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KEERTHANA - Research

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JSS COLLEGE OF PHYSIOTHERAPY

PRESENTATION-UG PROJECT

Exploring the personification of chronic low back pain:


an evaluation with the Ben-Gurion University Illness
Personification Scale (BGU-IPS)

Presenter: Keerthana G
Guide: Muhammed Rashid
PhD Scholar

Date: 30-09-2023
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CONTENTS
Chapter 1

1.0 Background
1.1 Need of study
1.2 Hypotheses
1.3 Objective of the study

Chapter 2

2.0 Introduction and areas of literature review


2.1 overview of section
2.2 keywords used
2.3 individual sections
2.4 overview of sections

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Chapter 3
3.0 Methodology
3.1 Research gap
3.2 Participant characteristics
3.3 Procedure 3.4 Data analysis

Chapter 4
4.0 Result table
4.1 Result pie- chart
4.2 correlation table

Chapter 5
5.0 Discussion

Chapter 6
6.0 Conclusion
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Introduction
BACKGROUND

•Low back pain (LBP) is the most prevalent problem in the world. It has a profound effect on well
being and is often the cause of significant physical and psychological health impairment.
(manchikanti et al., 2014)
•Many studies have proven that LBP increases linearly from the third decade of life on, until the
60year of life. LBP is common yet an exclusive disorder. It is multidimensional in nature and has
a multifactorial aetiology depending upon their life style.
(kostova and koleva, 2001)
•Yet LBP is prevalent it is not gender oriented. Both men and women have equal amount of
prevalence.
(hoy et al.,2012)

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•LBP can be caused due to specific and non- specific reasons such as obesity, spinal cord injury,
psychological disorder and various life style etc.
( frilander et al., 2015)

•When stress become chronic, as in case of chronic pain, patient personify their pain that they
form a mental representation of the pain as possessing specific traits, which in turn impacts their
ability to adapt.
( tsur et al 2022)
•Hence by using BGU-IPS scale we evaluate personification of chronic low back pain and find the
elation of negative and positive personification and their impact on the lifestyle.

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Need for the study
•As chronic low back pain is one of the commonest problem faced by the Indian population, it is
important to know how people are accepting the pain whether they are accepting pain in positive or
negative way because individual who ascribe a negative meaning to their chronic illness [e.g. enemy or
punishment] compared to the individuals who ascribe a positive meaning often report a higher quality of
life and low level of anxiety and depression.
(degner etal.2003)
•We use Ben- gurion university illness personification scale [ BGUIPS] a novel measure of illness
personification to examine negative and positive pain personification.

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Objective
•Primary objective
To evaluate the personification of chronic low back pain by using Ben- gurion
university illness personification scale [ BGUIPS] questioner method

•Secondary objective
To test the potential moderating role of chronic pain intensity in the link
between pain personification and outcome variable.

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Methodology of literature review
•Databases used: Google Scholar, PubMed.

•Search limits/ filters applied: English.

•Number of total articles cited in the review of literature: 24

Keywords used for each section:

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Sections of literature review
2.1 Definition and concepts of low back pain
•2.1.1: Overview of chronic low back pain
•2.1.2: Prevalence of CLBP (global and national)
•2.1.3: Prevalence of psychological disorders in CLBP
•2.1.4: Importance of understanding the psychosocial aspects of CLBP
•2.1.5 The biopsychosocial model of chronic pain
•2.1.6: Section summary

2.2 Illness personification theory


•2.2.1 Definition and concepts of Illness personification
•2.1.2 Pain personification
•2.1.3 The role of illness perception and personification in CLBP
•2.1.4 Methods of measuring pain personification
•2.1.5: Previous studies on pain personification measurement in any clinical condition
•2.1.6: Section summary
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2.3 Ben-Gurion University Illness Personification Scale (BGU-IPS)
•2.3.1 Overview of the BGU-IPS and its development
•2.3.2 Description of the scale's structure and scoring system
•2.3.3 Validity and reliability of the BGU-IPS
•2.3.4 Previous applications of the BGU-IPS in health research
•2.3.5: Section summary

•2.4 Methodological considerations


•2.4.1: Sample size calculation in research
•2.42: Sample size calculation for survey studies
•2.4.3: Data analysis in research
•2.4.4: Data analysis for survey studies
•2.4.5: Section summary
•2.5 Overall summary

