Robert Schütze | Curtin University, Perth (original) (raw)

Papers by Robert Schütze

Clinical Orthopaedics and Related Research

BMJ Open

IntroductionLow back pain (LBP) is the leading cause of disability globally and its costs exceed ... more IntroductionLow back pain (LBP) is the leading cause of disability globally and its costs exceed those of cancer and diabetes combined. Recent evidence suggests that individualised cognitive and movement rehabilitation combined with lifestyle advice (cognitive functional therapy (CFT)) may produce larger and more sustained effects than traditional approaches, and movement sensor biofeedback may enhance outcomes. Therefore, this three-arm randomised controlled trial (RCT) aims to compare the clinical effectiveness and economic efficiency of individualised CFT delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling LBP.Methods and analysisPragmatic, three-arm, randomised, parallel group, superiority RCT comparing usual care (n=164) with CFT (n=164) and CFT-plus-movement-sensor-biofeedback (n=164). Inclusion criteria include: adults with a current episode of LBP >3 months; sought primary care ≥6 weeks ago for this episode of LBP; a...

Behavioural and Cognitive Psychotherapy

Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of pop... more Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliabl...

The journal of pain : official journal of the American Pain Society, 2018

Pain catastrophizing (PC), defined as an exaggerated negative cognitive-affective orientation tow... more Pain catastrophizing (PC), defined as an exaggerated negative cognitive-affective orientation toward pain, is one of the strongest psychological predictors of pain outcomes. Although regularly included as a process variable in clinical trials, there have been no comprehensive reviews of how it can be modified. Using a registered protocol (PROSPERO 2016 CRD42016042761), we searched MEDLINE, PsychINFO, EMBASE, CINAHL, and CENTRAL up to November 2016 for all randomized controlled trials measuring PC in adults with chronic noncancer pain. Two authors independently screened studies and assessed bias risk using the Cochrane tool. Quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation criteria. We included 79 studies (n = 9,914), which mostly recruited participants with musculoskeletal pain and had low risk of bias. Meta-analyses (standardized mean difference) showed 9 interventions had efficacy compared with waitlist/usual care or acti...

Journal of Orthopaedic & Sports Physical Therapy

British journal of health psychology, Jan 3, 2017

Pain catastrophizing is widely studied in quantitative pain research because of its strong link w... more Pain catastrophizing is widely studied in quantitative pain research because of its strong link with poor pain outcomes, although the exact nature of this construct remains unclear. Focusing on its ruminative dimension, the present qualitative study aimed to explore a nascent aspect of pain catastrophizing - metacognition - by documenting people's attitudes towards rumination and examining how these metacognitions might influence the course it takes. Qualitative interview study. Semi-structured interviews were conducted in a tertiary care setting with 15 adults experiencing chronic (≥6 months) low back pain who scored highly (≥30) on the Pain Catastrophising Scale. Transcripts were analysed using interpretative phenomenological analysis. The first aim of documenting pain metacognitions revealed both positive (e.g., 'thinking helps me to cope') and negative (e.g., 'rumination is uncontrollable') attitudes towards pain rumination. These were often held simultaneous...

BMJ open, Dec 9, 2016

To investigate young people's experiences of persistent musculoskeletal pain, including care ... more To investigate young people's experiences of persistent musculoskeletal pain, including care needs and current service gaps as well as perceptions about the role of digital technologies to support their co-care. A qualitative study employing two independent data collection modes: in-depth individual semistructured interviews and focus groups. Community settings throughout Australia. Participants were included if they had experienced persistent musculoskeletal pain of >3-month duration with an average of ≥3 on the visual analogue scale over the preceding 3 months, including non-specific conditions (eg, low back pain) and specific conditions (eg, juvenile idiopathic arthritis and other systemic arthritides), with/without pre-existing or current diagnosed mental health conditions. 23 young people (87.0% women; mean (SD) age: 20.8 (2.4) years) from across 6 Australian jurisdictions participated. Almost two-thirds of participants with persistent musculoskeletal pain reported comor...

