Table 3.
CERQual GRADE Evidence Profile for Review Findings
| Summary of review finding | No. of studies contributing to finding (ref no.) | Methodologic limitations | Coherence | Adequacy | Relevance | CERQual overall assessment |
|---|---|---|---|---|---|---|
| 1. The need for information: Patients sought information from different sources. They needed information to understand their condition and be able to cope better with the pain. | 6 studies (24–28, 39) | Minor concerns (1 of the 6 studies has low CASP28) | No or very minor concerns. | No or very minor concerns. | Minor concerns (2 studies had a TMD sample in addition to other COFP conditions,24,25 1 of which consisted of elderly patients25). | High confidence |
| 2. Validation of the pain experience: This entitled patients to seek support and helped ease their anxiety, especially if surrounding people believed they were exaggerating the symptoms. | 6 studies (9, 24, 28–30, 39) | Minor concerns (2 of the 6 studies have low CASP28,30) | No or very minor concerns. | Minor concerns (the finding is complex and could be explored in more detail). | Minor concerns (2 studies had a TMD sample in addition to other COFP conditions24,29). | Moderate confidence |
| 3. Patient characteristics: Some personal traits may influence the choice to seek professional help, such as catastrophizing. | 1 study (26) | Very minor concerns | No or very minor concerns. | Moderate concerns (supported by 1 study only26). | No or very minor concerns. | High confidence |
| 4. Nature of symptoms: Persistent or recent change in symptoms drove patients to seek medical help. | 3 studies (8, 26, 39) | Very minor concerns | No or very minor concerns. | Moderate concerns (supported by 3 studies only8,26,39). | No or very minor concerns (1 study had a TMD sample in addition to other COFP conditions8). | High confidence |
| 5. Concerns seeking professional help include cost, time, finding the right caregiver, and the attitude of the clinician. | 8 studies (25–27, 30–32, 38, 39) | Minor concerns (2 of the 8 studies have low CASP30,32) | No or very minor concerns. | No or very minor concerns. | Minor concerns (1 study had a TMD sample in addition to other COFP conditions and consisted mainly of elderly patients,25 and 1 study consisted of adolescent patients31). | High confidence |
| 6. Patients were unhappy with the health care services if they felt unsupported, passed around, were not given enough time, and waited a long time for appointments. | 11 studies (8, 9, 26, 27, 29, 31–34, 37, 39) | Minor concerns (1 of the 11 studies has low CASP32) | No or very minor concerns. | No or very minor concerns. | Minor concerns (3 studies had a TMD sample in addition to other COFP conditions,8,29,34 and 1 consisted of adolescent patients). | High confidence |
| 7. Patients who were content with the clinical visit reported reduced anxiety and a better relationship with the pain and abandoned their search for information and invasive treatments. | 2 studies (24, 39) | Very minor concerns | Moderate concerns (this finding is complex, and, if explored further, contradictory patterns may emerge). | Moderate concerns (the finding is complex, and further exploration is needed). | No or very minor concerns (1 study had a TMD sample in addition to other COFP conditions24). | Moderate confidence |
| 8. Repeated clinical attendance to health care services was due to lack of diagnosis, unresolved pain, and dissatisfaction with the clinical visit. | 5 studies (9, 26, 30, 33, 38) | Minor concerns (1 of the 5 studies has low CASP30) | No or minor concerns. | No or very minor concerns. | No or very minor concerns. | High confidence |
| 9. The patient-clinician interaction: A negative attitude on the part of the clinician was sometimes reported. This affected the patients’ willingness to accept information and discouraged them from seeking further treatment. | 13 studies (8, 9, 24–27, 29, 30, 33–35, 37, 38) | Minor concerns (1 of the 13 studies has low CASP30) | No or minor concerns. | No or very minor concerns. | Moderate concerns (5 studies had a TMD sample in addition to other COFP conditions, 8,24,29,34,37 1 consisted of elderly patients,25 and 1 consisted of Sami women35). | High confidence |
| 10. The patient-clinician interaction: Understanding and empathic clinicians inspired trust in the information and treatment given. It also helped with the ability to self-manage. | 3 studies (8, 9, 24) | Very minor concerns | Minor concerns (additional patterns may emerge if explored further). | Minor concerns (effects of a positive clinician attitude need to be explored more thoroughly). | Minor (2 studies had a TMD sample in addition to other COFP conditions8,24). | Moderate confidence |
| 11. Diagnosis was important for improvement: Diagnosis validated the pain experience, helped in abandoning the search for answers, helped in initiating self-coping strategies, and gave entitlement to seek support. | 7 studies (9, 24, 30, 32–34, 38) | Minor concerns (2 of the 7 studies have low CASP30,32) | No or very minor concerns. | No or very minor concerns. | No or very minor concerns (1 study had a TMD sample in addition to other COFP conditions24). | High confidence |
| 12. Management: A range of treatment options were offered with varying degrees of success. They were occasionally inconsistent or inappropriate, which led to ineffective pain control. | 9 studies (8, 28–33, 35, 38) | Minor concerns (3 of the 9 studies have low CASP28,30,32) | No or very minor concerns. | No or very minor concerns. | Moderate concerns (2 studies had a TMD sample in addition to other COFP conditions, 1 of which consisted of Sami women35 and 1 that consisted of adolescent patients31). | High confidence |
| 13. Seeking support: Patients appreciated being told about support groups. | 2 studies (24, 27) | Very minor concerns | No or very minor concerns. | Moderate concerns (supported by 2 studies only). | No or very minor concerns (1 study had a TMD sample in addition to other COFP conditions24). | High confidence |
| 14. Family and friends: While some patients relied heavily on the support of family and friends to cope with the pain, others preferred to deal with the pain on their own. They did not want to burden family and friends with their pain or assume the identity of a chronic pain patient. | 5 studies (25, 27, 29, 31, 32) | Minor concerns (1 of the 5 studies has low CASP32) | No or very minor concerns. | No or very minor concerns. | Moderate concerns (2 studies had a TMD sample in addition to other COFP conditions, 25,29 1 of which consisted of elderly patients.25 Another consisted of adolescent patients31). | High confidence |