Specialized Hospital for Polio and Accident Victims, Fjeldhammervej 8, 2610, Roedovre, Denmark.
Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
BMC Musculoskelet Disord. 2023 Jul 4;24(1):549. doi: 10.1186/s12891-023-06392-z.
Assessment is an important part of chronic pain rehabilitation and should be conducted in line with the current biopsychosocial conceptualization of pain to capture the subjectivity and context of pain. However, pain assessment is commonly conducted from a biomedical framework. A course in Acceptance and Commitment Therapy (ACT) was provided to spinal pain clinicians as a framework to promote more person-centered and psychosocially focused assessments and related psychologically informed practices. The purpose of this qualitative study was to explore the verbal content of clinicians' communication with patients experiencing spinal pain in assessment situations before and after clinicians participated in an ACT course.
Pain assessments of patients with chronic low back pain conducted by six spinal pain clinicians from different professions were audio-recorded and transcribed. This was done before and after participation in an eight-day ACT course with four following supervisions. A thematic analysis was carried out by two authors across all material, and a comparison of the applied number of codes pre-course and post-course was carried out as an indicator of change.
Data consisted of transcripts from the six clinicians across 23 different patients (12 before course participation). Through analysis, 11 codes were developed, which were clustered in three overarching themes: Psychological domains, Communication Techniques, and Intervention Elements. Overall, there was an increase in the application of many of the codes in the transcripts from pre-course to post-course, however with large differences across codes. Increases were primary related to the discussion of life values and value-based action and quality of life as well as the employment of mirroring, challenging beliefs and assumptions, and addressing coping and pacing.
While not the case for all factors, the present findings indicate an increase in including psychological factors and employing interpersonal communication skills after a course in ACT. However, it remains unknown due to the design if the changes reported in this study reflect a clinically valuable change and whether they are due to the ACT training itself. Future research will improve our understanding of the effectiveness of this type of intervention in assessment practices.
评估是慢性疼痛康复的重要组成部分，应符合当前疼痛的生物心理社会概念，以捕捉疼痛的主观性和背景。然而，疼痛评估通常是从生物医学框架进行的。为脊柱疼痛临床医生提供了一门接受与承诺疗法 (ACT) 课程，作为促进更以人为本和更注重心理社会的评估以及相关心理知情实践的框架。本定性研究的目的是探讨脊柱疼痛临床医生在参加 ACT 课程前后，在评估情境中与脊柱疼痛患者沟通的言语内容。
从不同专业的六名脊柱疼痛临床医生对慢性下腰痛患者进行的疼痛评估进行了录音和转录。这是在参加为期八天的 ACT 课程并进行四次后续监督之前和之后完成的。两位作者对所有材料进行了主题分析，并对课程前后应用的代码数量进行了比较，作为变化的指标。
数据包括六名临床医生对 23 名不同患者（课程参与前 12 名）的记录。通过分析，开发了 11 个代码，这些代码分为三个总体主题：心理领域、沟通技巧和干预要素。总体而言，从课程前到课程后，许多记录中的代码应用都有所增加，尽管代码之间存在很大差异。增加主要与生活价值观和基于价值观的行动以及生活质量的讨论有关，以及镜像、挑战信念和假设以及应对应对和节奏的使用。
尽管并非所有因素都是如此，但本研究结果表明，在接受 ACT 课程后，包括心理因素和运用人际交往沟通技巧的频率增加。然而，由于设计原因，尚不清楚本研究报告的变化是否反映了有临床价值的变化，以及它们是否归因于 ACT 培训本身。未来的研究将提高我们对这种干预在评估实践中的有效性的理解。
