review

Seven things that made me go ‘gggrrrrrrrr!’ in 2008


It’s the time of year to reflect and review, so today I’m going to look at some of the stand-out events and issues that got me riled.  You might, after reading these, think that a kind of theme fits these things but as I write them I promise I’m not choosing them to fit any preconceived ideas!  They appear in no particular order, either…

  1. Health professionals ‘turf protecting’ – it could be occupational therapists holding out to be ‘the only ones who do goal-setting’; clinical psychologists saying ‘but we’re the only ones who can really do CBT’; physiotherapists proclaiming ‘but only we can do talk about posture’; anyone who says ‘but I don’t want to do generic case work because I’m special’– well you know what I mean!  Enough already, there are a bunch of generic skills out there that anyone who has health professional training can and should be able to do.  Let’s get over ourselves and just do it, OK?
  2. System that focus on seeing lots of patients and generating lots of income without ensuring teams are able to provide quality treatments. In health care, it really does make a difference to the patient if the focus is on quantity rather than quality.  If we don’t spend time reviewing our practice, integrating research, developing strong teams and caring about what we do and how we do it, our patients don’t benefit.  It’s not simply about efficiency, it’s about effectiveness.
  3. Medics who can’t resist the ‘just one more’ approach. People living with chronic pain are so often on a roller-coaster of ‘it might help’ then ‘but it didn’t’ that someone at some point needs to say that it’s time to get on and live.  It is actually possible to live a full, rich, rewarding and enriching life despite experiencing chronic pain.  Reducing pain doesn’t improve the unhappy relationship, stop the job from being a dead-end one, or connect a sad person with new contacts. (more…)

Questionnaire Validation: A Brief Guide for Readers of the Research Literature


Questionnaire Validation: A Brief Guide for Readers of the Research Literature. Mark Jensen.

I thought I’d give you a quick overview of a brief but very useful (and readable) article that explains how readers of research literature in pain can evaluate the literature.  It provides a summary of the issues surrounding the evaluation of pain measures by reviewing the essential concepts of validity and reliability, and how these are usually evaluated in pain assessment research.

It also has a glossary of terms used in evaluating psychometric properties of pain measures that is very helpful as a brief dictionary, and it covers just what needs to be included in any paper about a new pain assessment:

(1) the rationale for the measure (what will this measure do that previous measures cannot?);

(2) validity data that specifically addresses the uses for which the measure is being proposed; and

(3) initial reliability data.

Any psychology student (and many other health science students) will very quickly realise that there are thousands of pain measures already available, yet each year there are many more that are published.  Why oh why would we need any more?  The answer is not just that each researcher keenly wants to be ‘known’ for his or her new questionnaire – but that ‘our understanding of pain, and the effects of pain treatments, is so dependent on our ability to measure pain, any improvement in pain assessment should ultimately result in an improvement in our understanding and treatment of pain.’

Jensen writes that there are two main reasons for developing a new pain measure:

(1) that the new measure assesses a dimension or component of pain not assessed by existing measures, and

(2) that the new measure shows clear improvements over existing measures of the same pain dimension (eg, it is shorter, it is easier to administer and score, it is a better predictor of important outcomes, it is more sensitive to change).

Although this is not a new article – it was published in 2003, it summarises all the relevant psychometric areas in such a succinct and reader-friendly way that I think it should be compulsory reading for anyone learning about pain assessment (and certainly anyone in the midst of dreaming up a new measure!).

Jensen, M. (2003). Questionnaire Validation: A Brief Guide for Readers of the Research Literature. The Clinical Journal of Pain, 19:345–352.

Back from holiday – aaah!refreshed!


Bo on a lean…

Bo on a lean…
The walls and floor in this room at Wanaka’s Puzzling World are set to confuse my poor brain…

Holidays provide time for thinking for me – lots of opportunity to consider my options and wonder. Once again, activities that aren’t often appreciated in our output-driven society.

I reflected often on the number of people I’ve had the privilege to work with who, for a multitude of reasons, have developed ongoing pain and who have needed to take time to re-evaluate their lives. It’s an opportunity that some seize with both hands, while others are cautious and angry and don’t want to look at the good of anything except the past.

Having a chronic health problem myself makes their struggles resonate within myself – sometimes more than I recognise at the time. I know the time and trouble it has taken me to accept my illness as part of who I am, not some interruption to what I want to do. Having said that I still don’t like having depression! Especially when it makes me more vulnerable than other people to other events in my life having a huge impact.

Some of you may know that this time last year I sustained a concussion injury – a ‘mild’ traumatic brain injury. Mild? Mild!

12 months later it still has a significant impact on how well I function! One of the more troublesome aspects is my need to make sure my energy isn’t depleted. Another is my need to avoid excessive head motion. I had no idea this would be a problem until I travelled with Bo down the West Coast and felt car sick. And when we went to the PuzzlingWorld in Wanaka, and entered the room with the slanted floor – all the visual cues to right myself were wrong and didn’t my brain work hard to try to put things right…

Which makes me think about how the people we work with have to work soooo hard to learn new cues, working their brains incredibly hard to deal with the monumental changes that pain has wrought. Not only do they need to do this when their pain is high, but they have to continue to do this in every part of their life. AND when they are dealing with this, is it any wonder that any other part of their life in which they are just a bit vulnerable can feel the strain too?

So, something I think might be in order is a huge amount of respect for the people we work with, and a touch of acknowledgement that humour and time out from rehabilitation can work wonders.