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| Title: | 以縱貫資料初探慢性疼痛患者疼痛強度、自我效能、寂寞感、及疼痛接受度之關係
Exploring the Relationship among Pain Intensity, Self-efficacy, Loneliness, and Pain Acceptance in Chronic Pain Patients: A Longitudinal Study |
| Authors: | 楊皓涵
Yang, Hao-Han |
| Contributors: | 吳治勳
Wu, Chih-Hsun
楊皓涵
Yang, Hao-Han |
| Keywords: | 疼痛接受度
疼痛自我效能
疼痛強度
寂寞感
負向情緒
pain acceptance
pain self-efficacy
pain intensity
loneliness
negative emotion |
| Date: | 2022 |
| Issue Date: | 2022-08-01 18:10:35 (UTC+8) |
| Abstract: | 研究背景:許多研究指出，疼痛接受度對慢性疼痛患者的身心適應狀態有正向影 響。從反抗疼痛到接納疼痛、與疼痛共處，患者在過程會歷經許多困難，藉由現 象觀察及文獻回顧，本研究歸納出疼痛強度、寂寞感及疼痛自我效能是可能影響 疼痛接受度的因素，並提出一路徑模式。透過臨床追蹤研究，本研究試圖釐清疼 痛強度、寂寞感及疼痛自我效能三者與疼痛接受度的關係。
研究方法:以北部某教學醫學中心之慢性疼痛患者為研究對象，進行追蹤研究，起始點(T0)與追蹤(T1)間隔三個月。以疼痛評估量尺、慢性疼痛接受度量表 8題版(Chronic Pain Acceptance Questionnaire-8)、疼痛自我效能量表(Pain Self- Efficacy Questionnaire)、UCLA寂寞量表3題版(UCLA 3-item Loneliness Scale)、 慢性病負向情緒量表(Negative Emotions due to Chronic Illness Screening Test)作為測量工具，評估疼痛強度、疼痛接受度(包含「活動參與」與「甘願疼痛」兩 個概念)、疼痛自我效能、寂寞感及負向情緒。路徑分析部分，先以描述統計檢視各研究變項，並利用結構方程模型進行分析，檢視所提出模式是否適配，並探討T0疼痛強度、寂寞感、自我效能、疼痛接受度以及T1疼痛強度與負向情緒之關係。
研究結果:共有176位參與者完成起始點(T0)及三個月追蹤(T1)之評估，平均年齡為60.32歲(SD = 13.76)，平均疼痛強度為6.00(SD = 2.63)，平均持續 時間為96.52個月(SD = 109.65)。結果發現年齡與負向情緒各自和研究變項有顯著相關，故將年齡以共變項加入模式進行控制，負向情緒則分為高、低負向情緒兩組進行多組並行之路徑分析。路徑分析之參數估計結果顯示(1)全樣本之自我效能能夠正向預測活動參與(β = .42, p = .004)，寂寞感能夠負向預測活動參 與(β = -.28, p = .004);自我效能能夠完全中介疼痛強度對活動參與之關係(Effect Size(ES)=-.10,p=.010)，部分中介寂寞感對活動參與之關係(ES=-.12,p=.004); 活動參與能夠負向預測疼痛強度(β = -.16, p = .027)及負向情緒(β = -.36, p = .004)。(2)高負向情緒組之寂寞感能夠負向預測活動參與(β = -.24, p = .033)， 自我效能能夠正向預測活動參與(β = .36, p = .004)，並部分中介寂寞感對活動參與之關係(ES = -.12, p = .011)。活動參與能夠負向預測疼痛強度(β = -.22, p = .047)及負向情緒(β = -.33, p = .010)。(3)低負向情緒組之自我效能能夠正向預測活動參與(β= .52, p = .004)，並完全中介疼痛強度對活動參與之關係(ES = -.23, p = .004);活動參與能夠負向預測負向情緒(β = -.48, p = .004)。此外，甘願疼痛無法被任何因素預測，亦無法預測疼痛強度與負向情緒。
討論與結論:本研究發現自我效能對於疼痛接受度有正向預測效果，疼痛接受度能夠正向預測疼痛強度與負向情緒。此結果在臨床上有重要的意義，因自我效能在過去研究中被證實能夠透過相關臨床心理介入提升，因此若能夠藉由自我效能之介入提升自我效能，或許能夠改善患者疼痛接受度並緩解疼痛強度與負向情緒狀態。此外，區辨慢性疼痛患者負向情緒狀態亦有重要的臨床意義:高負向情緒的患者，自我效能顯著受到寂寞感之負向影響;低負向情緒之患者，自我效能則顯著受到疼痛強度之負向影響。在進行照顧時，若能夠先評估患者之負向情緒狀態，可以更有效率地提供適合的介入。未來研究若能夠拓展收案場域至社區，進一步探索患者之不同特徵對本模型的影響，並納入生活品質等較整體性適應評估，或許能夠使疼痛接受之概念與模型更加完整，優化疼痛整體性照護。
Background: Many studies have found that pain acceptance positively affects physical and psychological adaptation in chronic pain patients. It is a suffering process, from resisting pain to accepting pain and living with pain for the patients. Through clinical observations and literature review, this study suggested that pain intensity, loneliness, and pain self-efficacy are the factors that may affect pain acceptance. This study proposes a path model to explore the relationships among pain intensity, loneliness, pain self-efficacy, and pain acceptance in a clinical longitudinal study.
