| dc.description.abstract | Planning and carrying through rehabilitation involve determining both users and providers views. A negotiation-centred approach implies a rehabilitation situation in which the power is shared by the client and the therapist, reflected in the interaction between the two parties. As a rehabilitation provider, the occupational therapist requires not only comprehensive information about the client as a person and how she is affected by the problem, but also about how and why the person s life-world is influenced and disturbed. An understanding of the past gives a better understanding of the ill person s thoughts about the future. When a person is ill or injured her habits, meanings, and personal and contextual relationships change. The meaning of habit in peoples daily lives is deeply connected with the experience of themselves as persons and the world wherein the habits and activities are a part. They locate people in their ordinary, taken-for-granted life and protect their daily lives from chaos. Habits can be used to reconstruct the occupational self in response to chronic illness, including the learning of both new habits and new ways of thinking. Chronic non-malignant pain is a common condition in the adult population. The condition leads to psychological, social, behavioural and physical consequences. Despite evidence concerning the success of behaviour-oriented rehabilitation programmes, not all participants experience the expected change. For rehabilitation to be successful, it is necessary that each individual is guided towards the most appropriate form of treatment in relation to his/her life-world. Persons with chronic pain and professionals differ in the interpretation of the pain condition and in the perceptions of rehabilitation needs. As pain is conceptualised as a lived, existential, cultural experience, it cannot be properly understood without investigating how persons with chronic pain concretely live and understand their specific life-world situation. The principal aim of the thesis was to investigate, explore and understand features of the life-world of persons with chronic pain. Four studies were included in the thesis. Two of the studies had a qualitative approach investigating conceptions of health in persons after their taking part in a rehabilitation programme for persons with chronic pain condition (study I) and exploring participants experiences of the design, content and format of the same rehabilitation programme (study III). The two other studies had quantitative design and evaluated long-term influences regarding visits to the doctor and sick-listing for persons with chronic pain after having taken part in the rehabilitation programme (study III) and developed and tested a self-administered Swedish treatment-planning and predictive instrument for persons with chronic pain (study IV). The findings of the first three studies were regarded as features of the life-world of the participants and included descriptions of the participants being aware of their own capacity and responsibility as well as finding it important and meaningful to have their pain and the pain condition confirmed in various ways and being respectfully treated in their contacts with health care. Other features expressed were that the relation to the pain and the pain condition was ambiguous, and that it was possible to establish a passive approach due to the pain. In the life-world with pain the environment was described as having a meaning comprising an encouraging mediator and representing an object that could be influenced. Changes in sick-listing and frequency of doctor visits after participating in rehabilitation were seen as life-world features revealing rehabilitation as an opportunity to influence health-care needs and accept of reject disability. The features were used to form the basis for the development of the instrument, which was tested by means of face validity and stability over time. The instrument in its final form comprised 26 items, which showed face validity and reliability in terms of stability over time. The first step in the further development of the instrument will be to construct a manual with instructions for interpreting the responses and with guidelines for choosing the form of treatment. The results have shown a limited but nevertheless, important number of features of value to treatment planning in the form of self-images and habits in relation to pain and rehabilitation. The heterogeneity of the participants in the studies included in the thesis with regard to both diagnoses and duration of pain assures that the instrument is based on different perspectives regarding pain and on different experiences of pain. It is therefore appropriate for a wide range of persons suffering from different forms of chronic pain conditions. The development process based on features of the life-world of the target group constitutes an attempt to reach a better understanding between rehabilitation providers and persons with chronic pain, which in turn may lead to a more negotiation-centred treatment with a shared responsibility for rehabilitation. | en |
