慢性疼痛のある人のための家の経験：混合研究法による調査

Chronic pain, defined as intermittent or continuous pain for a minimum of 3 months, is a prevalent and pervasive health issue that commonly results in occupational participation changes and individuals spending more time within the home. Yet the role of the home environment in pain and pain management has not been specifically explored. This study had two aims. The first aim was to explore how home is experienced for people with chronic pain across the six dimensions of home using the Dimensions of Home Measure. The second aim was to explore relationships between pain, mood, and dimensions of home to understand how the experience of home influences reported pain and its co-morbidities.

An online cross-sectional survey collected data from people with chronic pain across Australia. Participants provided information on their demographic characteristics, experience of home (Dimensions of Home Measure), pain and interference (Brief Pain Inventory), and symptoms of psychological distress (Depression, Anxiety, and Stress Scale 21 items). Descriptive statistics and mediation regression analyses from pain interference (PI) on psychological distress through aspects of dimensions of home were conducted.

An interprofessional chronic pain rehabilitation team, including medical doctors and allied health, highlighted the need for this study and partnered with academics. Professional and consumer pain associations throughout Australia supported the study by promoting the study details and assisting with participant recruitment. The research team included members with lived experience of chronic pain, caring for people with pain, and treating pain who were involved in the design, analysis, and reporting of results.

A total of 107 people aged 18 years or older participated. The results suggest that the experience of home is generally considered to be positive for people living with chronic pain; however, some aspects of home life such as perceiving the home as a place for activities, safety within the home, and in temporal aspects of home life (e.g., daily and weekly routines and feeling that the home is set up for the future) may be less positively regarded compared to other aspects of home life. Mediation findings, with pain interference as the predictor, suggest a strong reciprocal relationship between feelings of safety within the home and symptoms of anxiety and with perceiving the home as a place for activities and in temporal dimensions of home life with depressive symptoms.

The results of this study provide preliminary support for the further examination of the home as a determinant of health, including as a potential factor to be considered beyond the biopsychosocial model of pain. Occupational therapists working with clients for pain management within their home should consider how the home can be modified or structured to improve occupational participation, particularly in relation to safety, the home as a place for activities, the routines of daily life, and that the home is well set up for the future. This may have a profound impact on how home is experienced for people with chronic pain and on their emotional wellbeing.