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This cross-sectional study was conducted to investigate the relationships between patients' pain beliefs, health beliefs about complementary and alternative medicine, and levels of spiritual well-being in a Physical Medicine and Rehabilitation outpatient clinic. Adult participants between 18 and 65 years of age were enrolled. Standardized questionnaires were used to evaluate psychological status, pain-related beliefs, attitudes toward complementary and alternative medicine, and spiritual well-being. The study aimed to contribute to holistic pain management approaches by integrating psychological, spiritual, and health belief perspectives.
Detailed Description:
This cross-sectional analytical study was designed to evaluate the interrelationships between pain beliefs, health beliefs regarding complementary and alternative medicine (CAM), and spiritual well-being in patients attending a Physical Medicine and Rehabilitation (PMR) outpatient clinic.
Rationale:
Chronic musculoskeletal pain is among the most frequent reasons for PMR admission. Prior research has examined pain beliefs, CAM utilization, or spirituality separately, yet little is known about their combined influence on patient coping, psychological status, and treatment orientation. Understanding these multidimensional factors is essential for advancing holistic, patient-centered rehabilitation strategies.
Study Design and Methods:
The study was conducted at Yozgat Bozok University, Faculty of Medicine, Department of PMR. A cross-sectional analytical design was employed. Eligible participants were adults aged 18-65 years who were literate, cognitively intact, and consented voluntarily. Exclusion criteria included communication or cognitive impairments, refusal to participate, or age outside the inclusion range.
Assessments:
Participants completed standardized, validated Turkish versions of the following instruments:
Hospital Anxiety and Depression Scale (HADS): evaluation of anxiety and depression symptoms.
Pain Beliefs Questionnaire (PBQ): assessment of organic and psychological pain beliefs.
Complementary, Alternative, and Conventional Medicine Attitude Scale (CACMAS): evaluation of attitudes toward CAM and conventional medicine.
Complementary and Alternative Medicine Health Belief Questionnaire (CHBQ): assessment of CAM-related health beliefs.
Three-Factor Spiritual Well-Being Scale (TFSWBS): measurement of transcendence, harmony with nature, and anomie.
Statistical Plan:
Descriptive statistics were calculated for demographic and clinical variables. Group comparisons were performed using Student's t-test, ANOVA, or chi-square tests, as appropriate. Correlation analyses explored associations among psychological, cognitive, and spiritual outcomes. Multiple regression models were applied to identify predictors of CAM health beliefs and spiritual well-being. Sample size was determined a priori using G*Power (version 3.1.9.7) to achieve 95% power with five predictors at α = 0.05.
Expected Contribution:
By integrating cognitive, psychological, and spiritual dimensions, the study seeks to clarify how pain beliefs and CAM health beliefs relate to spiritual well-being in rehabilitation patients. Findings are expected to support the incorporation of structured spiritual assessments and evidence-based CAM counseling into PMR practice to enhance holistic pain management.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rehabilitation Outpatients | Adult patients (18-65 years) attending a university hospital Physical Medicine and Rehabilitation outpatient clinic. Participants were evaluated once using self-report questionnaires and scales |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Questionnaire Administration | Other | Participants completed a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale, the Pain Beliefs Questionnaire, the Complementary, Alternative, and Conventional Medicine Attitude Scale, the Complementary and Alternative Medicine Health Belief Scale, and the Three-Factor Spiritual Well-Being Scale. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Beliefs Questionnaire | Description: The Pain Beliefs Questionnaire was developed in 1992 by Edwards and colleagues. It contains 12 items. Six items assess organic pain beliefs (score range: 6-30) and four items assess psychological pain beliefs (score range: 4-20). Participants rate each item using a Likert-type scale from 1 to 5. Higher scores on the organic subscale indicate stronger beliefs in an organic cause of pain (considered maladaptive), while higher scores on the psychological subscale indicate stronger beliefs in a psychological origin of pain (considered more adaptive). | At enrollment |
| Three-Factor Spiritual Well-Being Scale | Description: The Three-Factor Spiritual Well-Being Scale was developed in 2017 by Eksi and Kardas. It contains 29 items with three subscales: transcendence (11 items, score range: 11-55), harmony with nature (6 items, score range: 6-30), and anomie (12 items, score range: 12-60; reverse-scored). Items are rated on a 5-point Likert scale. The total score ranges from 29 to 145. Higher total scores indicate greater levels of spiritual well-being (a better outcome). | At enrollment |
| Complementary and Alternative Medicine Health Belief Scale | This scale was developed in 2004 by Lie and Boker. It contains 10 items. Each item is scored on a seven-point Likert scale. Three of the items are reverse-scored. The total score ranges from 10 to 70. Higher scores indicate stronger health beliefs related to complementary and alternative medicine. The scale does not have a cut-off score. | At enrollment |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital Anxiety and Depression Scale | This scale was developed in 1983 by Zigmond and Snaith. It contains 14 items. Seven items measure anxiety and seven items measure depression. Each item is scored on a scale from 0 to 3. Some items are reverse-scored. The cut-off score is 10 for anxiety and 7 for depression. Higher scores indicate higher levels of anxiety or depression. The scale does not provide a total score but gives separate scores for the two subscales. |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients aged 18 to 65 years who attended the Physical Medicine and Rehabilitation outpatient clinic of a university hospital in Türkiye.
