Clinician–Patient Agreement About the Work Disability Problem of Patients Having Persistent Pain: Why it Matters

Abstract

Background Studies from different fields documenting the differences between clinicians’ and workers’ representations have not elucidated where the differences exist or how they can be resolved. Purpose To define and describe scenarios depicting the differences between clinical judgment, workers’ representations about their disability and clinicians’ interpretations of these representations. Methods A multiple case-study design was used. Semi-structured prospective interviews were conducted at four points in time, with five clinicians managing 12 cases of workers having persistent pain and participating in an evidence-based work rehabilitation program. Results Four scenarios depicting differences in representations were found, but not all the differences necessarily had a negative impact on the program outcomes. For the clinicians, clear identification of the problem was important to allow for the use of concrete, pragmatic strategies. For the workers, congruence between the proposed strategy and their representations was crucial. Conclusion During rehabilitation, the objectives must be acceptable to both parties or the proposed strategy must, at least, make sense to the patient.

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References

  1. 1.

    Watson Wyatt Wordwide. Staying at work: making the connection to a healthy organization. Toronto: Canada; 2005.

    Google Scholar 

  2. 2.

    Krause N, Dasinger LK, Deegan LJ, Rudolph L, Brand RJ. Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis. Am J Ind Med. 2001;40(4):374–92.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Foster NE, Thomas E, Bishop A, Dunn KM, Main C. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain. 2010;148:398–406.

    PubMed  Article  Google Scholar 

  4. 4.

    Toombs SK. The meaning of illness: a phenomenological approach to the patient–physician relationship. J Med Philos. 1987;12(3):219–40.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Leventhal H, Brissette I, Leventhal EA. The common sense model of self-regulation of health and illness. In: Cameron L, Leventhal H, editors. The self-regulation of health and illness behaviour. London: Routledge; 2003. p. 42–65.

    Google Scholar 

  6. 6.

    Leventhal H, Meyer D, Gutmann M, Haynes RB, Mattson ME, Engebretson O. The role of theory in the study of compliance to high blood pressure regimens. In: Anonymous, editor. Patient compliance to prescribed antihypertensive medication regimens: a report to the National Heart Lung and Blood Institute (NIH Publication No. 81–2102). Washington: U.S. Department of Health and Human Services; 1980.

  7. 7.

    Leventhal H, Zimmerman R, Gutmann M. Compliance: a self-regulation perspective. In: Gentry WD, editor. Handbook of behavioral medicine. New York: Guilford Press; 1984. p. 369–436.

    Google Scholar 

  8. 8.

    Leventhal H, Diefenbach M, Leventhal EA. Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Ther Res. 1992;16:143–63.

    Article  Google Scholar 

  9. 9.

    Croyle RT, Jemmott IJB. Psychological reaction to risk factor testing. In: Skelton JA, Croyle RT, editors. Mental representation in health and illness. New York: Springer; 1991. p. 85–107.

    Google Scholar 

  10. 10.

    Bandura A. A social learning theory. Englewood: Prentice Hall; 1977.

    Google Scholar 

  11. 11.

    Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman; 1997.

    Google Scholar 

  12. 12.

    Leventhal H, Diefenbach M. The active side of illness cognition. In: Skelton JA, Croyle RT, editors. Mental representation in health and illness. New York: Springer; 1991. p. 247–72.

    Google Scholar 

  13. 13.

    Daykin AR, Richardson B. Physiotherapists’ pain beliefs and their influence on the management of patients with chronic low back pain. Spine. 2004;29(7):783–95.

    PubMed  Article  Google Scholar 

  14. 14.

    Cedraschi C, Robert J, Perrin E, Fischer W, Goerg D, Vischer TL. The role of congruence between patient and therapist in chronic low back pain patients. J Manipulative Physiol Ther. 1996;19(4):244–9.

    PubMed  CAS  Google Scholar 

  15. 15.

    Sewitch MJ, Abrahamowicz M, Bitton A, Daly D, Wild GE, Cohen A, et al. Psychosocial correlates of patient-physician discordance in inflammatory bowel disease. Am J Gastroenterol. 2002;97(9):2174–83.