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Section 1 Summary
• Low back pain (LBP) is an acute, sub-acute or chronic discomfort localized to the anatomic area
below the posterior ribs and above the lower margin of the buttock.
(david et al., 1996 )

• Prevalence of LBP globally is 8.20% in 1990 and slight decreased to 7.50% in 2017 and
nationally, annual, and lifetime prevalence of LBP is 48%, 51% and 66% respectively.
(M shetty et al., 2022)

• CLBP global prevalence was 4.2% in individuals aged between 24 to 39 years old and 19.6% in
those aged between 20 to 59 years old.
(meucci et., 2015)

•Prevalence of psychiatric comorbidity was between 40% and 100%. A study was done to examine
the prevalence of anxiety, depression, disability, insomnia, and sleep quality in chronic pain
patients. The mean ODI score was 31.54%, VAS score was 6.08, and insomnia of varying
severity was found in 29 patients.
(Cohen et., 2004)
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Section 2 Summary
•Illness personification is an individual's tendency to ascribe human attributes to chronic illness
qualities relevant to their self and identity. A study on ILL-PERF in SLE patients found that they
personify their illness as persecution, the self being as victim, and some reported as a warrior-
hero fighting an enemy. This suggests that personification differs from person to person, with
some taking their illness in a positive way while others take it in a negative way.
(schattner et., 2008)
•Pain personification is the tendency to ascribe human characteristics to chronic pain sensation in
a way that is relevant to the self. It has been proven that individuals who ascribe positive meaning
to chronic pain have lower levels of anxiety and depression and improved quality of life.
(Tsur et., 2020)
•Dr. Jonathan and Mike Osborn's research explored the relationship between chronic benign LBP
and their sense of self from an idiographic, phenomenological perspective. The majority of
participants described chronic pain as a fear, shame and sensitivity to punishment or rejection and
fear of social punishment.
( jonathan et., 2019)
• It is important to know the pain perception in chronic condition as it has major role on the
psychological and psychosocial factor of a individual.
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Section 3 Summary
•The Ben-Gurion University Illness Personification Scale (BGU-IPS) is a psychological
assessment tool developed by DR. Rinat Noyman-Veksler and Dr. Shimon E.spiro in 2009. It
measures the extent to which individuals personify their illness or pain, with six positive
statements and six negative statements, after rating each statement from 1-5, the average is taken
and the rate of personification of pain is calculated.
(tsur et., 2022 )

•Roy Aloni and Golan Shahar's article Negative and Positive Personification of Multiple Sclerosis
(MS) found that BGU-IPS is a good to excellent test-retest reliability for negative personification
scale (ICC = 0.81; P<.001) for positive personification scale (ICC = 0.76; P<.001).
(Aloni et., 2023)

• Previous applications of BGU-IPS in health research have found that negative personification is
associated with elevated level of psychological and psychopathological aspects, low level of
health related adaptation and salutogenic adaptation.
(tsur et., 2022 )

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Section 4 Summary
•Sample size is the number of units needed to answer a research hypothesis. It is important to
determine the appropriate sample size according to the study design and objective of the study, as
making mistakes during sample size calculation can lead to incorrect or insignificant results.
(kang et., 2021)
•There are many statistical books and software programs available to help sample size calculation.
Manual methods can be used for sample size calculation in survey studies, but it is difficult for
non-statically expert researchers. Software and websites can be used to calculate sample size,
such as G-power and , PASS, PS, R Packages, SPSS, STATA, minitab, etc.
(kang et., 2021)

•Data analysis is a process used to reduce data to a story and interpret it to derive insight. It
involves coding, tabulating, and drawing statistical inference. In survey studies, data analysis
requires a deeper understanding of the sample design, survey data, and interpretation of the
statistical methods.
(Serdar er., 2022)
•Survey Data analysis involves defining the problem and statement of objectives, understanding
the sample design, understanding the design variable, underlying constructs and missing data,
analysing the data, interpreting and evaluating the result, and reporting the estimates and
inferences from the survey data. These steps are essential for successful data analysis.
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Research Gap
•As chronic pain as a greater impact on the psychological and psychosocial aspect of an
individual, it is important to know the personification of pain so that the modification can be
done in treatment plan, coping strategies and psychological support can be given to individual.
•Previous research was done on personification of chronic pain by using BGU-IPS but still now
pain personification is not evaluated in any chronic conditions such as back pain, knee pain etc.

