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Use of metaphors in the management of people with chronic musculoskeletal pain; a qualitative study.

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  • Full or part time
    Prof A Sumathipala
    Dr J Ashworth
    Mr T Kingstone
    Dr S Farooq
  • Application Deadline
    No more applications being accepted
  • Funded PhD Project (European/UK Students Only)
    Funded PhD Project (European/UK Students Only)

Project Description

In this study, we aim to investigate the current use of metaphors in the management of people with chronic MSK pain and compile a collection of metaphors used in routine practice. Chronic MSK pain is defined as pain that persists for 3+ months and affects muscles and/or joints (e.g. low back pain, osteoarthritis-relate pain). Then we will explore the usefulness of these metaphors and determine how these may be refined to improve their usefulness in enhancing management of people with these conditions. Our aim is to explore the existing metaphors used by clinicians and also to support future development of a metaphors-based intervention that could be incorporated into low intensity brief CBT interventions delivered by non-specialist/ generalists and testing their clinical and cost effectiveness.

Objectives and Research questions

The overall objective is to explore the use of metaphors by clinicians/healthcare practitioners in the management of people with chronic MSK and to refine and improve them to enhance the management of people with chronic MSK pain by developing a new CBT-led intervention as the next step. Hence this ACORN PhD proposal will be the qualitative component informing the development of a later intervention.

Research questions

1. What is the existing knowledge about the use of metaphors in relation to chronic MSK pain?
2. How do healthcare practitioners/people with chronic MSK pain use metaphors during consultations about MSK?
3. What metaphors do healthcare practitioners/people with chronic MSK pain use in the context of managing/experiencing chronic MSK pain?
4. Can metaphors be refined and improved to enhance management of people with chronic MSK pain?

Methods

Meta-synthesis: A meta-synthesis of qualitative and quantitative research will be conducted to examine existing use of metaphors in the management and experience of chronic pain. The search criteria will be agreed with the supervisory team and with input from the Systematic Review Team in the RI.

Qualitative semi-structured interviews: with up to 25 healthcare practitioners (who manage the care of people with chronic MSK pain) and up to 15 people with chronic MSK pain will be conducted to explore the use of metaphors in routine practice. The interviews are expected to last for up to 30 minutes and will be conducted either face-to-face, over the telephone, or via Skype. Purposive sampling with snow-balling will be used to recruit HCPs to ensure that different categories of practitioners such as GPs, rheumatologists, physiotherapists, psychologists are interviewed, with range of gender, years as a practitioner. People with chronic MSK pain will be recruited via third sector organisations, community groups and social media.

Patient and public involvement and engagement (PPIE):
A project advisory group involving members of the Research User Group (RUG) at Keele University will be established to support the PhD student in decision making along the PhD process. The group will be invited to have input on, for example, the design of the study and of patient-facing documents for ethics.

Ethical considerations

NHS ethical approval and Health Research Authority approvals will be sought by the PhD student with support from the supervisory team prior to the commencement of data collection. The student will follow Standard Operating Procedures (SOPs) to ensure that the project meets best practice standards of Keele University.

Analysis plan

Semi-structured interviews will be digitally recorded and transcribed verbatim with consent. The interview transcripts will be used to identify and compile a list of metaphors for refinement. In addition, thematic analysis (Guest, MacQueen & Namey, 2011) using principles of constant comparison (Charmaz, 2013) to compare across healthcare practitioner interviews and people with chronic MSK pain separately. Themes will then be compared and combined/refined to identify key themes around the use of metaphors in clinical practice. A separate analysis to identify the themes of the metaphors will also be conducted.

Funding Notes

All fees paid at current UK/EU rates, for three years only
Stipend paid at current Research Council rate, for three years full time or six years part time.

Fees provided at EU rates only, Non-EU students would be required to pay the additional overseas fees themselves. Fees will only be paid for three years full time or six years part time.

Good (2:1 or above) First degree in a social sciences, psychology or health-related discipline. A Master’s degree in a relevant discipline is highly desirable. Work experience in a health-related discipline, would be useful. Experience in qualitative research methods desirable.



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