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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

Online
ISSN
1877-8879
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Volume 13, Issue 1

Issues

Constructs of health belief and disabling distal upper limb pain

Daniel Whibley
  • Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
  • Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Scotland, UK
  • Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work,University of Aberdeen, Scotland, UK
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ross MacDonald
  • Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
  • School of Mathematics and Statistics, University of St Andrews, Scotland, UK
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gary J. Macfarlane
  • Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
  • Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Scotland, UK
  • Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work,University of Aberdeen, Scotland, UK
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gareth T. Jones
  • Corresponding author
  • Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
  • Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Scotland, UK
  • Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work,University of Aberdeen, Scotland, UK
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2016.07.003

Abstract

Background

Musculoskeletal pain in the distal upper limb is common and is a cause of disability and healthcare consultation. At the time of presentation individuals reporting similar pain severities may report different levels of related disability. The biopsychosocial model proposes that health beliefs may help explain this difference. The aim of this cross-sectional study was to identify underlying constructs of health belief in those referred to physiotherapy with pain in the distal upper limb and investigate whether these constructs moderated the relationship between pain severity and extent of disability.

Method

Health beliefs were assessed using an instrument included in a questionnaire completed before randomisation to the Arm Pain Trial (ISRCTN79085082). Ordinal responses to statements about health beliefs were used to generate a polychoric correlation matrix. The output from this matrix was then used for Exploratory Factor Analysis to determine underlying constructs. The moderating influence of the identified health belief constructs was then tested using interaction terms in linear regression models.

Results

476 trial participants contributed data, age range 18–85 (mean 48.8, SD 13.7), 54% female. Five health belief constructs were identified: beliefs about hereditary factors, beliefs about movement and pain, beliefs about locus of control, beliefs about the role of lifecourse/lifestyle factors, and beliefs about prognosis. The only health belief construct found to moderate the pain-disability relationship was beliefs about prognosis, with greater pessimism resulting in higher levels of disability at mild-to-moderate levels of pain severity (B –0.17,95% CI –0.30, –0.036).

Conclusion

This exploratory cross-sectional study identified five constructs of health belief from responses to a previously used set of statements investigating fear avoidance and illness beliefs in a clinical population with pain in the distal upper limb. Of these constructs, beliefs about prognosis were found to moderate the relationship between pain and disability.

Implications

At the time of referral to physiotherapy it may be beneficial to assess patients’ perception of prognosis. For those with higher than expected disability for the presenting level of pain, and pessimism about prognosis, focused reassurance may play an important part in initial consultation. Longitudinal study is required to support the findings from this study and investigate whether a causal relationship exists. Future investigations should confirm the health belief constructs proposed.

This article offers supplementary material which is provided at the end of the article.

Keywords: Distal upper limb; Musculoskeletal pain; Disabling pain; Health beliefs; Factor analysis

References

About the article

Room 1.025, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. Tel.: +44 0 1224 437143.


Received: 2016-05-02

Revised: 2016-07-20

Accepted: 2016-07-21

Published Online: 2016-10-01

Published in Print: 2016-10-01


Author contributions: DW, GJM and GTJ conceived of the idea for the study; DW drafted the manuscript; DW and RM undertook the analysis; GJM and GTJ oversaw all work and provided feedback and revisions to drafts. All authors discussed the results and commented on the manuscript.

Disclosures: The Arm Pain Trial was funded by Arthritis Research UK (grant number: 19231). DW was funded by a University of Aberdeen Institute of Applied Health Sciences Doctoral Studentship. RM was funded by a Medical Research Scotland Undergraduate Vacation Scholarship (grant number: 810-2015). There are no conflicts of interest to declare.

Ethical issues: Ethical approval for the Arm Pain Trial and secondary analyses was obtained from the UK South Central (Hampshire A) Research Ethics Committee (reference: 11/SC/0107). All participants provided written informed consent before completing baseline questionnaires.

Conflict of interestConflict of interest statement: There are no conflicts of interest to declare.


Citation Information: Scandinavian Journal of Pain, Volume 13, Issue 1, Pages 91–97, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2016.07.003.

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