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•Justification for the methodology : the BGU-IPS was used to evaluate pain personification in
chronic pain and multiple sclerosis condition which analysis of BGU-IPS reliability was good to
excellent test-retest reliability. For negative (ICC= 0.81; P< .001) as well as for positive
personification scale (ICC = 0.76% ; P < .001).
• Sample size : 76
• Outcome measure : Reliability BGU-IPS questionnaire it as a good to excellent reliability.

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Methodology
•Research question: Evaluate pain personification in chronic low back patient and what is the
effect of pain personification in individual's health
•Study design: Survey method
•Study setting and place of study: The study will be conducted as an online survey, and hosted
using the goggle form
•Study population: People with chronic low back pain.

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Inclusion criteria Exclusion criteria

Pain between the 12th rib and gluteal fold, Digitally illiterate participants
or low back related leg symptoms

The duration should be more than three Participants who do not know English
months

Adults aged 18 and above Those who are cognitively impaired

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•Duration of study: Three months
•Sampling method: Convenience
•Sample size: The sample size for this research study was calculated using GPower software
version 3.1.9.4. The input parameters for the calculation were as follows: z-tests correlations (two
independent Pearson's r), two-tailed test, effect size of 0.6, alpha error of 0.05, and a desired
power of 0.95. The allocation ratio between the two groups (n2/n1) was set to 1. A total sample
size of 76 was achieved.
•Data collection method:
•Permission was obtained from the JSS college of Physiotherapy Internal Review Committee. The
questionnaires was exported to the goggle form and send to the identified participants through
email/ whatsApp. Subject information and consent details was attached to the email along with
the questionnaire. The demographic details (age and gender) was also collected along with the
questionnaire.
•Each participant were approached through telephone and the need and aim of the study were
explained. The participant details was kept confidentially and the name and other subjective
details was collected during the data collection.

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Approval from the IRC was taken.

The BGU-IPS questionnaire was exported to goggle form.

Participants were selected based on inclusion criteria.

Questionnaire was sent through Google form to the


participants.

Informed consent was given to the participants.


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Questionnaire given to the participants answered within 10 days.

Reminder was sent to the participants on 5th day, and 10th day.

Responses obtained was exported to the excel sheet.

The obtained data was analysed descriptively.

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Data Analysis

The data was derived from a Likert scale. The shapiro-wilk test of normality was used to confirm
the normality of the data. The descriptive statistics was computed to interpret the data and to
summarise the demographic characteristics. The association of low back pain and the pain
personification was computed using spearmen correlation test/ Pearson’s correlation test.

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Result

•Demographic characteristics

Age (mean & Gender Duration of low NPRS


average ) back pain (months)
50.62±27.58 male-22 10.30±1.41 4±1
Female - 28

NPRS – Numerical pain rating scale

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Pain Items Total score Mean
personification (__/250) score(_/5)
Negative pain My pain is stubborn 115 2.3
personification My pain is destructive 122 2.44
My pain is to blame for most of my 161 3.22
problems
My pain prevent me from becoming 123 2.46
whom I want to be
My pain is shameful 147 2.94
My pain is contagious 111 2.22
My pain devastates all that is good 123 2.46
My pain is treacherous 107 2.14
Positive pain My pain is a good friend 116 2.32
personification My pain encourages me to grow 116 2.32
My pain connects me to myself 114 2.28

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Result Pie chart

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• Correlation between BGU-IPS questionnaire and VAS

Items Correlation co- Significance


efficient

BGU-IPS 0.367 0.009


questionnaire and VAS

•BGU-IPS: Ben-Gurion University Illness Personification Scale VAS: Visual Analogue Scale

The correlation coefficient of 0.367** indicates a moderately positive correlation between VAS
(pain intensity measured on the Visual Analog Scale) and Personification Score. The significance
value (0.009) is less than 0.01, which means this correlation is statistically significant at the 0.01
level (2-tailed).
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Participant Name Email Age Gender Duration of Low back Total BGU-IPS
address (Mean±SD) low back pain pain intensity score
(months) in the past
week (VAS)

Participant 1

Participant 2

Participant 3

Participant 4

Participant 5

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