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The effect of involving significant others in chronic pain programs for adult patients with chronic non-malignant pain: a systematic review protocol

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The effect of involving significant others in chronic pain programs for adult patients with chronic non-malignant pain: a systematic review protocol
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  The effect of involving significant others in chronic painprograms for adult patients with chronic non-malignantpain: a systematic review protocol Carrinna A. Hansen 1  Palle Larsen 2 1 Faculty of Health and Medical Sciences, Copenhagen, Denmark, Clinic of Neuroanesthesiology, Rigshospitalet – Glostrup, University of Copenhagen, Copenhagen, Denmark,  2 Department of Public Health, Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centreof Excellence, Section of Nursing Science, Aarhus University, Aarhus, Denmark  Review question/objective:  The objective of this review is to identify the effect of the involvement of significantothers in chronic pain management programs for adult patients with chronic non-malignant pain on function, self-efficacy and pain.More specifically, the objectives are to identify the effect of involving significant others in chronic managementprograms for adults with chronic non-malignant pain in primary, secondary or tertiary health care. This is comparedto those receiving usual care or other self-management interventions. Keywords  Chronic non-malignant pain; involvement; management program; significant other  JBI Database System Rev Implement Rep  2017; 15(1):20–29. Background C hronic non-malignant pain is a worldwide pub-lic health problem generally defined as currentpain that has lasted for minimum six months orlonger, is due to non-life-threatening causes, whichhas not responded positively to available methods of treatment and may continue throughout the individ-ual’s life. 1 Self-management is, therefore, a necessityfor each individual. In Europe, chronic non-malig-nant pain affects approximately one out of fivepeople aged 16 years or older. 2 It has been welldocumented that Denmark has a high incidence,with a prevalence of 26.8%, and this trend, basedonalmosttwodecades,doesnotappeartobedeclin-ing. 2-4 Chronic non-malignant pain is often com-plex, causing difficulty in reaching a diagnosis. Theprocess of diagnosis is naturally prolonged, as sev-eral treatment options have to be tested. In addition,it is customary for patients to have to wait forspecialized treatment in pain clinics and centersfor up to two years, at least in Denmark, due tothe lack of general political attention, leading to alack of overall guidelines and resource priorities inthe chronic pain area. 5 Chronic non-malignant pain is a chronic illnessleading to altered life circumstances, requiringadjustments within the family according to rolesand tasks due to the patient’s functional impairmentand fatigue, and, commonly also, to the occu-pational situation and social activities of the indi-vidual with pain. 6,7 Multi-disciplinarychronic painmanagement pro-grams are led by an interdisciplinary team consistingof at least three of the following professionals: phys-icians, nurses, physiotherapists, occupational thera-pists, social workers and psychologists. 1,2,8 Due tothe complexity of the condition, a patient-centeredor biopsychosocial approach is mainly used in anindividualand/orgroup-basedcontextwithelementsof physical training, cognitive behavior therapy,mindfulness, relaxation training techniques, copingstrategy training, workability assessment andothers. 1,2,8 In recent years, the involvement of relatives inrehabilitation processes has been increasingly inves-tigated as part of a strategy to support the patient’smanageability and self-management of chronic dis- ease, 9 stroke, 10 cancer 11,12 and pressure ulcers. 13 Researchsuggeststhattheinvolvementofsignificantothers in the rehabilitation process of chronic Correspondence:  Carrinna A. Hansen, carrinna.hansen.01@regionh.dk  There is no conflict of interest in this project.DOI: 10.11124/JBISRIR-2016-003239 JBI Database of Systematic Reviews and Implementation Reports    2017 THE JOANNA BRIGGS INSTITUTE  20 SYSTEMATIC REVIEW PROTOCOL ©2017 Joanna Briggs Institute Unauthorized reproduction of this article is prohibited  non-malignant pain produces a positive effect oncomprehensive pain management, self-efficacy, levelof functioning, stress and common understand-ing. 7,8,14,15 A qualitative chronic pain study basedon semi-structured interviews with patients and sig-nificant others found that the involvement of signifi-cant others in rehabilitation programs may beessential in developing a shared understanding of the management of the condition for those sufferingchronicpain, aswell asthe significant others and thefamily as a whole. 8 Particularly, involvement of significant others seems to be important for theprocess of realizing and adjusting to the new lifecircumstances,rolesandresponsibilitiesinthehome,as well as celebrating achievements together duringrehabilitation. 8 Another perspective of involvingsignificant others was found in a study exploringthe support person’s perceptions and experiences of the roles they undertook throughout the rehabilita-tion process. 