Methods: Chronic pain patients were recruited from pain clinics in a medical center in northern Taiwan. Participants were asked to fill the following scales: pain intensity scale, Chronic Pain Acceptance Questionnaire-8, Pain Self-Efficacy Questionnaire, UCLA 3-item Loneliness Scale, and Negative Emotions due to Chronic Illness Screening Test (NECIS) to assess pain intensity, pain acceptance (including “Activity Engagement (AE)” and “Pain Willingness (PW)”), pain self-efficacy, loneliness, and negative emotion, at baseline (T0) and 3-month follow-up (T1). Descriptive and comparative statistics were used to describe the data. Structural equation modeling was used to perform path analysis. To examine the goodness-of-fit of the model and the relationships among pain intensity, loneliness, self-efficacy, pain acceptance, and follow-up pain intensity and negative emotion.
Results: There were 176 participants completed both T0 and T1 evaluations. The mean age of the participants was 60.32 (SD = 13.76), the mean pain intensity was 6.00 (SD = 2.63), and the mean duration was 96.52 months (SD = 109.65). The results showed that age and negative emotions were significantly correlated with other variables. Thus, age was controlled by included as a covariate to the model, and negative emotions were used as a grouping variable to separate high and low negative emotions for a multi-group path analysis. The results of the parameter estimations showed that (1) All participants: self-efficacy can positively predict Activity Engagement(AE) (β = .42, p = .004) of pain acceptance, and loneliness can negatively predict AE (β = -.28, p = .004); self-efficacy fully mediates the relationship between pain intensity and AE (Effect Size (ES) = -.10, p = .010), and partially mediates the relationship between loneliness and AE (ES = -.12, p = .004); AE can negatively predicted pain intensity (β = -.16, p = .027) and negative emotion (β = -.36, p = .004). (2) High negative emotion group: loneliness can negatively predict AE (β = -.24, p = .033), and self-efficacy can positively predict AE (β = .36, p = .004), and partially mediate the relationship between loneliness and AE (ES = -.12, p = .011). AE can negatively predicted pain intensity (β = -.22, p = .047) and negative emotion (β = -.33, p = .010). (3) Self-efficacy in the low negative emotion group can predict AE (β= .52, p = .004), and completely mediate the relationship between pain intensity and AE (ES = -.23, p = .004); AE can negatively predict negative emotion (β = -.48, p = .004). In addition, pain willingness was not predicted by any variables, nor could it predict any pain indicators.
Discussion and conclusion: This study found that self-efficacy positively affects pain acceptance, and pain acceptance can positively predict pain adaptation. This result may provide a clinically significant meaning, as past studies have proven that self-efficacy can be improved through clinical psychological intervention. Therefore, patients` pain acceptance might be improved through self-efficacy intervention. Furthermore, self- efficacy is significantly affected by loneliness in patients with high negative emotions but significantly affected by pain intensity in the low negative emotion group. Thus, interventions can be provided more efficiently if the patient`s negative emotions can be assessed for further care. Finally, to expand the model`s generalizability and further explore the phenomena of pain acceptance, future research should extend the sample
from clinical to the community, explore the influence of patients` different characteristics on this model, and incorporate more holistic adaptation assessments such as quality of life. |
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| Description: | 碩士
國立政治大學
心理學系
107752002 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0107752002 |
| Data Type: | thesis |
| DOI: | 10.6814/NCCU202200746 |
| Appears in Collections: | [心理學系] 學位論文
|
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