Abstract
This research project explored the impact of introducing a lay led self-management approach known as the Expert Patient Programme (EPP) at patients' initial referral stage to a pain management clinic in a secondary care setting. It involved a randomised controlled trial and employed a mixed method approach permitting triangulation of data with a longitudinal design. Sixty-three patients (Control group n=33, Intervention group n=30) with persistent non-malignant musculo-skeletal pain conditions referred to a District General Hospital (DGH) Pain Clinic , agreed to take part and provided data for the research. The intervention was usual care and an invitation to attend a lay led self-management programme known as the Expert Patients Programme (EPP). This consisted of six 2 hour per week programmes led by lay tutors. The Control group received only usual care, data being collected at baseline, 3-6 months and 10-14 months. The primary hypothesis was to determine if the early introduction of a selfmanagement approach alongside medical treatments could influence and encourage participants to adopt self-management approaches to managing their persistent pain. The primary outcome, readiness to take action to self-manage persistent pain symptoms was measured by the Pain Stages of Change Questionnaire (PSOCQ). Secondary outcomes of Acceptance, Pain and Interference were measured by applying the Chronic Pain Acceptance Questionnaire (CPAQ), and Brief Pain Inventory (BPI). The Qualitative data was gathered using focus groups. The results identified significant promotion through the Stages of Change process accompanied by improvements in Pain and Interference levels for the Intervention groups' data at 10-14 months; no significant changes were found in the Control group. Improvements in the Intervention group were related to a synergistic effect of offering a self-management approach in parallel with a medical model approach and participants taking actions to relinquish their Sick Role. This study is the first to suggest an association between the Stages of Change process and the Sick Role. Results provide evidence that improvements seen in the Intervention group were associated with progress through the Stages of Change and linked with participants adopting self-management approaches and relinquishing their Sick Role; this allowed them to take on a more appropriate role described as the Persistent Condition Role (PCR).