15 The researchers found that involve-ment of significant others was entirely dependent onthe willingness of the person with chronic pain toinvolve them. It is also dependent on the extent towhich the individual with pain was able to make useof the support provided by their significant other.The main benefits from involving significant othersfrom the significant others point of view wereincreased understanding of the condition and mech-anisms of rehabilitation and therefore feeling moreconfident in encouraging their loved one to continuetraining,despiteincreasedlevelsofpain.Inaddition,being able to talk with health professionals attunedunrealisticexpectationstowardrehabilitation. 15 Inaone-year randomized controlled trial study of 36chronic low back pain patients and their spouses, itwas found that a brief and low-intensity spouse-assisted multi-disciplinary pain management pro-gram showed promising results at the 12-month fol-low-up time point. Patients receiving the spouse-assisted multi-disciplinary pain management pro-gram had significant improvements in kinesophobia(fearavoidancebehavior)andruminationaboutpain(thecompulsivelyfocusedattentiononthesymptomsof one’s distress and on its possible causes and con-sequences,asopposedtoitssolution)comparedtothetwo other groups, a patient-oriented multi-discipli-nary approach and standard medical care. 14 Because of the promising reports on the increasedself-management due to involvement of significantothers in chronic pain programs, 8,15 it is importanttoconductasystematicreviewontheeffectofinvolv-ing significant others in chronic pain programs.The rationale of this systematic review is toidentify the evidence base regarding involving sig-nificant others in chronic pain programs and health-care regimens of adult patients with chronic non-malignant pain in primary, secondary or tertiaryhealthcare settings. This will inform the develop-ment of future case management interventions atmulti-disciplinary pain clinics. Developing effectiveinterventionsinvolvingsignificantothersisessential,as the presence of chronic pain can affect the fam-ily. 8,15,17 Accordingly, involvement of significantothers is vital to successful comprehensive painmanagement. 7,8,14-17 This review will contributeby drawing attention to the crucial intervention of incorporating significant others in effective andmeaningful ways in future rehabilitation programsof chronic non-malignant pain. The following sour-ces were initially searched for published systematicreviews on the topic:  JBI Database of SystematicReviews and Implementation Reports ,the CochraneLibrary and MEDLINE. No systematic reviews onthis topic were found. Inclusion criteria Types of participants The current review will consider studies that addressinvolvement of significant others and include adultpatients treated at primary, secondary or tertiaryhealthcare institutions for chronic (six months orlonger) non-malignant/non-cancer pain. Sincechronic pain affects adults of all ages, there will beno upper age limit set; we will include participantsaged16yearsorover.Patientswithcancerpainwillbeexcluded from this review due to the specific natureand management of cancer pain, which often differsfrom non-cancer-related causes of chronic pain. Inaddition, adults who are not treated at primary,secondary or tertiary healthcare institutions forchronic benign pain are also considered beyond thescopeofthisreview.Inthesesettings,theinvolvementof significant others is likely to require differentdesigns compared to community-dwelling interven-tionsandthereforediffergreatlyfromthese. 7,8,14 Thedefinition of signif icant others will be in accordance with Abbasi  et al. , 14 Lewandowski  et al. 7 and Swift etal. , 8 thereforedefinedas‘‘peoplethatanindividualwithchronicpain definesastheirkeysourceofsocialand psychological support’’. 8(p.48) SYSTEMATIC REVIEW PROTOCOL  C.A. Hansen and P. Larsen JBI Database of Systematic Reviews and Implementation Reports    2017 THE JOANNA BRIGGS INSTITUTE  21 ©2017 Joanna Briggs Institute Unauthorized reproduction of this article is prohibited  Types of interventions The current review will consider studies that evalu-ate any intervention of involving significant otherswith the purpose of supporting the patient in man-aging chronic non-malignant pain. Any intervention(mono- or multi-faceted) that includes a definedelement of involvement of significant others, deliv-ered to groups or individuals in any format, includ-ing face-to-face, telephone and internet-basedinterventions, will be considered for inclusion. Inter-ventionstudieswithoutadefinedelementofinvolve-ment of significant others will be excluded.Significant others may have been selected by thepatient, self-selected or selected by health pro-fessionals; comprising any relative, spouse, family,friend or neighbor and others. This review willconsider studies that have compared involvementfrom significant others to any intervention that pro-vides usual care as their comparator or other self-management interventions without an element of involving significant others. Outcomes The current review will consider studies that includeone or several of the following outcome measures of physically or psychological function, self-efficacy orself-assessed pain. The outcomes measures may be,butarenotlimitedto,theStanfordHealthAssessmentQuestionnaire, The Pain Disability Index, Pain Self-Efficacy Questionnaire, The general self-efficacyquestionnaire, Arthritis Self-Efficacy Scale, The PainStages of Change Questionnaire, the Oswestry LowBack Pain Disability Questionnaire, OccupationalUnderstanding of Challenges – Chronic Pain Ques-tionnaire, The McGill Pain Questionnaire and TheBehavioral Assessment of Pain Questionnaire and soon will be considered for inclusion. This is alignedwith recommendations for outcome measurement inchronic pain and self-management research. 