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Do Pain-related Beliefs Influence Adherence to Multidisciplinary Rehabilitation?: A Systematic Review

Thompson, Emma L. GradDipPsych*; Broadbent, Jaclyn PhD*; Bertino, Melanie D. MD, DPsych*,†; Staiger, Petra K. PhD*

doi: 10.1097/AJP.0000000000000235
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Objectives: To understand how pain-related cognitions predict and influence treatment retention and adherence during and after a multidisciplinary rehabilitation program.

Methods: Electronic databases including Medline, CINAHL, PsycINFO, Academic Search Complete, and Scopus were used to search 3 combinations of key words: chronic pain, beliefs, and treatment adherence.

Results: The search strategy yielded 591 results, with an additional 12 studies identified through reference screening. Eighty-one full-text papers were assessed for eligibility and 10 papers met the inclusion and exclusion criteria for this review. The pain-related beliefs that have been measured in relation to treatment adherence include: pain-specific self-efficacy, perceived disability, catastrophizing, control beliefs, fear-avoidance beliefs, perceived benefits and barriers, and other less commonly measured beliefs. The most common pain-related belief investigated in relation to treatment adherence was pain-related self-efficacy. Findings for the pain-related beliefs investigated among the studies were mixed. Collectively, all of the aforementioned pain-related beliefs, excluding control beliefs, were found to influence treatment adherence behaviors.

Discussion: The findings suggest that treatment adherence is determined by a combination of pain-related beliefs either supporting or inhibiting chronic pain patients’ ability to adhere to treatment recommendations over time. In the studies reviewed, self-efficacy appears to be the most commonly researched predictor of treatment adherence, its effects also influencing other pain-related beliefs. More refined and standardized methodologies, consistent descriptions of pain-related beliefs, and methods of measurement will improve our understanding of adherence behaviors.

Supplemental Digital Content is available in the text.

*School of Psychology, Deakin University

The Victorian Rehabilitation Centre, VIC, Australia

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.clinicalpain.com.

The authors declare no conflict of interest.

Reprints: Jaclyn Broadbent, PhD, School of Psychology, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125, Australia (e-mail: jaclyn.broadbent@deakin.edu.au).

Received February 17, 2014

Received in revised form April 13, 2015

Accepted March 1, 2015

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