Multidimensional assessment of people with chronic pain : A critical appraisal of the Person, Environment, Occupation model

Abstract: The present thesis is an attempt to organize the phenomena to be assessed and the methods for assessment in the management of chronic pain, using a conceptual model. To that aim, the Person-Environment-Occupation (PEO ) model was evaluated in several respects, e.g. origin and credibility. Also, psychometric characteristics were investigated for ten assessment instruments used for operationalization of the central model concepts. A method for the assessment of daily occupations was developed, the Capability to Perform Daily Occupation (CPDO). A sample of patients with chronic pain on sick-leave (Group P) were compared with a sample of people not suffering from chronic pain who were presently working (Group W). Multiple logistic regression analyses were used to explore the extent to which membership in Groups P and W can be predicted on the basis of the PEO model data. All ten assessment instruments had alpha coefficients that suggest that they are suitable for group comparisons. The CPDO was shown to possess good homogeneity and validity. The most consistent discriminative/predictive capacity was demonstrated for instruments assessing the dimension Occupation. Regression analyses demonstrated that attainment-importance discrepancies for Life Values (life in general), Intermediate ADL, and Social activity were the strongest predictive variables for Group P membership. The most important predictor was Intermediate ADL. The PEO model showed a correct classification for 90.6% of the cases. The results suggests that the PEO model is useful as a framework for assessment of people with chronic pain.