    PubMed  Article  Google Scholar 

  16. 16.

    Giri P, Poole J, Nightingale P, Robertson A. Perceptions of illness and their impact on sickness absence. Occup Med (Lond). 2009;59(8):550–5.

    Article  Google Scholar 

  17. 17.

    Coutu MF, Baril R, Durand MJ, Côté D, Rouleau A, Cadieux G. Transforming the meaning of pain: an important step for the return to work. Work. 2010;35:209–19.

    PubMed  Google Scholar 

  18. 18.

    Yin RK. Case study research: design and methods Applied social research methods series. Thousand Oaks: Sage; 1994.

    Google Scholar 

  19. 19.

    Coutu MF, Durand MJ, Baril R, Labrecque ME, Ngomo S, Côté D et al. A review of assessment tools of illness representations: are these adapted for a work disability prevention context? J Occup Rehabil. 2008;18(4):347–61.

    Google Scholar 

  20. 20.

    Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995;18(2):179–83.

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, et al. A population-based, randomized clinical trial on back pain management. Spine. 1997;22(24):2911–8.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Abenhaim L, Rossignol M, Valat J-P, Nordin M, Avouac B, Blotman F, et al. The role of activity in the therapeutic management of back pain: report of the International Paris Task Force on Back Pain. Spine. 2000;25(4 Suppl):1S–33S.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered: a randomized clinical trial. Spine. 1995;20(4):473–7.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Dionne C, Bourbonnais R, Fremont P, Rossignol M, Stock S, Laroque I. A clinica return-to-work rule for patient with back pain. Can Med Assoc J. 2005;172(12):1559–67.

    Article  Google Scholar 

  25. 25.

    Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol. 2002;156(11):1028–34.

    PubMed  Article  Google Scholar 

  26. 26.

    van Tulder M, Ostelo R, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ. Behavioral treatment for chronic low back pain. Spine. 2000;26(3):270–81.

    Article  Google Scholar 

  27. 27.

    Franche R-L, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J, et al. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil. 2005;15(4):607–31.

    PubMed  Article  Google Scholar 

  28. 28.

    Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther. 1992;72(4):279–90.

    PubMed  CAS  Google Scholar 

  29. 29.

    Frank JW, Sinclair S, Hogg-Johnson S, Shannon H, Bombardier C, Beaton D, et al. Preventing disability from work-related low-back pain. Can Med Assoc. 1998;158:1625–31.

    CAS  Google Scholar 

  30. 30.

    Loisel P, Durand MJ. Worker accommodation, clinical intervention and return to work. In: Sullivan T, Frank J, editors. Preventing and managing disability at work. London: Taylor & Francis; 2003.

    Google Scholar 

  31. 31.

    Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: systematic review. Br Med J. 2001;322(7301):1511–6.

    Article  CAS  Google Scholar 

  32. 32.

    Lloyd KR, Jacob KS, Patel V, St Louis L, Bhugra D, Mann AH. The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders. Psychol Med. 1998;28(5):123–7.

    Article  Google Scholar 

  33. 33.

    Weiss M. Explanatory Model Interview Catalogue (EMIC): framework for comparative study of Illness. Transcult Psychiatry. 1997;34(6):235–63.

    Article  Google Scholar 

  34. 34.

    Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Comparative studies of health systems and medical care; no. 3. Berkeley: University of California Press; 1980.

  35. 35.

    Durand MJ, Loisel P, Durand P. Therapeutic return to work: rehabilitation in the workplace. Work. 2001;17:57–63.

    PubMed  Google Scholar 

  36. 36.

    Coutu MF, Baril R, Durand MJ, Côté D, Rouleau A. Representations: an important key to understanding workers’ coping behaviours during rehabilitation and the return-to-work process. J Occup Rehabil. 2007;17(3):522–44.

    PubMed  Article  Google Scholar 

  37. 37.

    Landry R. L’analyse de contenu. In: Gauthier B, editor. Recherche sociale de la problématique à la collecte de données. Québec: Presses de l’Université du Québec; 1997. p. 329–56.

