Dribbling past chronic pain – Evaluating meaningful support through a remote person-centred care intervention

Abstract

Background: Chronic pain has a profound impact on the persons living with it, their social networks and society. Support is crucial for people living with chronic pain; however, the concept of support is multifaceted. Overall aim: to elucidate the mean-ing of support among persons living with chronic pain and to perform an efficacy- and process evaluation of a remote person-centred intervention that combines tele-phone and eHealth support. Methods: Phenomenological hermeneutics was applied to elucidate the meaning of support (Study I). Inferential statistics were used in the randomised controlled trial Early Accessible Person-centred Rehabilitation for peo-ple with long-term pain (EAPER-P), to compare a composite score of self-efficacy and sick leave rate between a control group (n=30) and intervention group (n=29) (Study II). In a mixed methods process evaluation, the meaningfulness of the EAP-ER-P intervention was investigated and explored (Study III). In a multimethod study, the goals formulated in the EAPER-P intervention, their attainment and the distribu-tion of self-efficacy and sick leave rates depending on goal attainment were de-scribed (Study IV). Results: The meaning of support was illustrated with a football metaphor: balancing between being the most valuable player (being capable) and passing the ball (accepting help to continue being capable) (Study I). A statistically significant difference in the composite score was observed, favouring the interven-tion (Study II). Most participants perceived the intervention as meaningful, especial-ly the person-centred conversations. Talking to a friendly outsider (healthcare pro-fessional) without formal documentation proved valuable, and goals were considered meaningful upon successful completion. By contrast, the non-attainment of goals could lead to negative consequences (Study III). Goals encompassed pain, physical activity and function, other lifestyle habits, career plans and emotional processes; <20% of these goals were achieved. The group that achieved goals had a greater improvement in self-efficacy and a lower sick leave rate compared to the group that did not (Study IV). Conclusion: This thesis offers novel insights into the meaning of support within the context of chronic pain, aligning with a person-centred approach to care. Person-centred care demonstrates efficacy and meaning for individuals expe-riencing chronic pain; however, future interventions require meticulous attention to goal setting and achievement. Further research is needed to understand the influence of medical records and to develop eHealth components suitable for person-centred care delivery.