Do coping strategies for pain mediate between psychosocial factors and physical activity for people with chronic pain?
Sessford, James David 1983-
Background. Canadian public health guidelines recommend at least 150 minutes per week of moderate to vigorous physical activity (MVPA) for all adults including people with chronic diseases such as arthritis. Unfortunately, many of these individuals do not meet these guidelines and thus are less likely to accrue the many health benefits of being active. At the core of successful self-management of health behaviours (e.g., MVPA) are the skills of self-regulation. Self-regulation is the ability to adapt and strategise in order to persist in the pursuit of a goal such as weekly MVPA. In order to understand self-regulation in the context of dealing with chronic disease symptoms and pursuing MVPA goals, gaining insight into the causal influences that motivate self-regulatory action is necessary. One approach to examining whether correlates are implicated in causal influence is to identify whether some correlates mediate the relationship between a variable thought to determine behaviour and actual behaviour. Social psychological theories about human behaviour specify such mediators. Correlational research indicates a positive relationship between self-regulatory efficacy (SRE) and exercise as well as pain acceptance and exercise for people coping with chronic pain from arthritis. Process variables such as self-regulatory actions to cope with pain and exercise are examples of potential mediators of the relationships between SRE, pain acceptance, and MVPA. Theoretically, the nature of the proposed mediation relationships is that SRE and pain acceptance should be related to coping strategy use, which should influence exercise behaviour. Three such types of coping strategies (maintenance, adaptive, and maladaptive) have been identified in previous research. Experts note many published studies of mediation effects do not satisfy criteria to properly test the mediation. Recommended criteria include but are not limited to large samples, minimising measurement error, and longitudinal research designs of at least three time points. Purposes. Therefore, the purposes of each study in this dissertation program of research were as follows: Study 1 was an exploratory secondary analysis of a larger arthritis study data set to identify (a) proposed mediation relationships utilising regression analyses, and (b) determine whether SRE for scheduling/planning exercise (SRE-SP) met recommendations in the literature for the construction of SRE scales. The purpose of Study 2 was to refine measures. Specifically, examination of measures included (a) a modified, exercise-specific chronic pain acceptance questionnaire (CPAQ-E) and (b) a comparison of the utility of various exercise-specific and disease-specific SRE measures as predictors of future exercise. In Study 3, the purpose was to employ a three time point longitudinal design to test the proposed mediation relationships using coping strategies as mediators. Results. Study 1 found some support for the proposed mediation relationships in that SRE and pain acceptance were significant predictors in the expected direction (ps < .001) of each of the types of coping strategy use, with the exception of adaptive strategy use. A multiple regression found that only maintenance strategy use predicted exercise volume (p < .001). The SRE-SP measure was found to meet most recommendations of SRE measure development. Study 2 examined the factorial validity of the CPAQ-E, a modified pain acceptance measure. A 14-item, two-factor model was retained in the final factor structure (χ2=85.695, df=64, p<.037; RMSEA=.055; CFI=.967; TLI=.954) and had good psychometric properties among exercising adults with arthritis (N = 98). The questionnaire also demonstrated some predictive utility in that both subscales and the total score positively predicted future weekly exercise bouts (ps range from <.001 to <.05) and the activities engagement subscale predicted future weekly exercise volume (p < .05). Among numerous SRE measures, only the SRE-SP and self-efficacy for exercise (SEE) measures significantly predicted future exercise volume (p=.002 and p=.001 respectively). Study 3 utilised a three time point design to examine proposed mediation relationships between psychological measures (CPAQ-E, SRE-SP, SEE), coping strategy use, and exercise behaviour. Product of coefficients testing was the procedure used to test for mediation whereby z scores greater than 1.96 indicate statistical significance. Maintenance strategy use was found to partially mediate exercise behaviour in the expected direction regardless of which psychological variable was entered as the independent variable. Maladaptive strategy use did not significantly mediate CPAQ-E and exercise but had mixed support for partial mediation of SRE measures and exercise. Conclusions. This research program expands upon existing correlational studies of social-cognitions related to exercise behaviour by examining mediation relationships for those with chronic pain. Maintenance strategy use was supported as a mediator between cognitions (SRE and pain acceptance) and exercise whereas maladaptive strategy use was only partly supported as a mediator of those relationships. Coping with extreme pain (e.g., arthritis flares) would be an additional context in which to study individuals’ coping strategy use and similar mediation relationships. The CPAQ-E demonstrated initial utility as a measure of pain acceptance in pursuing exercise behaviour but should be compared directly with the original CPAQ to determine if either is superior to the other in exercise studies. Future studies should employ a large enough sample to explore possible differences in mediation relationships among inactive individuals, exercise initiates, and maintainers.
DegreeDoctor of Philosophy (Ph.D.)
SupervisorBrawley, Lawrence R
CommitteeGyurcsik, Nancy C; Spink, Kevin S; Webber, Sandra C
Copyright DateJune 2017