Patient-defined meaningfulness within chronic pain rehabilitation: A concept analysis

Background: As the problem of chronic pain grows worldwide, rehabilitation is critical to improved patient well-being. There is thus a need for rehabilitation-focused research. It appears that outcomes are improved when patients perceive the rehabilitation process to be meaningful. However, there is no empirical evidence determining how this would be achieved. An important first step is to identify and describe the concept of meaningfulness as it is used in the chronic pain rehabilitation literature. Objective: This paper reports the findings of a structured concept analysis to define meaningfulness from the patient perspective in chronic pain rehabilitation. Methodology: In consultation with a medical librarian, a search strategy was developed and articles retrieved. The Walker and Avant concept analysis method was used to analyze the data, identify the defining attributes of meaningfulness, develop contrary, borderline, and model cases, and identify its antecedents and consequences. Results: The search revealed extensive use of the terms ‘meaningfulness’ and ‘meaningful’ within the chronic pain rehabilitation literature from the healthcare provider and system perspective. However, only ten articles met the inclusion criteria, and used the terms meaningful or meaningfulness from the patients’ perspective. Given the paucity of relevant studies, it was not possible to retrieve a clear definition of meaningfulness specific to the context of chronic pain rehabilitation, nor to identify specific outcome measures used to confirm whether rehabilitation is meaningful for people with chronic pain. Conclusions: There is a worrisome gap in the chronic pain rehabilitation literature regarding the application of the concept of ‘meaningfulness’ as perceived by the patient. This study lays the foundation to further the conceptual clarity required for rigorous research to determine potential benefits of personally meaningful chronic pain rehabilitation. Further work is required to define and operationalize the concept, develop valid assessment tools, and build the evidence base regarding relationships between patient-defined meaningfulness and positive outcomes in rehabilitation