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| Name | Affiliation | Role |
|---|---|---|
| Gülseren Demir Karakılıç, Asst Prof | Yozgat Bozok University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Yozgat Bozok University Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Yozgat | Yozgat | 66100 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Uslu, F. (2020). Geleneksel ve tamamlayıcı tıp (getat) sağlık inanış anketinin türkçe geçerlilik ve güvenilirlik çalışması. (Uzmanlık Tezi). Sağlık Bilimleri Üniversitesi Ankara Dışkapı Yıldırım Beyazıt Sağlık Uygulama ve Araştırma Merkezi Aile Hekimliği Kliniği, Ankara. https://tez.yok.gov.tr/UlusalTezMerkezi/ sayfasından erişilmiştir. (Tez Numarası 644233). | ||
| Background | Elif, K. Ö. S. E., Hasan Çetin Ekerbiçer, and Ünal Erkorkmaz. "Complementary, alternative and conventional medicine attitude scale: Turkish validity reliability study." Sakarya Tıp Dergisi 8.4 (2018): 726-736. | ||
| 12667973 | Background | Hyland ME, Lewith GT, Westoby C. Developing a measure of attitudes: the holistic complementary and alternative medicine questionnaire. Complement Ther Med. 2003 Mar;11(1):33-8. doi: 10.1016/s0965-2299(02)00113-9. | |
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The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. De-identified data will be shared for academic and research purposes in accordance with institutional and ethical guidelines.
De-identified individual participant data and supporting documents will be available beginning 6 months after publication of the study results and will remain available for 5 years.
De-identified individual participant data and supporting documents will be available upon reasonable request to the corresponding author for academic and research purposes only. Requests will be reviewed by the study investigators, and data will be shared via secure electronic transfer in accordance with institutional and ethical guidelines.
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| ID | Term |
|---|---|
| D059350 | Chronic Pain |
| D009140 | Musculoskeletal Diseases |
| D001008 | Anxiety Disorders |
| D003863 | Depression |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| At enrollment |
| Complementary, Alternative, and Conventional Medicine Attitude Scale | This scale was developed in 2010 by McFadden and colleagues. It contains 25 items. It has three subscales: attitudes toward complementary and alternative medicine, dissatisfaction with conventional medicine, and holistic balance. Participants rate each item using a Likert-type scale. The scale does not have a cut-off score. Higher scores indicate a more favorable attitude toward complementary and alternative medicine and stronger belief in holistic balance. | At enrollment |
| Background |
| Edwards LC, Pearce SA, Turner-Stokes L, Jones A. The Pain Beliefs Questionnaire: an investigation of beliefs in the causes and consequences of pain. Pain. 1992 Dec;51(3):267-272. doi: 10.1016/0304-3959(92)90209-T. |
| Background | Aydemir, O. J. T. P. D: Hastane Anksiyete ve Depresyon Ölçeği Türkçe Formunun Geçerlilik ve Güvenilirliği. Türk Psikiyatri Dergisi, 8, 187-280, 1997. |
| 6880820 | Background | Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x. |
| 37819529 | Background | Okan N, Kose N, Kardas S. Spiritual Contradiction Scale: A New Way of Understanding Internal and External Contradictions. J Relig Health. 2024 Apr;63(2):1567-1584. doi: 10.1007/s10943-023-01924-2. Epub 2023 Oct 11. |
| 18159574 | Background | Berk HO, Bahadir G. [The experience of chronic pain and pain beliefs]. Agri. 2007 Oct;19(4):5-15. Turkish. |
| D001523 | Mental Disorders |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |