Agency orientation and chronic musculoskeletal pain: effects of a group learning program based on the personal construct theory.
OBJECTIVE
This study evaluated the effects of a group learning program on patients with chronic musculoskeletal pain and high absenteeism and investigates what characterizes those patients who may benefit from such a program. The learning program was based on personal construct theory. The theory included the following: (1) participation in an educational program is related to a favorable outcome across the outcome measures (pain, pain coping, management of daily life, absenteeism, and use of health care), (2) patients with high agency orientation (i.e., inner-directed) cope with their pain and manage daily life in a better manner than do patients with low agency orientation (i.e., outer-directed), and (3) patients with high personal control, measured in terms of agency orientation, in terms of health locus of control, or in both terms, will benefit more from the educational program than will patients with low personal control.


METHODS
The study was a randomized controlled study.


METHODS
One hundred and sixteen patients with chronic musculoskeletal pain and high absenteeism answered a questionnaire before and after the intervention program. The intervention group (n = 61) consisted of nine subgroups geographically spread through the eastern part of Norway and met for four hours every 2 weeks from February 1997 to October 1997. A total of 12 meetings were held.


RESULTS
The intervention group reported a significantly higher score for the variable "management of everyday life" (p <0.005) and for the variable "health care consumption" (p <0.001) than did the control group. Patients with high agency orientation benefited more from the program with regard to pain reduction and improved pain coping than did those patients with low agency orientation (p <0.05). Patients with high agency orientation also reported less absenteeism than did those patients with low agency orientation (p <0.05).
Haugli
L
L
Department of General Practice, University of Oslo, Norway. liv.haugli@samfunnsmed.uio.no
Steen
E
E
Laerum
E
E
Finset
A
A
Nygaard
R
R
D000041:Absenteeism; D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy*; D010146:Pain / Q000523:psychology* / Q000534:rehabilitation; D059408:Pain Management; D010353:Patient Education as Topic / Q000458:organization & administration; D017060:Patient Satisfaction; D011209:Power, Psychological; D015397:Program Evaluation; D011582:Psychological Theory; D011615:Psychotherapy, Group / Q000458:organization & administration*; D012649:Self Concept