Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery

Abstract

Background: Despite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal amongst adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age-appropriate daily activities. The aim of this study was to gain a comprehensive insight into adolescents' perceptions of the barriers they need to overcome to engage with age-appropriate activities in order to achieve functional recovery. Methods: Forty-one adolescents who were starting an IIPT program completed the 'passenger-on-the-bus metaphor', an exercise in which they identify and describe their perceived barriers (i.e., 'passengers' on their bus) that prevent them from engaging with age-appropriate activities. The responses were analysed using inductive thematic analyses to generate a taxonomy of perceived barriers to functional recovery. Results: We generated a taxonomy of seven different barriers that participants described facing on their road to functional recovery: physical constraints, being 'fed up', low self-confidence and self-esteem, perfectionism, avoidance of engagement with pain, feelings (such as sadness, anger, guilt, anxiety), and social barriers (received from a range of sources such as parents, friends, school, and wider society). Conclusion: The findings reveal a variety of barriers that were perceived to hinder functional recovery through reduced engagement with age-appropriate activities and thereby hamper progress within IIPT. The passenger-on-the-bus metaphor can be used to identify similar barriers faced by adolescents in an individualized treatment approach, thereby making it possible for clinicians to target their IIPT more precisely. Additional Information: Question Response Significance Below please give a paragraph entitled "Significance", indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. The signifiance statement should be short, attention-grabbing,non-redundant with the conclusions and rigorously in line with the contents of the full article. It should not exceed 80 words and will be added to the end of the abstract at the time of typesetting. This paragraph will NOT Explicit identification of adolescents' individual barriers towards obtaining functional could be critical to enhance the adolescents' motivation to engage with and adhere to recovery intensive interdisciplinary pain treatment.