BMJ open, Jan 19, 2015

The fear-avoidance model describes how the belief that pain is a sign of damage leads to pain-rel... more The fear-avoidance model describes how the belief that pain is a sign of damage leads to pain-related fear and avoidance. But other beliefs may also trigger the fear and avoidance responses described by the model. Experts have called for the next generation of fear avoidance research to explore what beliefs underlie pain-related fear and how they evolve. We have previously described damage beliefs and suffering/functional loss beliefs underlying high pain-related fear in a sample of individuals with chronic back pain. The aim of this study is to identify common and differential factors associated with the beliefs in this sample. A qualitative study employing semistructured interviews. Musculoskeletal clinics in Western Australia. 36 individuals with chronic back pain and high scores on the Tampa Scale (mean 47/68). The overarching theme was a pain experience that did not make sense to the participants. The experience of pain as unpredictable, uncontrollable and intense made it threa...

British journal of health psychology, Jan 3, 2017

Pain catastrophizing is widely studied in quantitative pain research because of its strong link w... more Pain catastrophizing is widely studied in quantitative pain research because of its strong link with poor pain outcomes, although the exact nature of this construct remains unclear. Focusing on its ruminative dimension, the present qualitative study aimed to explore a nascent aspect of pain catastrophizing - metacognition - by documenting people's attitudes towards rumination and examining how these metacognitions might influence the course it takes. Qualitative interview study. Semi-structured interviews were conducted in a tertiary care setting with 15 adults experiencing chronic (≥6 months) low back pain who scored highly (≥30) on the Pain Catastrophising Scale. Transcripts were analysed using interpretative phenomenological analysis. The first aim of documenting pain metacognitions revealed both positive (e.g., 'thinking helps me to cope') and negative (e.g., 'rumination is uncontrollable') attitudes towards pain rumination. These were often held simultaneous...

There can be no doubt that the Murdoch press played an important role in cohering what support th... more There can be no doubt that the Murdoch press played an important role in cohering what support there was for Australia's involvement in 'Gulf War Two'. From the start, Murdoch's 'Australian' newspaper was firmly committed to the coalition of the willing and provided a well-orchestrated cheer squad for Prime Minister John Howard and the war against Iraq.

There can be no doubt that the Murdoch press played an important role in cohering what support th... more There can be no doubt that the Murdoch press played an important role in cohering what support there was for Australia's involvement in 'Gulf War Two'. From the start, Murdoch's 'Australian' newspaper was firmly committed to the coalition of the willing and provided a well-orchestrated cheer squad for Prime Minister John Howard and the war against Iraq.

Four specialists – a clinical psychologist, a physiotherapist, a pain specialist and an orthopaed... more Four specialists – a clinical psychologist, a physiotherapist, a pain specialist and an orthopaedic surgeon – each discuss their own particular aspect of the care of this young patient with ongoing knee pain.

The Clinical Journal of Pain, 2014

The Tampa Scale of Kinesiophobia has been used to identify people with back pain who have high le... more The Tampa Scale of Kinesiophobia has been used to identify people with back pain who have high levels of "fear of movement" in order to direct them into fear reduction interventions. However there is considerable debate as to what construct(s) the scale measures. Somatic Focus and Activity Avoidance subscales identified in factor analytic studies remain poorly defined. Employing a mixed methods design, this study sought to understand the beliefs that underlie high scores on the Tampa Scale in order to better understand what construct(s) it measures. In-depth qualitative interviews with 36 adults with chronic nonspecific low back pain (average duration=7 y), scoring highly on the Tampa Scale (average score=47/68) were conducted. Following inductive analysis of transcripts, individuals were classified into groups based on underlying beliefs. Associations between groups and itemized scores on the Tampa Scale and subscales were explored. Frequencies of response for each item were evaluated. Two main beliefs were identified:1. The belief that painful activity will result in damage and 2. The belief that painful activity will increase suffering and/or functional loss. The Somatic Focus subscale was able to discriminate between the two belief groups lending construct validity to the subscale. Ambiguous wording of the Activity Avoidance subscale may explain limitations in discriminate ability. The Tampa Scale may be better described as a measure of the "beliefs that painful activity will result in damage and/or increased suffering and/or functional loss".

