Further support for the pain stages of change model: suggestions for improved measurement.

Recent efforts to operationalize persons' readiness to adopt a self-management approach to chronic pain have met with promising, but somewhat limited, results. The current study describes the development and psychometric evaluation of a German version of Pain Stages of Change Questionnaire (PSOCQ). A new item pool was developed to attempt to improve in particular the discriminant validity of the scales and in order to obtain a shortened measure. The items were administered to 494 chronic pain patients who were split into two independent samples. Item- and factor-analysis performed on data from one half of the sample resulted in four scales: precontemplation, preparation, action, and maintenance. The scales of the new measure, called the "Freiburg Questionnaire-Stages of Chronic Pain Management (FQ-STAPM)", showed good indices of reliability, homogeneity, and discriminant validity. Both the concurrent and divergent validity indices and the relationships between scale scores and pain related variables proved to be consistent with the transtheoretical model. Confirmatory factor analysis using LISREL performed on the second half of the sample supported the goodness-of-fit of the structure model. Implications of these findings for future research exploring the relevance of the pain stages of change model are discussed.

Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): overall and gender-specific effects.

The effects of a nurse-managed secondary prevention program for patients after acute cardiac events were examined. Special interest was given to gender-specific results. The design was a prospective, randomized, controlled trial involving 343 patients following 3 weeks of inpatient cardiac rehabilitation, randomly assigned to either of two study groups. Patients in the treatment group were contacted monthly by phone over 1 year. The main goals of the intervention were the reduction of behavioural coronary risk factors and enhancing quality of life. The program was conducted by specially trained nurses. The control group received written information only. Primary outcome was the Framingham risk score. Follow-up examination after 12 months was completed by 297 patients. Patients in the intervention group showed lower Framingham risk scores as compared to controls. Separate analyses by sex revealed that this was mostly due to the men in the sample. Women, on the other hand, showed a significant rise of clinically relevant anxiety/depressiveness in the control but not in the intervention group; in males there were no differences between study conditions. In conclusion, telephone counselling by specially trained nurses seems a cost-effective way to achieve a lasting reduction in cardiac risk factors and to maintain the effects of cardiac rehabilitation.

Preliminary validation of a German version of pain stages of change questionnaire.

This study describes the development of the German questionnaire FF-STABS (Freiburg Questionnaire--Stages of Chronic Pain Management), which documents the willingness of chronic pain patients to use cognitive-behavioural methods for pain management independently. The newly constructed assessment instrument, modified from a similar instrument developed by Kerns and his colleagues, was administered to a heterogeneous sample of 118 chronic pain patients. Item and factor analysis support the identification of four reliable scales: precontemplation, preparation, action and maintenance. All scales evidenced sufficient indices of reliability and discriminant validity. Deviations from the original American version and suggestions for future refinements in the new measure are discussed.

[Development and psychometric evaluation of the "Freiburg questionnaire--stages of change in tinnitus" (FQ-STATI)]. / Entwicklung und Psychometrie des "Freiburger Fragebogens--Stadien der Veränderungsbereitschaft bei Tinnitus" (FF-STATI).

This study describes the psychometric development of an instrument to measure the "stages of change" in tinnitus sufferers. Based on our own previous work about measuring stages of change in chronic pain patients, 48 items were administered to 128 tinnitus sufferers in inpatient and outpatient facilities as well as in self helping groups. Principle component analysis and item analysis led to a four factor solution. Each factor (resp. stage) consisted of four items: precontemplation, preparation, action, and termination. Scales showed theoretically conformed associations with measure of pain burden e. g. tinnitus loudness and cumbersomeness as well with standardized measures (HADS, TB-12, SF-12). High burden was correlated positively with high expressions on the lower scales, and it was correlated negatively with higher stage scores. Against the assumption there was no association between tinnitus durability and stages expression.

Factorial validity and norm data comparison of the Short Form 12 in patients with inflammatory-rheumatic disease.

Measuring quality of life is increasingly considered as an outcome criterion in clinical studies. In order to assess quality of life, disease specific as well as generic instruments are used. Generic instruments make it possible to compare outcomes among different indications, but for this purpose a test of the factorial validity of the method in each indication is necessary. In this study, the generic short form 12 was administered to a sample survey of 545 patients with inflammatory-rheumatic disease. Patients data from three scientific rehabilitation research projects were pooled for the analysis. First the structure was tested using confirmatory structural equation modeling. In a second step age and gender specific values were calculated and compared to norm data from the German National Health Survey 1998. The questionnaire's structure is acceptable and comparable to international results. Confirmatory analyses support a model allowing covariations of error terms between items of the same subdimensions. The two latent dimension are highly correlated. Crossloadings of items from different subdimension does not improve the model fit significantly. Comparisons with the German norm data shows that the patients are impaired within their physical and mental dimension of subjective health. Higher impairment is evident especially on the physical sumscale. Women show higher impairment in both scales. However no effects of age can be detected. The SF-12 could be used with trust in the study of patients with inflammatory-rheumatic diseases. But physical and mental health can not be seen as independently.