Treatment outcome in individuals with chronic pain: is the Pain Stages of Change Questionnaire (PSOCQ) a useful tool? Jenny Strong a, * , Kym Westbury a , Glen Smith b , Ian McKenzie c , William Ryan c a Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia b School of Psychology, The University of Queensland, Brisbane, Queensland 4072, Australia c Gregory Terrace Rehabilitation, Spring Hill, Queensland 4000, Australia Received 2 January 2001; received in revised form 13 November 2001; accepted 15 December 2001 Abstract The efficacy of psychological treatments emphasising a self-management approach to chronic pain has been demonstrated by substantial empirical research. Nevertheless, high drop-out and relapse rates and low or unsuccessful engagement in self-management pain rehabilitation programs have prompted the suggestion that people vary in their readiness to adopt a self-management approach to their pain. The Pain Stages of Change Questionnaire (PSOCQ) was developed to assess a patient’s readiness to adopt a self-management approach to their chronic pain. Preliminary evidence has supported the PSOCQ’s psychometric properties. The current study was designed to further examine the psychometric properties of the PSOCQ, including its reliability, factorial structure and predictive validity. A total of 107 patients with an average age of 36.2 years ðSD ¼ 10:63Þ attending a multi-disciplinary pain management program completed the PSOCQ, the Pain Self- Efficacy Questionnaire (PSEQ) and the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) pre-admission and at discharge from the program. Initial data analysis found inadequate internal consistencies of the precontemplation and action scales of the PSOCQ and a high correlation (r ¼ 0:66, P , 0:01) between the action and maintenance scales. Principal component analysis supported a two-factor structure: ‘Contemplation’ and ‘Engagement’. Subsequent analyses revealed that the PSEQ was a better predictor of treatment outcome than the PSOCQ scales. Discussion centres upon the utility of the PSOCQ in a clinical pain setting in light of the above findings, and a need for further research. q 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved. Keywords: Pain Stages of Change Questionnaire; Chronic pain; Readiness for rehabilitation 1. Introduction The cognitive-behavioural model of chronic pain posits that patients’ beliefs, coping mechanisms and perceptions of control influence their behavioural and psychological func- tioning (Turk et al., 1983; Jensen et al., 1999). Cognitive- behavioural interventions focus on the self-management of chronic pain, which is developed through the adoption of an active, problem solving perspective, and adaptive skill acquisition (Turk and Rudy, 1992; Turk et al., 1996; Morley et al., 1999). Empirical research has documented links between cognitive-behavioural pain management programs and improved control over pain, increased use of positive coping strategies and improved physical and psychological functioning in patients with chronic pain (Williams et al., 1993; Jensen et al., 1999). However, unsuccessful engage- ment and high drop-out and relapse rates in these treatments have been commonly noted (Turk and Rudy, 1990, 1991; Spence and Sharpe, 1993). Kerns and his coworkers have suggested that people vary in their readiness to adopt a self- management approach to their pain as an alternative to continuing to pursue traditional medical interventions (Kerns et al., 1997; Kerns and Rosenberg, 2000). Readiness is defined as the degree to which a person accepts personal responsibility for pain control, and the extent to which they are thinking about changing their behaviour to cope with their pain (Kerns and Rosenberg, 2000). Drawing on Prochaska and DiClemente’s (1984) Trans- theoretical Model of Behaviour Change, Kerns et al. (1997) developed the Pain Stages of Change Questionnaire (PSOCQ) to assess patients’ readiness to adopt a self- management approach to their chronic pain condition. Preli- minary support has been provided for the PSOCQ’s relia- bility, stability and discriminant and criterion-related validity (Kerns et al., 1997; Kerns and Rosenberg, 2000). In the initial development of the questionnaire, confirmatory factor analysis supported a four-factor measure correspond- ing to Prochaska and DiClemente’s (1984) ‘Precontempla- tion’, ‘Contemplation’, ‘Action’ and ‘Maintenance’ stages Pain 97 (2002) 65–73 0304-3959/02/$20.00 q 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved. PII: S0304-3959(01)00493-6 www.elsevier.com/locate/pain * Corresponding author. Tel.: 161-7-33651320; fax: 161-7-33654383. E-mail address: j.strong@mailbox.uq.edu.au (J. Strong).