Initial development

Nielson, et al. (2003) began development of a MPRCQ (pronounced ‘em-perk’) to provide an instrument that would allow initial research into a multidimensional model. The items for this questionnaire were based on the self-management strategies often taught in multidisciplinary programmes as described in our motivational model. Initial item development included ten primary scales as well as five cognitive control content scales. During the item analyses one scale, ‘Avoid Guarding’ was dropped because of difficulties in obtaining adequate internal consistency. The resulting 46-item questionnaire had adequate internal reliability (a = 0.70 to 0.93) and there was little or no effect of social desirability. The final nine primary scales assess readiness to engage in the coping strategies of (1) exercise, (2) task persistence, (3) relaxation, (4) cognitive control, (5) pacing, (6) avoiding pain-contingent rest, (7) avoiding asking for assistance, (8) assertive communication, and (9) proper body mechanics. The five cognitive control subscales are (1) diverting attention, (2) self-statements, (3) reinterpreting sensations, (4) avoiding catastrophizing, and (5) ignoring pain. Good concurrent validity for the PSOCQ scales was obtained in the form of moderate correlations with the PSOCQ, the Chronic Pain Coping Inventory (Jensen et al. 1995, 2008), a measure of pain coping and the Survey of Pain Attitudes (Jensen and Karoly 2008; Jensen et al. 1994), which measures attitudes regarding pain self-management.

Although these data were encouraging, there were a number of elements of the MPRCQ that we felt warranted improvement. In particular, it is difficult to convey the concept of being ready to stop engaging in a behaviour. The awkwardness of this concept, along with the combination of instructions and the wording of some items that created apparent double negatives, made some items more difficult for patients to understand. In addition, we had based the MPRCQ response options on the stages of change and felt that, psychometrically and theoretically, it made more sense to have these options reflect a readiness to change continuum rather than the discrete stages of change. Indeed, the concept of discrete stages of change has been challenged in the health behaviour change literature. For example, West (2005) has suggested that stages of change are arbitrary, oversimplified (stages contain multiple constructs such as time, intent and past attempts to change) and include only motivational elements of which the patient is consciously aware.

 
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