The Importance of Self-Efficacy in the Context of Pain

Self-efficacy – ‘An individual’s belief in their capacity to implement behaviours necessary to produce positive outcomes despite pain. More simply put, self-efficacy is a person’s belief that they can reach a desired outcome.’

Pain is multidimensional and complex, and in the context of chronic pain, it is often the case that there are several mediating factors associated with one’s ongoing disability. As a clinician working within a multidisciplinary team, it is important to flag and address factors which can reduce an individual’s disability and improve their overall quality of life.

Notably, pain can understandably lead to feelings of anxiety and low mood, which in turn is often associated with disengagement from meaningful tasks. This can be unhelpful and only serve to exacerbate ongoing levels of disability as individuals lose confidence in their ability to complete purposeful and meaningful activities in their day to day lives.

As an Exercise Physiologist, we are often tasked with the responsibility to assist and guide our clients back to such meaningful tasks as we believe in the benefits of movement and mastery. But how can we do this with the knowledge that pain can be difficult to reduce and often the literature has shown that it is not feasible to fully eliminate pain? Is it possible to improve one’s disability despite ongoing symptoms? And can we have people return gradually to meaningful tasks and instil the confidence necessary to achieve longer term goals despite symptoms? This can be possible through a concept known as ‘self-efficacy’.

A recent study found that improvements in self-efficacy as measured by the Patient Self Efficacy Scale (PSEQ) is associated with reductions in disability despite no significant change in symptoms. Furthermore, there is supporting evidence that higher levels of self-efficacy at baseline are predictive of positive outcomes at long term follow up. So, what does this tell us? Does this mean that we should tell people to go straight back to their usual tasks without concern? No – but what it does suggest is as a clinician, we should endeavour to identify potential tasks and activities that can be maintained within current tolerances and with the appropriate guidance we can tailor strategies to improve confidence and abilities to complete these tasks. It also suggests that measuring one’s self-efficacy early in an intervention / exercise program could provide insight into potential targets for treatment.  

How do we as clinicians aim to improve self-efficacy and target treatment for those we identify with low self-efficacy?

  • Firstly, we can provide tailored education and reassurance. Often, we meet people that are uncertain, apprehensive and avoidant of movement due to fears or misinformation around their condition. As health professionals we can reassure and educate around pain as well as pacing strategies.
  • Following this education and reassurance, we can provide ‘permission to move’ so to speak and start to work with our clients in a collaborative way by identifying tasks and activities they could potentially return to.
  • We also provide a platform around vicarious learning. At Guardian Exercise Rehabilitation we have a unique mobile service delivery model where we often have the opportunity to meet people and re-integrate them back into social settings.
  • Lastly and likely most important, we provide a platform for self-exploration through movement. Within our clients, we want to develop independence and encourage a transition to self-management with rehabilitation. As an individual becomes independent and achieves their own improvements, they can begin to internalise the idea that they are able to progress which naturally improves one’s confidence moving forwards to achieve other milestones.  

If you do suffer from chronic pain and feel as though you require guidance and support to achieve long term goals, an Exercise Physiologist or Physiotherapist could assist. Feel free to visit My Health Portal on our website to explore further resources and information around pain and wellbeing.

References:

Karasawa, Y et al. (2019). Association between change in self-efficacy and reduction in disability among patients with chronic pain. PloS One.

Chester, R et al. (2018). Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis. British Journal of Sports Medicine.

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