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On integrating biomedical and behavioural approaches to activity limitation with chronic pain : testing integrated models between and within persons

Johnston (1996) proposed that disability can be predicted by a model integrating biomedical and psychological variables; Johnston’s model has mainly been tested in chronic pain and most studies have found it to predict disability better than impairment alone. The first study replicated Dixon’s (2006) structural equation modelling study, which tested an updated variant of Johnston’s model with ICF constructs in orthopaedic patients on a waiting list for joint replacement surgery. The present study also extended these tests to post-surgery. Supportive results were found before surgery, as Dixon had also found, but also after surgery. However, few tests of the model at the within-person level had been conducted. Methodology of published experimental single-case studies targeting behaviour change was investigated in a large systematic review. Studies varied in quality and robustness of design, and few used statistical analyses. Johnston’s model was tested at the within-person level in a series of five correlational single-case studies; whether mood was predictive was also tested. Community participants with arthritis, chronic pain and activity limitations completed a daily dietary using a PDA of pain, activity level, mood and Johnston’s proposed variables, and wore an accelerometer to collect activity data. Differing from previous findings, pain (impairment) was not predictive, nor was self-efficiency, but motivational constructs (intention and goal-setting) did predict activity (limitations) in several cases. PBC predicted in the direction contrary to theory in two cases and was not predictive in the others. Mood was not predictive. Differences from previous findings suggest that the model may not predict the same way within individuals as between them, requiring further investigation.
Date January 2010
CreatorsQuinn, Francis
PublisherUniversity of Aberdeen
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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