A behavioral medicine intervention for older women living alone with chronic pain – a feasibility study

Figures & data

Figure 1 Flow chart of study sample.

Table 1 Description of the content in the intervention for the experimental group

Visit	Intervention components	Contents
1	Identification of a problematic everyday activity. Choice of goal behavior	Observation of the performance of the goal behavior. Identification of physical, psychological and environmental factors that can have importance for the goal behavior. Identification of short and long term consequences the woman perceived from the behavior.
	Advice about physical activity	Oral and written information about the advice and instruction on how to fill in the activity diary.
2	Individual Functional Behavioral Analysis (FBA)	Summary and analysis of collected information. Formulation of hypotheses regarding the relations between the physical, psychological, and environmental factors, the goal behavior and the consequences of the goal behavior.
	Specific, Measurable, Activity-based, Realistic and Time-delimited (SMART) goal-setting and intervention planning	Discussion and agreement about performance and dosage of training according to the SMART goal setting.
3–5	Basic skills acquisition	Training of basic physical, psychological and organizational skills relevant to the goal behavior.
6–8	Applied skills acquisition Generalization	Training to apply basic skills adequately in the goal behavior. Application of basic and applied skills in other behaviors starting with subsequent activity goals.
	Maintenance and relapse prevention	Discussion about how the woman could be able to maintain her new behavior. Discussion of problem solving strategies, how she could prevent and deal with new activity problems that may arise related to the goal behavior and in relation to be physically active.

Table 2 Baseline characteristics for the participants

Baseline characteristics	Experimental group (n=12)	Comparison group (n=11)	P-value
Age, years, mean (SD)	84.5 (6.7)	83.8 (4.9)	0.57
MMSE,^Citation25 mean (SD)	27.7 (1.3)	27 (1.3)	0.22
Years with pain, mean (SD)	28.8 (21.8)	26 (22.1) (n=10)	0.21
Help from relatives, %, yes (no)	75 (25)	72 (18) (n=10)	0.78
Home-help services, number of visits per week, mean (SD)	17.3 (6.7)	15.6 (9.5) (n=10)	0.56
Get outdoors by themselves, %, yes (no)	58 (42)	27 (63) (n=10)	0.18
Number of diseases, mean (SD)	3.6 (1.2)	3.1 (1.8)	0.06
Number of medications, mean (SD)	8.3 (4.0)	5.2 (1.7)	0.65
Number of prescribed/nonprescribed pain medications, mean (SD)	0.57/0.99 (0.78/0.35)	0.29/1 (0.49/0)	0.96/0.56

Abbreviations: SD, standard deviation; MMSE, Mini-Mental State Examination.

Table 3 Baseline assessments for the participants, presented as means (standard deviation)

Assessment	Experimental group (n=12)	Comparison group (n=11)	P-value
Pain intensity, CPGQ^Citation29,Citation30 (0–100*)	46.1 (30.9)	50.6 (19.7)	0.93
Disability score, CPGQ^Citation29,Citation30 (0–100*)	30.3 (20.2)	15.9 (18.5)	0.07
Number of nongrade, CPGQ^Citation29,Citation30	1		0.52 (total grade score)
Grade I, n	5	7
Grade II, n	4	4
Grade III, n	0	0
Grade IV, n	2	0
Morale, PGCMS^Citation11,Citation33 (0–17*)	9.0 (3.6)	10.1 (3.9)	0.49
Affective distress, MPI-S^Citation34 (0–6*)	2.5 (2.5)	0.5 (1)	0.06
CAT, CSQ^Citation35,Citation36 (0–36*)	8.6 (11.1)	5.5 (5.5)	0.66
Control over pain, CSQ^Citation35,Citation36 (0–6*)	2.2 (1.6)	1.6 (2.1)	0.39
Ability to decrease pain, CSQ^Citation35,Citation36 (0–6*)	1.4 (1.8)	0.8 (±1.4)	0.42
FES-I(S)^Citation37,Citation38 (0–68*)	41.1 (11.2)	38.5 (9.0)	0.74
SEE-SV^Citation39,Citation40 (0–90*)	46 (28.4)	25.6 (26.4)	0.16
Physical activity scale^Citation43,Citation44 (1–6*)	2.4 (0.51)	2.4 (0.52)	0.86
30-second chair stand test,^Citation46 n	3.5 (3.8)	1.6 (2.6)	0.19
2.4 m gait test^Citation48, seconds	12.2 (20.1)	7.5 (2.9)	0.32

Note: Data are expressed as mean (standard deviation).

* Minimum–maximum scores of the assessment.

Abbreviations: CPGQ, Chronic Pain Grade Questionnaire; nongrade, persons who not get any scores on CPGQ; PGCMS, Philadelphia Geriatric Center Morale Scale; MPI-S, Multidimensional Pain Inventory, brief screening version, Swedish; CAT, catastrophizing thoughts; CSQ, Coping Strategy Questionnaire; FES-I(S), Falls Efficacy Scale, International, Swedish; SEE-SV, Self-Efficacy for Exercise scale, Swedish Version.