PAIN, 2010

The relationship between persistent pain and self-directed, non-reactive awareness of present-mom... more The relationship between persistent pain and self-directed, non-reactive awareness of present-moment experience (i.e., mindfulness) was explored in one of the dominant psychological theories of chronic pain - the fear-avoidance model[53]. A heterogeneous sample of 104 chronic pain outpatients at a multidisciplinary pain clinic in Australia completed psychometrically sound self-report measures of major variables in this model: Pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability. Two measures of mindfulness were also used, the Mindful Attention Awareness Scale [4] and the Five-Factor Mindfulness Questionnaire [1]. Results showed that mindfulness significantly negatively predicts each of these variables, accounting for 17-41% of their variance. Hierarchical multiple regression analysis showed that mindfulness uniquely predicts pain catastrophizing when other variables are controlled, and moderates the relationship between pain intensity and pain catastrophizing. This is the first clear evidence substantiating the strong link between mindfulness and pain catastrophizing, and suggests mindfulness might be added to the fear-avoidance model. Implications for the clinical use of mindfulness in screening and intervention are discussed.

Journal of Midwifery & Women's Health, 2014

Introduction: This pilot study tested the feasibility and effectiveness of using Mindfulness-Base... more Introduction: This pilot study tested the feasibility and effectiveness of using Mindfulness-Based Childbirth Education (MBCE), a novel integration of mindfulness meditation and skills-based childbirth education, for mental health promotion with pregnant women. The MBCE protocol aimed to reduce fear of birth, anxiety, and stress and improve maternal self-efficacy. This pilot study also aimed to determine the acceptability and feasibility of the MBCE protocol.

Clinical Orthopaedics and Related Research

BMJ Open

IntroductionLow back pain (LBP) is the leading cause of disability globally and its costs exceed ... more IntroductionLow back pain (LBP) is the leading cause of disability globally and its costs exceed those of cancer and diabetes combined. Recent evidence suggests that individualised cognitive and movement rehabilitation combined with lifestyle advice (cognitive functional therapy (CFT)) may produce larger and more sustained effects than traditional approaches, and movement sensor biofeedback may enhance outcomes. Therefore, this three-arm randomised controlled trial (RCT) aims to compare the clinical effectiveness and economic efficiency of individualised CFT delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling LBP.Methods and analysisPragmatic, three-arm, randomised, parallel group, superiority RCT comparing usual care (n=164) with CFT (n=164) and CFT-plus-movement-sensor-biofeedback (n=164). Inclusion criteria include: adults with a current episode of LBP >3 months; sought primary care ≥6 weeks ago for this episode of LBP; a...

Behavioural and Cognitive Psychotherapy

Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of pop... more Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliabl...

The journal of pain : official journal of the American Pain Society, 2018

Pain catastrophizing (PC), defined as an exaggerated negative cognitive-affective orientation tow... more Pain catastrophizing (PC), defined as an exaggerated negative cognitive-affective orientation toward pain, is one of the strongest psychological predictors of pain outcomes. Although regularly included as a process variable in clinical trials, there have been no comprehensive reviews of how it can be modified. Using a registered protocol (PROSPERO 2016 CRD42016042761), we searched MEDLINE, PsychINFO, EMBASE, CINAHL, and CENTRAL up to November 2016 for all randomized controlled trials measuring PC in adults with chronic noncancer pain. Two authors independently screened studies and assessed bias risk using the Cochrane tool. Quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation criteria. We included 79 studies (n = 9,914), which mostly recruited participants with musculoskeletal pain and had low risk of bias. Meta-analyses (standardized mean difference) showed 9 interventions had efficacy compared with waitlist/usual care or acti...

