Pain coping and acceptance as longitudinal predictors of health-related quality of life among people with haemophilia-related joint pain.

BACKGROUND: Interventions based on coping and acceptance can be adapted for people with different painful conditions. Evidence about baseline characteristics that predict improved outcomes is informative for matching people to interventions, whereas evidence about changes that predict improved outcomes is informative about the processes that interventions should target.
METHODS: Participants in a low-intensity programme to promote self-management of haemophilia-related chronic joint pain (n = 101) reported pain intensity, coping, acceptance and quality of life at baseline and 6-month follow-up. Baseline and change measures of pain intensity, coping and acceptance were used to predict follow-up quality of life, taking account of baseline quality of life.
RESULTS: Changed (reduced) pain intensity predicted better physical quality of life, independently of age, haemophilia severity, baseline pain intensity and baseline physical quality of life. Lower baseline passive coping and changed (increased) pain acceptance predicted better mental quality of life, independently of age, severity and baseline mental quality of life. Increased activity engagement but not pain willingness predicted better mental quality of life when pain acceptance was decomposed. Changed (reduced) negative thoughts also predicted better mental quality of life when separate acceptance subscales were used. Active pain coping did not predict physical or mental quality of life.
CONCLUSIONS: Initially high levels of passive coping may be an obstacle to improving mental quality of life. Acceptance rather than coping may be a more useful behavioural change target, but more research is needed about the meanings and therapeutic implications of different elements of pain acceptance.