outcomes / Issue 1/2013
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/1477-7525-11-216

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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