Readiness to Change Among Adolescents with Chronic Pain and Their Parents: Is the German Version of the Pain Stages of Change Questionnaire a Useful Tool?

Lorin Stahlschmidt,Boris Zernikow,Donnamay Brown,Susanne Grothus,Julia Wager

doi:10.3390/children7050042

Abstract

The Pain Stages of Change Questionnaire (PSOCQ) measures patients’ willingness to engage in active self-management of their pain. The present study aimed to create validated German short versions of the PSOCQ for adolescents (PSOCQ-A) and their parents (PSOCQ-P). Additionally, an investigation of stages of change regarding pain characteristics and treatment outcomes was undertaken. In Study 1, the data of adolescents aged 11 to 18 years and their parents were collected prior to intake (N = 501) and at admission (N = 240) to specialist inpatient pain treatment. Confirmatory factor analyses indicated a poor fit of the full PSOCQ measures prior to intake, but an acceptable fit at admission. Short PSOCQ-A and PSOCQ-P versions were identified. In Study 2, these results were cross-validated with data from an additional N = 150 patients and their parents, collected during and 3 months after interdisciplinary inpatient pain treatment. Model fits for both short versions were acceptable, although low internal consistency for the PSOCQ-A Precontemplation and Contemplation subscales was identified. During treatment, both patients’ and their parents’ readiness to change increased. Stage of change at discharge did not predict treatment non-response 3 months later. This study indicates that the PSOCQ is neither meaningful prior to admission nor predictive of non-response to treatment. While some value may exist in monitoring treatment progress, based on the results of this study, it is not recommended that the PSOCQ-A and PSOCQ-P be used as a measure of stage of change in German pediatric pain populations.

Highlights

Interdisciplinary pain treatment programs for highly impaired adolescents with severe chronic pain usually take an active self-management approach [1]
The Pain Stages of Change Questionnaire (PSOCQ), originally developed for adults [7], is derived from the transtheoretical model [8], which postulates that individuals experience differing levels of willingness to employ pain self-management strategies in identifiable stages
For the PSOCQ-P, an inadequate model fit was found for both the four-factor and the three-factor model

Summary

Introduction

Interdisciplinary pain treatment programs for highly impaired adolescents with severe chronic pain usually take an active self-management approach [1]. This means that patients are actively involved in, and personally responsible for, managing their pain by applying active pain coping strategies. Insufficient motivation to self-manage pain is thought to be an important factor contributing to unsatisfactory treatment outcomes in both pediatric and adult pain patients [3,4,5,6]. The Pain Stages of Change Questionnaire (PSOCQ), originally developed for adults [7], is derived from the transtheoretical model [8], which postulates that individuals experience differing levels of willingness to employ pain self-management strategies in identifiable stages. Four stages of change are assessed by the PSOCQ; Precontemplation, Contemplation, Action and Maintenance [7]

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Discussion

Conclusion