Top

Published in:

01-03-2012

Readiness for Change Predicts Outcomes of Functional Rehabilitation Following Motor Vehicle Accident

Authors: Gregg A. Tkachuk, John K. Marshall, Annalyn C. Mercado, Bruce McMurtry, Fern Stockdale-Winder

Published in: Journal of Occupational Rehabilitation | Issue 1/2012

Abstract

Introduction Previous research has found pre-treatment motivational readiness to engage in pain self-management to be associated with completion of a rehabilitation program. This preliminary study examined this relationship, as well as the ability of pre-treatment readiness to change to predict clinical decisions of post-treatment functional work capacity. Methods The sample consisted of 106 individuals involved in a tertiary functional rehabilitation program for motor vehicle accident (MVA) survivors. The Multidimensional Pain Inventory (MPI) and Pain Stages of Change Questionnaire (PSOCQ) were completed prior to treatment. Results Hierarchical logistic regression analyses revealed that PSOCQ profile scores (P = 0.008), including higher individual PSOCQ contemplation (OR = 5.30; P = 0.017) and action (OR = 5.16; P = 0.049) scores, significantly increased the likelihood of completing the functional rehabilitation program. Clinical decisions about functional work capacity were predicted by MPI profile scores (P = 0.001), and this model was significantly improved by the addition of PSOCQ scores (P = 0.037). Lower MPI interference (OR = 5.41; P = 0.002), and higher MPI affective distress (OR = 2.81; P = 0.010), MPI support (OR = 1.72; P = 0.027), and PSOCQ action (OR = 5.35; P = 0.038) scores were significant predictors of clinicians’ decisions regarding functional work capacity in the final model that identified 88% of those judged capable of returning to work and 63% of those who were judged not capable of returning to work. Conclusions This preliminary study suggests that readiness to self-manage pain is an important predictor of both completion of functional rehabilitation program and clinicians’ decisions regarding functional work capacity after an MVA. The latter outcome appears to be more complex, influenced both by motivational readiness to engage in pain self-management and cognitive-behavioral adaptation to pain.

Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006;7:779–93.PubMedCrossRef

Turk DC. Clinical effectiveness and cost-effectiveness of treatment for patients with chronic pain. Clin J Pain. 2002;18:355–65.PubMedCrossRef

Vendrig AA, van Akkerveeken PF, McWhorter KR. Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck. Spine. 2000;25:238–44.PubMedCrossRef

Sullivan MJL, Adams H, Rhodenizer T, Stanish WD. A psychosocial risk factor–targeted intervention for the prevention of chronic pain and disability following whiplash injury. Phys Ther. 2006;86:8–18.PubMed

Turk DC, Rudy TE. Neglected factors in chronic pain treatment outcome studies—referral patterns, failure to enter treatment, and attrition. Pain. 1990;43:7–25.PubMedCrossRef

Turk DC, Rudy TE. Neglected factors in chronic pain treatment outcome studies—relapse, noncompliance, and adherence enhancement. Pain. 1991;44:5–28.PubMedCrossRef

Proctor TJ, Mayer TG, Theodore B, Gatchel RJ. Failure to complete a functional restoration program for chronic musculoskeletal disorders: a prospective 1-year outcome study. Arch Phys Med Rehabil. 2005;86:1509–15.PubMedCrossRef

Fishbain DA, Rosomoff HL, Goldberg M, Cutler R, Abdel-Moty E, Khalil TM, Rosomoff RS. The prediction of return to the workplace after multidisciplinary pain center treatment. Clin J Pain. 1993;9:3–15.PubMedCrossRef

Sullivan MJL, Feuerstein M, Gatchel R, Linton SJ, Pransky G. Integrating psychosocial and behavioral interventions to achieve optimal rehabilitation outcomes. J Occup Rehabil. 2005;15:475–89.PubMedCrossRef

10.

Carosella AM, Jeffrey M, Lackner JM, Feuerstein M. Factors associated with early discharge from a multidisciplinary rehabilitation program for chronic low back pain. Pain. 1994;57:69–76.PubMedCrossRef

11.

Baltov P, Cote J, Truchon M, Erhmann Feldman D. Psychosocial and socio-demographic factors associated with outcomes for patients undergoing rehabilitation for chronic whiplash associated disorders: a pilot study. Dis Rehabil. 2008;30:1947–55.CrossRef

12.

Olsson I, Bunketorp O, Carlsson SG, Styf J. Prediction of outcome in whiplash-associated disorders using West Haven-Yale Multidimensional Pain Inventory. Clin J Pain. 2002;18:238–44.PubMedCrossRef

13.

Adams H, Ellis T, Stanish WD, Sullivan MJL. Psychosocial factors related to return to work following rehabilitation of whiplash injuries. J Occup Rehabil. 2007;17:305–15.PubMedCrossRef

14.

Gun RT, Osti OL, O’Riordan A, Mpelasoka F, Eckerwall CGM, Smyth JF. Risk factors for prolonged disability after whiplash injury: a prospective study. Spine. 2005;30:386–91.PubMedCrossRef

15.

Sullivan MJL, Ward LC, Tripp D, French DJ, Adams H, Stanish WD. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. J Occup Rehabil. 2005;15:377–92.PubMedCrossRef

16.

King SA, Snow BR. Factors for predicting premature termination from a multidisciplinary inpatient chronic pain program. Pain. 1989;39:281–7.PubMedCrossRef

17.

