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This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings., (Copyright (c) 2009 John Wiley & Sons, Ltd.)

Objective: Lack of referral guidelines can cause delayed or even non-existent rehabilitation for chronic pain patients. Indicators signalling the need for interventions could counteract this delay for pain rehabilitation and thereby prevent deteriorating patient health. This study aimed to explore the indicators of need for pain rehabilitation using a multidisciplinary expert panel working with pain rehabilitation., Methods: A three-round Delphi study was conducted with a multidisciplinary expert panel (n = 23), each representing one pain rehabilitation unit in Sweden. The expert panel produced indicators, which were then ranked using a four-point Likert scale., Results: Twenty multi-faceted indicators for pain rehabilitation were identified. A major part concerned patient problems with activity level, catastrophizing, coping, existential problems, fear avoidance, high pain rating, medication, mental health, motivation, no pain relief, pain spread/increase, psychosocial problems combined with activity problems, psychosocial problems, recovery, and reduced physical function. Furthermore, indicators concerned demographic factors, sick leave, situation in primary health care and work. Finally, tacit knowledge was pointed out as an indicator. The results support previous research but also bring out less quantifiable indicators, such as relying on tacit knowledge while assessing a patient's need for rehabilitation., Conclusion: The indicators for pain rehabilitation were comprehensive, pointing out that needs assessment is complex. Despite reaching consensus on 19 out of 20 indicators, further research is needed to deepen knowledge in this area and to secure a fair assessment of a patient's need for pain rehabilitation., (Copyright (c) 2009 John Wiley & Sons, Ltd.)

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.

Purpose: The purpose of the study was to elicit the actual state of self-perceived experience of long-term and/or recurrent pain and its effects as reported by women and men with disabilities due to pain, in order to determine criteria for assessing the need for measures in rehabilitation/occupational therapy., Methods: The study used a comparative design with a sample randomized from the Swedish population aged 18-58 years (n = 10,000). The inclusion criterion was that the respondents had or had had pain causing activity limitation or restricting participation in daily life. A special questionnaire including items concerning demography, pain, coping, occupations in daily life, work, treatments, care institutions and hospital/care staff visited, was posted to 1,849 persons and was answered by 1,448 respondents (study group n = 1,305, control group n= 117)., Results: Gender differences were found in the overall prevalence of pain, women reporting more frequent episodes of pain than men did. Differences were also found in pain variables, in daily occupations, days of sick-leave and work variables. Women completed more varied treatment than men. The incidence rate of long-term/recurrent pain in the population studied was 0.07., Conclusions: As a conclusion from this study, three essential components are suggested for use when assessing the need for rehabilitation/occupational therapy: (1) shoulder/arm or lower back pain of aching, tensed and/or searing character, particularly among women; (2) emotional/affective pain effects causing restlessness and depression, particularly among women; and (3) limitations in daily occupations assessed by FSQ and the demand/control/support model with results falling within the warning zones plus long sick-leave periods.

The aim of the study was to elucidate selection criteria for need of rehabilitation/occupational therapy, and to state criteria for participation in occupational therapy, among persons with long-term and/or recurrent pain causing activity limitations or restricting participation in daily life. The study involved 914 persons aged 18-58 years who answered a postal questionnaire concerning demography, pain, occupations in daily life, work, treatments and health care staff visited. The direct method in logistic regression analysis was used to test two models: (1) need of rehabilitation/occupational therapy and (2) participation in occupational therapy. The results for the first model revealed the selection criteria (1) 'feelings of irresolution', (2) 'gnawing/searing pain' and (3) 'use of technical aids'. The odds for need of rehabilitation/occupational therapy were higher for women than for men. The criteria derived from the second model, participation in occupational therapy, were whether (1) the participants had 'used tricks and/or compensated ways to perform tasks', (2) the participants had 'pain in shoulders' and (3) 'changes had been made at work due to health conditions'.

Needs assessment may be helpful in establishing health care priorities, especially when community financial resources are reduced and the need and demand for health services are increasing. As the starting point of empirical studies concerning needs assessment of rehabilitation and occupational therapy, this study aimed to establish the prevalence of self-perceived activity limitation and/or participation restrictions due to long-term or recurrent pain. The study sample (n = 10000) was taken at random from the Swedish population aged 18-58 years. After three reminders, the response rate to a postal questionnaire was 77.1%, by mail or to a telephone answering machine. The main results indicated prevalence frequencies of 26%, showing the actual state of self-perceived activity limitation and/or participation restrictions due to long-term and/or recurrent pain. Differences were found between genders, among almost all age-classes and between persons who had pain currently and those who had had pain previously. Suggested indicators from the study result were women born between 1940 and 1949 with long-term pain and previous pain.