Volition and low back pain: When patients talk




Abstract


Objective


Our objective was to explore, describe and understand volition of chronic low back pain (LBP) patients, highlighting barriers and facilitators to practicing regular physical activity in order to develop a questionnaire assessing those volitional competencies.


Methods


A content analysis of semi-structured interviews with 30 chronic LBP patients was performed. Participants were asked about their pain, motivation, physical abilities, barriers and facilitators to regular exercises and finally strategies implemented to achieve the exercise program.


Results


Patients often reported that they were motivated and that exercises had no negative effects on LBP. Many patients recognized having difficulties performing all their exercises regularly. The main barriers were: lack of time, fatigue, lack of visible results, pain and other daily priorities. The main facilitators were: group exercise, help from the therapist, strategic planning, favorable environment, pleasure associated with exercises, fear of pain recurrence and pain itself.


Conclusion


Content analysis showed that sharing stories allowed patients to express their experience of LBP in their own words. It provides a solid ground to develop a questionnaire assessing volitional competencies in chronic LBP patients in order to identify patients who will not realize their exercises and help them be (more) active and avoid chronicity.


1


Introduction


Physical exercises are recommended to treat chronic low back pain. They are effective to prevent work absenteeism and recurrent pain episodes . However, between 60 and 80% of patients do not fully (or not at all) perform the exercises prescribed by their therapist (primary care physician, specialist physician or physiotherapist) when they are alone at home, even when they reported being motivated . Thus, motivation is not sufficient to trigger an action. As a matter of fact, one is often confronted to barriers (e.g. forgetting about exercises, feeling that the activity on the long term is too expensive, distractors, bad habits, depressive moods) preventing the action of exercising .


According to the Health Action Process Approach (HAPA) model , developed to explore change pathways for unhealthy behaviors, it is essential to differentiate pre-intentional processes of a motivational nature and post-intentional processes of a volitional nature ( Fig. 1 ). Patients progress (ideally) from one stage to the next in a sequential manner and have common characteristics according to the stage they are in. The motivational stage includes three positive socio-cognitive predictors of an intention to act (e.g. “I intend to exercise”): risk perception related to a given pathology/disease, outcome expectancies of a specific action and perceived self-efficacy of this action. The concept of the volitional stage is driven by the need to appreciate that once patients have forged a global intention to develop a behavior, they must plan to implement this behavior into their routine (action planning), sustaining it over time against potential obstacles (coping planning) and make it effective (action). In related fundamental research, HAPA underlined facilitators for specific plans, called implementation intentions, for planning an action and coping . These specific intentions, wilful cognitive tools determined to consciously promote the initiation of an action, are conditional plans with the following structure “if…, then…”: “If faced with the situation Y , I will then adopt the behavior Z , geared towards the goal X ”. These plans specify under which circumstance (when and where) a certain goal-directed action will be required (how) . Action planning and coping planning are positively predicted by the self-perceived efficacy to elaborate quantitatively and qualitatively-suited action plans. Once the action is initiated, its proper execution must be controlled. On the one hand, barriers can arise and the problem in that case is sustaining the action; on the other hand the problem might lie in resuming the action after having stopped or given up. Action maintenance is positively predicted by the volitional maintenance self-efficacy, designating the optimistic beliefs related to the perceived ability to face barriers that might arise along the course of the action (e.g. “I feel able to continue my physical exercises in spite of fatigue”). The ability to resume an action is positively predicted by the volitional recovery self-efficacy, designating the confidence in the ability to resume the activity after interruption or failure (e.g. “I am confident that I can resume a physical activity even after having been sick”).


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Apr 20, 2017 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Volition and low back pain: When patients talk

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