An evaluation of self-efficacy of patients with chronic pain attending a community based exercise program

Currently one in five Australians suffer from chronic pain with this increasing to one in three Australians aged over 65 years. In 2007, this corresponded with 3.2million Australians with an economic cost of approximately $34.3 billion annually. Musculoskeletal disorders are a leading cause of disability, with low back pain and neck pain the single largest cause of this disability globally. Chronic pain and disability resulting from musculoskeletal disorders forms a significant portion of the burden of chronic pain borne by primary health care services, with these conditions predominantly managed by primary health care practitioners, such as physiotherapists. The Australian National Pain Strategy recommends active therapy as central to chronic pain management which appears to be most successful when it is specific to the individual’s needs, focuses on increasing activity levels, and incorporates the psychosocial aspects of pain, such as the individual’s self-efficacy beliefs. Self-efficacy is an individual’s belief in their ability to cope or succeed in a specific situation. It influences their ability to initiate certain behaviours and their willingness to persevere when faced with obstacles. It has been shown to be predictive of disability in chronic pain and has also been found to be related to mood, exercise adherence, pain intensity, coping and adjustment. It is also animportant mediator in the relationship between pain and disability in individuals with chronic pain. As self-efficacy is a primary mechanism of behaviour change and can be modified by experience, strategies to enhance self-efficacy are considered an important component of chronic pain management. This observational study evaluated the self-efficacy of 22 individuals with chronic pain who were attending an existing community-based exercise program. It evaluated whether participants pain self-efficacy changed over the ten-week exercise program and whether there were any associations between pain self efficacyand pain intensity, pain impact, kinesiophobia, catastrophising thoughts and feelings, disability and physical function. It also sought to evaluate whether participants pain self-efficacy was associated with overall program satisfaction. The participants of this study commenced the program with a high level of painself-efficacy which was maintained throughout the program. They experienced significant improvements in the impact of pain, kinesiophobia, disability and physical function in self-selected activities. There was also a high level of satisfaction among participants at the end of the program. This study identified associations between high pre-program pain self-efficacy and decreased catastrophising and decreased disability at post program and follow up time points respectively. The results of this observational study support the basis for utilising strategies to support and improve self-efficacy in individuals with chronic pain and indicate that greater understanding of the sources of self-efficacy may facilitate the management of disability associated with chronic pain.