Physiotherapy Research Unit, Nuffield Orthopedic Centre, Oxford, United Kingdom.
Disabil Rehabil. 2012;34(11):894-903. doi: 10.3109/09638288.2011.626483. Epub 2012 Feb 1.
To explore the differences in narrative between patients with persistent non-specific low back pain (PLBP) who benefited from a pain management programme, and those who did not benefit.
We conducted interviews with 20 patients attending a pain management programme; prior to attending the programme, immediately following the programme and at one year. Our analysis focused on a theoretical sample of patients who either described dramatic life improvements at one year, and who described themselves as much worse. We used the methods of grounded theory.
We found that finding hope was central to good outcome. Patients restored hope by making certain changes; (a) deconstructing specific fears, (b) constructing an acceptable explanatory model (c) reconstructing self identity by making acceptable changes. Those who had not restored hope retained fears of loss of self, remained committed to the biomedical model and were unable to make acceptable changes.
Our findings may help to operationalise the restoration of hope in patients with PLBP. Firstly, health care professionals need to identify and resolve any specific fears of movement. Secondly, patients need an acceptable explanatory model that fits their experience and personal narrative. Finally our study confirms the centrality of self concept to recovery.
探索在接受疼痛管理项目后受益和未受益的持续性非特异性下腰痛（PLBP）患者之间叙述的差异。
我们对 20 名参加疼痛管理项目的患者进行了访谈；在参加项目之前、参加项目后立即和一年后进行。我们的分析集中在一个理论样本上，这些患者要么在一年后描述了戏剧性的生活改善，要么描述自己的情况更糟。我们使用了扎根理论的方法。
我们发现找到希望是取得良好结果的关键。患者通过做出某些改变来恢复希望：（a）解构特定的恐惧，（b）构建可接受的解释模型，（c）通过做出可接受的改变来重建自我认同。那些没有恢复希望的人仍然对失去自我感到恐惧，仍然坚持生物医学模式，无法做出可接受的改变。
我们的发现可能有助于在 PLBP 患者中实现希望的恢复。首先，医疗保健专业人员需要识别和解决任何关于运动的具体恐惧。其次，患者需要一个可接受的解释模型，该模型符合他们的经验和个人叙事。最后，我们的研究证实了自我概念对康复的核心地位。