16,18-21 Therefore,thesemeasuresareexpectedtobeavailablefor consideration. Types of studies The current review will consider both experimentaland epidemiological study designs includingrandomized controlled trials, non-randomized con-trolled trials, quasi-experimental, before-and-afterstudies,prospectiveandretrospectivecohortstudies,case-control studies and analytical cross-sectionalstudies for inclusion.The current review will also consider descriptiveepidemiological study designs including case series,individual case reports and descriptive cross-sec-tional studies for inclusion in a narrative summary.This will enable the identification of current bestevidence regarding interventions addressing involve-ment of significant others for hospitalized adultpatients with chronic non-malignant pain. Search strategy The search strategy aims to find both published andunpublishedstudies.Athree-stepsearchstrategywillbe utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken fol-lowed by analysis of the text words contained in thetitle and abstract, and of the index terms used todescribe the article. A second search using all ident-ified keywords and index terms will then be under-taken across all included databases. Third, thereference list of all identified reports and articleswill be searched for additional studies. Studies pub-lished in English, German, Danish, Swedish andNorwegian will be considered for inclusion in thisreview. Studies published from inception of eachdatabase until the present will be considered forinclusion in this review.The databases to be searched include:CINAHLEmbaseMEDLINEPsycINFOScience Citation IndexScienceDirectSVEmedThe search for unpublished studies will include:Networked Digital Library of Theses and Disser-tationsSIGLEOpen GreyMedNarPubMed ‘‘related articles’’ feature will be used toidentify any additional studies identified by othersources.Initial keywords to be used will be:chronic nonmalignant pain OR chronic non-cancerpaincombinedwiththetermschronicpainprogram,rehabilitation, self-management, self-efficacy, cop-ing, involvement, participation, spouse-assisted, sig-nificant other, family, spouse, effect, quantitativeresearch, quantitative evaluation. Wildcard (  ) will SYSTEMATIC REVIEW PROTOCOL  C.A. Hansen and P. Larsen JBI Database of Systematic Reviews and Implementation Reports    2017 THE JOANNA BRIGGS INSTITUTE  22 ©2017 Joanna Briggs Institute Unauthorized reproduction of this article is prohibited  be used to ensure all inflections of the word areincluded in the search. In addition, specific measur-ing tools will be included in the search: Healthassessment Questionnaire, Pain Self-Efficacy Ques-tionnaire, The general self-efficacy questionnaire,Arthritis Self-Efficacy Scale, The Pain Stages of Change Questionnaire,the OswestryLow BackPainDisabilityQuestionnaire,OccupationalUnderstand-ingofChallenges – ChronicPainQuestionnaire,TheMcGill Pain Questionnaire and The BehaviouralAssessment of Pain Questionnaire and Health Edu-cation Impact Questionnaire. Assessment of methodological quality Papers selected for retrieval will be assessed by twoindependent reviewers for methodological validityprior to inclusion in the review using standardizedcriticalappraisalinstrumentsfromtheJoannaBriggsInstitute Meta-Analysis of Statistics Assessment andReview Instrument (JBI-MAStARI) (Appendix I).Any disagreements that arise between the reviewerswill be resolved through discussion or with a thirdreviewer. Data extraction Datawillbeextractedbytwoindependentreviewersfrom papers included in the review using the stand-ardized data extraction tool from JBI-MAStARI(Appendix II). The data extracted will includespecific details about the interventions, populations,study methods and outcomes of significance to thereview question and specific objectives. Data synthesis Whenever possible, quantitative papers will bepooled in statistical meta-analysis using JBI-MAS-tARI.Allresults will be subject to double data entry.Effect sizes expressed as odds ratio (for categoricaldata)andweightedmeandifferences(forcontinuousdata) and their 95% confidence intervals (CIs) willbe calculated for analysis. Heterogeneity will beassessed statistically using the standard chi-squareandalsoexploredusingsub-groupanalysesbasedonthe different quantitative study designs included inthis review. For observational studies, effect sizesexpressed as relative risk (cohort studies) and oddsratio (case-control studies) for categorical data andweighted mean differences (continuous data) andtheir 95% CIs will be calculated for analysis. Wherestatistical pooling is not possible, the findings willbe presented in narrative form including tablesand figures to aid in data presentation whereappropriate. References 1. 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Anesthesiology2010;112(4):810–33. SYSTEMATIC REVIEW PROTOCOL  C.A. Hansen and P. Larsen JBI Database of Systematic Reviews and Implementation Reports    2017 THE JOANNA BRIGGS INSTITUTE  24 ©2017 Joanna Briggs Institute Unauthorized reproduction of this article is prohibited
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