Richmond RL, Carmody TP. Dropout from treatment for chronic low back pain. Prof Psychol Res Pract. 1999;30:51–5.CrossRef

18.

Prochaska JO, DiClemente CC. The transtheoretical approach: towards a systematic eclectic framework. Homewood, IL: Dow Jones Irwin; 1984.

19.

Jensen MP, Nielson WR, Kerns RD. Toward the development of a motivational model of pain self-management. J Pain. 2003;4:477–92.PubMedCrossRef

20.

Kerns RD, Habib S. A critical review of the pain readiness to change model. J Pain. 2004;5:357–67.PubMedCrossRef

21.

Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornthwaite J. Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain. 1997;72:227–34.PubMedCrossRef

22.

Kerns RD, Rosenberg R. Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model. Pain. 2000;84:49–55.PubMedCrossRef

23.

Biller N, Arnstein P, Caudill MA, Federman CW, Guberman C. Predicting completion of a cognitive-behavioral pain management program by initial measures of a chronic pain patient’s readiness for change. Clin J Pain. 2000;16:352–9.PubMedCrossRef

24.

Gersh E, Arnold C, Gibson SJ. The relationship between the readiness for change and clinical outcomes in response to multidisciplinary pain management. Pain Med. 2011;12:165–172.PubMedCrossRef

25.

Lechner DE, Jackson JR, Roth DL, Straaton KV. Reliability and validity of a newly developed test of physical work performance. J Occup Med. 1994;36(9):997–1004.PubMed

26.

Tuckwell NL, Straker L, Barrett TE. Test retest reliability on nine tasks of the physical work performance evaluation. Work. 2002;19:243–53.PubMed

27.

Durand MJ, Loisel P, Poitras S, Mercier R, Stock SR, Lemaire J. The interrater reliability of a functional capacity evaluation: the physical work performance evaluation. J Occup Rehabil. 2004;14:119–29.PubMedCrossRef

28.

Kerns RD, Turk DC, Rudy TE. The West Haven-Yale multidimensional pain inventory (WHYMPI). Pain. 1985;23:345–56.PubMedCrossRef

29.

Bernstein I, Jaremko M, Hinkley B. On the West Haven-Yale multidimensional pain inventory. Spine. 1995;20:956–63.PubMedCrossRef

30.

Jensen MP, Nielson WR, Romano JM, Hill ML, Turner JA. Further evaluation of the pain stages of change questionnaire: is the transtheoretical model of change useful for patients with chronic pain? Pain. 2000;86:255–64.PubMedCrossRef

31.

Jensen M. Enhancing motivation to change in pain treatment. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management: a practitioner’s handbook. New York, NY: Guilford Press; 2002. p. 71–93.

32.

Miller WR, Rollnick S. Motivational interviewing: preparing people for change. New York, NY: Guilford Press; 2002.

33.

Michaelson P, Sjolander P, Johansson H. Factors predicting pain reduction in chronic back and neck pain after multimodal treatment. Clin J Pain. 2004;20(6):447–54.PubMedCrossRef

34.

Vlayen JWS, de Jong J, Leeuw M, Crombez G. Fear reduction in chronic pain: graded exposure in vivo with behavioral experiments. In: Asmundson GJG, Vlaeyen WS, Crombez G, editors. Understanding and treating fear of pain. New York: Oxford University Press; 2004. p. 313–43.

35.

McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998;74:21–7.PubMedCrossRef

36.

Kerns RD, Otis JD, Wise EA. Treating families of chronic pain patients: application of a cognitive-behavioral transactional model. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management: a practitioner’s handbook. New York, NY: Guilford Press; 2002. p. 256–75.

37.

Sullivan MJL, Adams H, Horan S, Maher D, Boland D, Gross R. The role of perceived injustice in the experience of chronic pain: scale development and validation. J Occup Rehabil. 2008;18:249–61.PubMedCrossRef

38.

Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping. Pain. 2004;111:84–95.PubMedCrossRef

Title: Readiness for Change Predicts Outcomes of Functional Rehabilitation Following Motor Vehicle Accident
Authors: Gregg A. Tkachuk
John K. Marshall
Annalyn C. Mercado
Bruce McMurtry
Fern Stockdale-Winder
Publication date: 01-03-2012
Publisher: Springer US
Published in: Journal of Occupational Rehabilitation / Issue 1/2012
Print ISSN: 1053-0487
Electronic ISSN: 1573-3688
DOI: https://doi.org/10.1007/s10926-011-9324-2

At a glance: The STEP trials

Springer Medicine

Readiness for Change Predicts Outcomes of Functional Rehabilitation Following Motor Vehicle Accident

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2012

The ‘Ability’ Paradigm in Vocational Rehabilitation: Challenges in an Ontario Injured Worker Retraining Program

Return to Work Expectations of Workers on Long-Term Non-Work-Related Sick Leave

Validation of the PHQ-15 for Somatoform Disorder in the Occupational Health Care Setting

Validity and Reliability of the Fear-Avoidance Beliefs Questionnaire (FABQ) in Workers with Upper Extremity Injuries

Helping Cancer Survivors Return to Work: What Providers Tell Us About the Challenges in Assisting Cancer Patients with Work Questions

J. C. Quick and L. E. Tetrick (eds): Handbook of Occupational Health Psychology, 2nd ed