Table 4 Results of consumer questions regarding rating of physical activity level and management of everyday life at follow-up 1 and 2 for both groups

Experimental group				Comparison group
Physical activity level, follow-up 1, n=10	Physical activity level, follow-up 2, n=9	Management of everyday life, follow-up 1	Management of everyday life, follow-up 2	Physical activity level, follow-up 1	Physical activity level, follow-up 2	Management of everyday life, follow-up 1	Management of everyday life, follow-up 2
Much higher or higher (n=8)	Much higher or higher (n=6)	In a much better way (n=5)	In a much better way (n=5)	Higher (n=3)	Higher (n=2)	In a much better or better way (n=5)	In a much better way (n=4)
No difference or lower (n=2)	No difference, lower, or much lower (n=3)	No difference, worse, or much worse (n=5)	No difference, worse, or much worse (n=4)	No difference or much worse (n=4)	No difference or much worse (n=5)	No difference or much worse (n=2)	No difference or much worse (n=3)

Table 5 Descriptive results presented as means (standard deviation) and significant differences for the effects of the intervention, within, and between groups

	Experimental group			Comparison group			Between groups
	Baseline (n=12)	Follow-up 1 (n=10) with significances	Follow-up 2 (n=9) with significances	Baseline (n=11)	Follow-up 1 (n=7) with significances	Follow-up 2 (n=7) with significances	Significances follow-up 1	Significances follow-up 2
Pain intensity, CPGQ^Citation29,Citation30 (0–100#)	46.1 (30.9)	59.4 (21.7)	64.8 (21.0)	50.6 (19.7)	54.3 (24.3)	49.7 (24.9)	NS	NS
Disability score, CPGQ^Citation29,Citation30 (0–100#)	30.3 (20.2)	32.9 (29.2)	43.4 (36.7)	15.9 (18.5)	32.7 (29.1)	19.9 (25.1)	NS	NS
Number of nongrade, CPGQ^Citation29,Citation30	1
Number of grade I	5	3	3	7	4	3
Number of grade II	4	5	3	4	1	2
Number of grade III	0	1	1	0	2	1
Number of grade IV	2	1	2	0		1
Morale, PGCMS^Citation11,Citation33 (0–17#)	9.0 (3.6)	8.3 (2.3)	7.9 (2.2)	10.1 (3.9)	10.4 (2.3)	9.0 (3.9)	NS	NS
Affective distress, MPI-S^Citation34 (0–6#)	2.5 (2.5)	2.1 (1.9)	1.8 (1.4)	0.5 (1)	2.7 (2.3)*	0.79 (1.5)	NS	NS
CAT, CSQ^Citation35,Citation36 (0–36#)	8.6 (11.1)	8.3 (11.3)	13.6 (12.7)	5.5 (5.5)	11.7 (14.3)	6.7 (7.6)	NS	**
Control over pain, CSQ^Citation35,Citation36 (0–6#)	2.2 (1.6)	2.7 (1.6)	2.6 (1.5)	1.6 (2.1)	2.6 (1.3)	1.4 (2.3)	NS	NS
Ability to decrease pain, CSQ^Citation35,Citation36 (0–6#)	1.4 (1.8)	1.3 (1.6)	2.1 (1.7)	0.8 (1.4)	1.0 (1.7)	1.6 (2.1)	NS	NS
FES-I(S)^Citation37,Citation38 (0–68#)	41.1 (11.2)	37.6 (12.2)	43.4 (11.6)*	38.5 (9.0)	40.4 (9.7)	42.9 (10.2)	NS	NS
SEE-SV^Citation39,Citation40 (0–90#)	46 (28.4)	71.2 (18.9)*	58.7 (37.0)	25.6 (26.4)	32.0 (20.3)	36.0 (32.3)	NS	NS
Physical activity scale^Citation43,Citation44 (1–6#)	2.4 (0.51)	2.7 (0.48)*	2.6 (0.53)	2.4 (0.52)	2.6 (0.54)	2.6 (0.54)	NS	NS
30-second chair stand test^Citation46, n	3.5 (3.8)	3.1 (3.5)	2.2 (3.5)	1.6 (2.6)	0 (0)	0 (0)	NS	NS
2.4 m gait test^Citation48, seconds	12.2 (20.1)	20.2 (37.8)*	17.9 (30.4)	7.5 (2.9)	9.8 (5.2)	6.8 (9.7)	NS	NS

Notes: Data are expressed as mean (standard deviation).

# Minimum–maximum scores of the assessment.

* P<0.05;

** P<0.001.

Abbreviations: CPGQ, Chronic Pain Grade Questionnaire; nongrade, persons who not get any scores on CPGQ; PGCMS, Philadelphia Geriatric Center Morale Scale; MPI-S, Multidimensional Pain Inventory, brief screening version, Swedish; CAT, catastrophizing thoughts; CSQ, Coping Strategy Questionnaire; FES-I(S), Falls Efficacy Scale, International, Swedish; SEE-SV, Self-Efficacy for Exercise scale, Swedish Version; NS, not significant.

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