Journal of Orthopaedic & Sports Physical Therapy

British journal of health psychology, Jan 3, 2017

Pain catastrophizing is widely studied in quantitative pain research because of its strong link w... more Pain catastrophizing is widely studied in quantitative pain research because of its strong link with poor pain outcomes, although the exact nature of this construct remains unclear. Focusing on its ruminative dimension, the present qualitative study aimed to explore a nascent aspect of pain catastrophizing - metacognition - by documenting people's attitudes towards rumination and examining how these metacognitions might influence the course it takes. Qualitative interview study. Semi-structured interviews were conducted in a tertiary care setting with 15 adults experiencing chronic (≥6 months) low back pain who scored highly (≥30) on the Pain Catastrophising Scale. Transcripts were analysed using interpretative phenomenological analysis. The first aim of documenting pain metacognitions revealed both positive (e.g., 'thinking helps me to cope') and negative (e.g., 'rumination is uncontrollable') attitudes towards pain rumination. These were often held simultaneous...

BMJ open, Dec 9, 2016

To investigate young people's experiences of persistent musculoskeletal pain, including care ... more To investigate young people's experiences of persistent musculoskeletal pain, including care needs and current service gaps as well as perceptions about the role of digital technologies to support their co-care. A qualitative study employing two independent data collection modes: in-depth individual semistructured interviews and focus groups. Community settings throughout Australia. Participants were included if they had experienced persistent musculoskeletal pain of >3-month duration with an average of ≥3 on the visual analogue scale over the preceding 3 months, including non-specific conditions (eg, low back pain) and specific conditions (eg, juvenile idiopathic arthritis and other systemic arthritides), with/without pre-existing or current diagnosed mental health conditions. 23 young people (87.0% women; mean (SD) age: 20.8 (2.4) years) from across 6 Australian jurisdictions participated. Almost two-thirds of participants with persistent musculoskeletal pain reported comor...

BMJ open, Jan 19, 2015

The fear-avoidance model describes how the belief that pain is a sign of damage leads to pain-rel... more The fear-avoidance model describes how the belief that pain is a sign of damage leads to pain-related fear and avoidance. But other beliefs may also trigger the fear and avoidance responses described by the model. Experts have called for the next generation of fear avoidance research to explore what beliefs underlie pain-related fear and how they evolve. We have previously described damage beliefs and suffering/functional loss beliefs underlying high pain-related fear in a sample of individuals with chronic back pain. The aim of this study is to identify common and differential factors associated with the beliefs in this sample. A qualitative study employing semistructured interviews. Musculoskeletal clinics in Western Australia. 36 individuals with chronic back pain and high scores on the Tampa Scale (mean 47/68). The overarching theme was a pain experience that did not make sense to the participants. The experience of pain as unpredictable, uncontrollable and intense made it threa...

British journal of health psychology, Jan 3, 2017

Pain catastrophizing is widely studied in quantitative pain research because of its strong link w... more Pain catastrophizing is widely studied in quantitative pain research because of its strong link with poor pain outcomes, although the exact nature of this construct remains unclear. Focusing on its ruminative dimension, the present qualitative study aimed to explore a nascent aspect of pain catastrophizing - metacognition - by documenting people's attitudes towards rumination and examining how these metacognitions might influence the course it takes. Qualitative interview study. Semi-structured interviews were conducted in a tertiary care setting with 15 adults experiencing chronic (≥6 months) low back pain who scored highly (≥30) on the Pain Catastrophising Scale. Transcripts were analysed using interpretative phenomenological analysis. The first aim of documenting pain metacognitions revealed both positive (e.g., 'thinking helps me to cope') and negative (e.g., 'rumination is uncontrollable') attitudes towards pain rumination. These were often held simultaneous...

