Date of Award
2024
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy
School
School of Medical and Health Sciences
First Supervisor
Associate Professor Annette Raynor
Second Supervisor
Professor Cary Brown
Abstract
Background
Chronic pain is an increasingly prevalent condition which can result in significant physical, psychological, financial, and social impacts. Rehabilitation is one strategy to improve function and restore well-being. Evidence suggests rehabilitation that is meaningful will be more engaging and achieve better outcomes, however, it is not clear what makes the rehabilitation experience meaningful from a client perspective, or how to translate this evidence for therapists in practice settings. The aims of this doctoral research were to: define and operationalise the concept ‘meaningfulness’ in relation to chronic pain rehabilitation; examine the relationship between self-reported personally[1]meaningful rehabilitation and aspects of well-being; explore the experience of personally-meaningful rehabilitation from the perspective of people with chronic pain; and investigate an evidence-based knowledge translation strategy for therapists on these findings into personally-meaningful rehabilitation.
Methods
The research included four interrelated studies. Firstly, a concept analysis of literature established a working definition of client-defined meaningfulness to underpin the remaining studies. Secondly, relationships between self-reported meaningful rehabilitation and well-being were examined through a pilot study using an online survey of people with chronic pain. Thirdly, to explore the lived experience of meaningful rehabilitation, people with chronic pain were interviewed in a qualitative phenomenological study. A prototype, evidence-based knowledge translation online resource was then developed based on findings of the first three studies, to share relevant aspects of personally-meaningful rehabilitation with therapists. Finally, a final qualitative descriptive study investigated therapists’ experience of this online knowledge translation strategy through focus groups and key informant semi-structured interviews.
Results
The concept analysis (Study 1) included ten articles from an initial search result of 113. Based on this analysis, client-defined meaningful rehabilitation includes that which the client self-identifies to be of personal value and relevant to their sense of self-identity. Study 2, the pilot survey of 48 people with chronic pain, identified a moderate positive correlation between personally-meaningful rehabilitation and the self-reported flourishing aspect of well-being. No additional statistically significant relationships, or differences between groups, were identified with pain interference or other client or therapy factors. The pilot study provided valuable evidence to inform future research, and further development of a measure of meaningfulness in rehabilitation. Study 3, the semi-structured interviews with ten people with experience of chronic pain rehabilitation, supported the concept analysis themes that therapy should be self-defined, personally-valued, and relevant to the person’s sense of self-identity. Additional, novel themes showed that personally-meaningful rehabilitation should also include a genuine connection with a therapist who is credible and can become a guiding partner. In Study 4, the final knowledge translation study, interviews were conducted with 24 therapists following their use of the prototype online knowledge translation tool. Their experience demonstrated that this was a positive user experience which added (translational) value to enhance learning on personally-meaningful therapy for people with chronic pain. This resource shows future potential for early career, experienced, and specialist therapists.
Conclusions
The client perspective of what makes chronic pain rehabilitation meaningful is largely overlooked in the literature. This doctoral research addresses this gap in the research and establishes preliminary evidence that personally-meaningful rehabilitation is correlated with the flourishing aspect of well-being. It also provides important insight into the lived experience of rehabilitation and underlines the relevance of patient-defined meaningfulness in the rehabilitation process. Personally-meaningful rehabilitation is an important concept, and a prototype, evidence-based online knowledge translation resource can assist rehabilitation therapists to envision how they may implement this new knowledge in their practice settings. This has potential to enhance practice and deliver more personally-meaningful rehabilitation for people who live with chronic pain.
DOI
10.25958/z6be-tt02
Access Note
Access to this thesis is embargoed is embargoed until 14 August 2025
Recommended Citation
Liddiard, K. J. (2024). Rehabilitation as a personally-meaningful experience for people with chronic pain, and the online translation of research findings for rehabilitation therapists. Edith Cowan University. https://doi.org/10.25958/z6be-tt02