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.
Study Type
OBSERVATIONAL
Enrollment
116
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.
Yozgat Bozok University Faculty of Medicine, Department of Physical Medicine and Rehabilitation
Yozgat, Yozgat, Turkey (Türkiye)
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).
Time frame: 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).
Time frame: 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.
Time frame: At enrollment
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.
Time frame: 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.
Time frame: At enrollment
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