There can be no doubt that the Murdoch press played an important role in cohering what support th... more There can be no doubt that the Murdoch press played an important role in cohering what support there was for Australia's involvement in 'Gulf War Two'. From the start, Murdoch's 'Australian' newspaper was firmly committed to the coalition of the willing and provided a well-orchestrated cheer squad for Prime Minister John Howard and the war against Iraq.

There can be no doubt that the Murdoch press played an important role in cohering what support th... more There can be no doubt that the Murdoch press played an important role in cohering what support there was for Australia's involvement in 'Gulf War Two'. From the start, Murdoch's 'Australian' newspaper was firmly committed to the coalition of the willing and provided a well-orchestrated cheer squad for Prime Minister John Howard and the war against Iraq.

Four specialists – a clinical psychologist, a physiotherapist, a pain specialist and an orthopaed... more Four specialists – a clinical psychologist, a physiotherapist, a pain specialist and an orthopaedic surgeon – each discuss their own particular aspect of the care of this young patient with ongoing knee pain.

The Clinical Journal of Pain, 2014

The Tampa Scale of Kinesiophobia has been used to identify people with back pain who have high le... more The Tampa Scale of Kinesiophobia has been used to identify people with back pain who have high levels of "fear of movement" in order to direct them into fear reduction interventions. However there is considerable debate as to what construct(s) the scale measures. Somatic Focus and Activity Avoidance subscales identified in factor analytic studies remain poorly defined. Employing a mixed methods design, this study sought to understand the beliefs that underlie high scores on the Tampa Scale in order to better understand what construct(s) it measures. In-depth qualitative interviews with 36 adults with chronic nonspecific low back pain (average duration=7 y), scoring highly on the Tampa Scale (average score=47/68) were conducted. Following inductive analysis of transcripts, individuals were classified into groups based on underlying beliefs. Associations between groups and itemized scores on the Tampa Scale and subscales were explored. Frequencies of response for each item were evaluated. Two main beliefs were identified:1. The belief that painful activity will result in damage and 2. The belief that painful activity will increase suffering and/or functional loss. The Somatic Focus subscale was able to discriminate between the two belief groups lending construct validity to the subscale. Ambiguous wording of the Activity Avoidance subscale may explain limitations in discriminate ability. The Tampa Scale may be better described as a measure of the "beliefs that painful activity will result in damage and/or increased suffering and/or functional loss".

PAIN, 2010

The relationship between persistent pain and self-directed, non-reactive awareness of present-mom... more The relationship between persistent pain and self-directed, non-reactive awareness of present-moment experience (i.e., mindfulness) was explored in one of the dominant psychological theories of chronic pain - the fear-avoidance model[53]. A heterogeneous sample of 104 chronic pain outpatients at a multidisciplinary pain clinic in Australia completed psychometrically sound self-report measures of major variables in this model: Pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability. Two measures of mindfulness were also used, the Mindful Attention Awareness Scale [4] and the Five-Factor Mindfulness Questionnaire [1]. Results showed that mindfulness significantly negatively predicts each of these variables, accounting for 17-41% of their variance. Hierarchical multiple regression analysis showed that mindfulness uniquely predicts pain catastrophizing when other variables are controlled, and moderates the relationship between pain intensity and pain catastrophizing. This is the first clear evidence substantiating the strong link between mindfulness and pain catastrophizing, and suggests mindfulness might be added to the fear-avoidance model. Implications for the clinical use of mindfulness in screening and intervention are discussed.

Journal of Midwifery & Women's Health, 2014

Introduction: This pilot study tested the feasibility and effectiveness of using Mindfulness-Base... more Introduction: This pilot study tested the feasibility and effectiveness of using Mindfulness-Based Childbirth Education (MBCE), a novel integration of mindfulness meditation and skills-based childbirth education, for mental health promotion with pregnant women. The MBCE protocol aimed to reduce fear of birth, anxiety, and stress and improve maternal self-efficacy. This pilot study also aimed to determine the acceptability and feasibility of the MBCE protocol.