    Google Scholar 

  38. 38.

    Strauss AL, Corbin JM. Grounded theory in practice. Thousand Oaks: Sage Publications; 1997.

    Google Scholar 

  39. 39.

    Hébert F, Duguay P, Massicotte P, Levy M. Révision des catégories professionnelles utilisées dans les études de l’IRSST portant sur les indicateurs quinquennaux de lésions professionnelles. Montréal: Institut Robert-Sauvé de recherche en santé et en sécurité au travail (IRSST); 1996, Contract No.: R-137.

  40. 40.

    Durand MJ, Vachon B, Loisel P, Berthelette D. Constructing the program impact theory for an evidence-based work rehabilitation program for workers with low back pain. Work. 2003;21(3):233–42.

    PubMed  Google Scholar 

  41. 41.

    Parsons S, Harding G, Breen A, Foster NE, Pincus T, Vogel S, et al. The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain. 2007;23(1):91–8.

    PubMed  Article  Google Scholar 

  42. 42.

    Kenny DT. Constructions of chronic pain in doctor-patient relationships: bridging the communication chasm. Patient Educ Couns. 2004;52:297–305.

    PubMed  Article  Google Scholar 

  43. 43.

    Barnes MP, Ward AB. Textbook of rehabilitation medicine. Oxford: Oxford University Press; 2000.

    Google Scholar 

  44. 44.

    Legare F, Moher D, Elwyn G, LeBlanc A, Gravel K. Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review. BMC Med Inform Decis Mak. 2007;7(30):1–16.

    Google Scholar 

  45. 45.

    Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment? Br Med J. 1999;319(7212):780–2.

    Article  CAS  Google Scholar 

  46. 46.

    Arnetz JE, Almin I, Bergstrom K, Franzen Y, Nilsson H. Active patient involvement in the establishment of physical therapy goals: effects on treatment outcome and quality of care. Adv Physiother. 2004;6:50–69.

    Article  Google Scholar 

  47. 47.

    O’Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009;(2):CD001431.

  48. 48.

    O’Connor AM, Bennett C, Stacey D, Barry MJ, Col NF, Eden KB, et al. Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? a systematic review and meta-analysis. Med Decis Making. 2007;27:554–74.

    PubMed  Article  Google Scholar 

  49. 49.

    Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation? A qualitative study. Soc Sci Med. 2003;56:589–602.

    PubMed  Article  Google Scholar 

  50. 50.

    Holmes-Rovner M, Rovner D. Measuring improved patient choice. J Eval Clin Pract. 2000;6(3):263–72.

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Coutu MF, Légaré F, Durand MJ, Corbière M, Stacey D, Loisel P et al. Fostering shared decision making by occupational therapists and workers involved in accidents resulting in persistent musculoskeletal disorders: a study protocol. Implement Sci. 2011;6(22). doi:10.1186/1748-5908-6-22.

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Acknowledgments

This study was made possible through the participation of workers on long-term absences from work. Their commitment to the project was demonstrated on more than one occasion by their ready availability for the interviews. Their generosity in sharing their viewpoints cast a new light on the work rehabilitation process. We also wish to offer our warmest thanks to the members of the interdisciplinary work-rehabilitation team involved for their availability and generosity in sharing their experience in this project. This study was supported by a joint grant from the Quebec Rehabilitation Research Network (a thematic network of the Fonds de Recherche en Santé du Québec) and the Institut de recherche Robert-Sauvé en santé et en sécurité au travail (IRSST). The first and third authors are supported by salary awards from the Fonds de Recherche en Santé du Québec.

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The authors have no conflict of interest to disclose.

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Correspondence to Marie-France Coutu.

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Coutu, M., Baril, R., Durand, M. et al. Clinician–Patient Agreement About the Work Disability Problem of Patients Having Persistent Pain: Why it Matters. J Occup Rehabil 23, 82–92 (2013). https://doi.org/10.1007/s10926-012-9387-8

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Keywords

  • Disability
  • Pain
  • Musculoskeletal
  • Dyadic
  • Representations
  • Vocational rehabilitation