Article

PURPOSE: To explore how patients construe bodily injury, examine how injury
representations change over the course of a rehabilitation program and how injury
representations influence adaptation and recovery trajectories. METHODS: A case
study method was used with qualitative interviews as the primary data source.
Qualitative semi-structured interviews were conducted three times over the course
of a 12-week intensive interdisciplinary occupational rehabilitation program with
one interview 1 month following discharge. To capture changes in rehabilitation
trajectories, data analysis employed a narrative approach informed by Bury
(progression, regression, and stability) and Frank's (chaos, restitution, and
quest) approaches. RESULTS: Sixteen patients (10 men and 6 women) were disabled
as a result of persistent pain and impairment from a variety of work injuries
participated. Progression/restitution narratives were characterized by the
transformation of bone and nerve problems to include soft tissue elements. These
participants expanded their scope of injury representations and appraisal to
include neurobiological aspects of chronic pain and dimensions of psychosocial
well-being, and linked diagnostic representations to self-management strategies
in a functional manner. CONCLUSION: Body representations of injury morphology and
pain mechanisms are important objects of fear and acceptance for injury recovery.
Active strategies that encourage a "hands on" understanding of diagnosis may
prove most effective in treating persistent pain. Implications FOR
REHABILITATION: Patient representations of pain and body injury are windows into
the personal experience of individuals with chronic musculoskeletal pain. When
patients enter programs, practitioners need to assess what the patient believes
is wrong with their body and what will be helpful in rectifying the problem.
Based on their initial assessment, practitioners need to direct education and
activity toward shifting patient beliefs to include elements of soft tissue and a
broader scope of pain sensitization and psychological impact. Activity-based
intervention is essential for creating coherence between injury and pain
representations and coping action. During rehabilitation, practitioners need to
monitor patient beliefs about their injury. Shifting beliefs are signs that the
patient is adopting a more adaptive cognitive stance toward their injury. Lack of
movement indicates that the message is not getting through and the approach needs
to be modified. When working with patients to transform beliefs, a collaborative
approach might be best to increase trust and reduce reactance.

Langue : ANGLAIS