596
P. Enthoven et al.
specific treatments. A study-specific self-rated im-
portant change should be applied. Further studies on
the meaning of enablement in patients with chronic
pain and construction of the PEI are recommended.
ACKNOWLEDGEMENTS
The authors would like to thank statistician Henrik Hedevik at
Linköping University for help with the statistical analyses. The
authors also thank the clinicians working in each participating
site and the patients who gave consent for their data to be used
for research purposes.
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors. The
original WAD study received funding from the Swedish govern-
ment in cooperation with the Swedish Social Insurance Agency
through the REHSAM foundation, the Research Council of
Southeast Sweden, Uppsala-Örebro Regional Research Council,
Sweden, Centre for Clinical Research Sörmland: Uppsala Uni-
versity, Sweden and from the County Council of Östergötland,
Sweden. The original CR study received funding from the
Swedish Research Council, the Research Council of Southeast
Sweden, the Swedish Society of Medicine, the County Council
of Östergötland, Sweden, and from Futurum, the Academy for
Healthcare, Jönköping County Council, Sweden.
The authors have no conflicts of interest to declare.
REFERENCES
1. Hudon C, Fortin M, Rossignol F, Bernier S, Poitras ME.
The Patient Enablement Instrument – French version in a
family practice setting: a reliability study. BMC Fam Pract
2011; 12: 71.
2. Hudon C, St-Cyr Tribble D, Bravo G, Poitras ME. Enable-
ment in health care context: a concept analysis. J Eval
Clin Pract 2011; 17: 143–149.
3. Howie JG, Heaney DJ, Maxwell M. Measuring quality in ge-
neral practice. Pilot study of a needs, process and outcome
measure. Occas Pap R Coll Gen Pract 1997: i–xii, 1–32.
4. Howie JG, Heaney DJ, Maxwell M, Walker JJ. A comparison
of a Patient Enablement Instrument (PEI) against two
established satisfaction scales as an outcome measure of
primary care consultations. Fam Pract 1998; 15: 165–171.
5. Haughney J, Cotton P, Rosen JP, Rosen JP, Morrison K, Price
D. The use of a modification of the Patient Enablement
Instrument in asthma. Prim Care Respir J 2007; 16: 89–92.
6. Kurosawa S, Matsushima M, Fujinuma Y, Hayashi D, Noro
I, Kanaya T, et al. Two principal components, coping and
independence, comprise patient enablement in Japan:
cross sectional study in Tohoku area. Tohoku J Exp Med
2012; 227: 97–104.
7. MacPherson H, Mercer SW, Scullion T, Thomas KJ. Empa-
thy, enablement, and outcome: an exploratory study on
acupuncture patients’ perceptions. J Altern Complement
Med 2003; 9: 869–876.
8. Mercer SW, Reilly D, Watt GC. The importance of empathy
in the enablement of patients attending the Glasgow Ho-
moeopathic Hospital. Br J Gen Pract 2002; 52: 901–905.
9. Pawlikowska TR, Nowak PR, Szumilo-Grzesik W, Walker JJ.
Primary care reform: a pilot study to test the evaluative
potential of the Patient Enablement Instrument in Poland.
Fam Pract 2002; 19: 197–201.
10. Lam CL, Yuen NY, Mercer SW, Wong W. A pilot study on
the validity and reliability of the Patient Enablement In-
strument (PEI) in a Chinese population. Fam Pract 2010;
27: 395–403.
11. Remelhe M, Teixeira PM, Lopes I, Silva L, Correia de Sousa
www.medicaljournals.se/jrm
J. The modified patient enablement instrument: a Portu-
guese cross-cultural adaptation, validity and reliability
study. NPJ Prim Care Respir Med 2017; 27: 16087.
12. SALAR. Uppgifter och kompetensbehov vid multimodal
rehabilitering. [Tasks and skills requirements in multimodal
rehabilitation.] Stockholm: Swedish Association of Local
Authorities and Regions; 2012 (in Swedish).
13. Ardern CL, Peterson G, Ludvigsson ML, Peolsson A. Satis-
faction with the outcome of physical therapist-prescribed
exercise in chronic whiplash-associated disorders: secon-
dary analysis of a randomized clinical trial. J Orthop Sports
Phys Ther 2016; 46: 640–649.
14. Wibault J, Oberg B, Dedering A, Lofgren H, Zsigmond P,
Peolsson A. Structured postoperative physiotherapy in pa-
tients with cervical radiculopathy: 6-month outcomes of a
randomized clinical trial. J Neurosurg Spine 2018; 28: 1–9.
15. Peolsson A, Landen Ludvigsson M, Overmeer T, Dedering
A, Bernfort L, Johansson G, et al. Effects of neck-specific
exercise with or without a behavioural approach in addition
to prescribed physical activity for individuals with chronic
whiplash-associated disorders: a prospective randomised
study. BMC Musculoskelet Disord 2013; 14: 311.
16. Peolsson A, Oberg B, Wibault J, Dedering A, Zsigmond P,
Bernfort L, et al. Outcome of physiotherapy after surgery
for cervical disc disease: a prospective randomised multi-
centre trial. BMC Musculoskelet Disord 2014; 15: 34.
17. Ludvigsson ML, Peterson G, O’Leary S, Dedering A, Peols-
son A. The effect of neck-specific exercise with, or without
a behavioral approach, on pain, disability, and self-efficacy
in chronic whiplash–associated disorders: a randomized
clinical trial. Clin J Pain 2015; 31: 294–303.
18. Turk DC, Dworkin RH, Revicki D, Harding G, Burke LB,
Cella D, et al. Identifying important outcome domains for
chronic pain clinical trials: an IMMPACT survey of people
with pain. Pain 2008; 137: 276–285.
19. Roost M, Zielinski A, Petersson C, Strandberg EL. Reliability
and applicability of the Patient Enablement Instrument
(PEI) in a Swedish general practice setting. BMC Fam
Pract 2015; 16: 31.
20. Rättsnätet Notisum AB. Personuppgiftslag (1998:204)
[updated 2014–02–13]. In. Stockholm, Sweden: Reger-
ingskansliets rättsdatabaser; 1998.
21. World Medical Association. World Medical Association De-
claration of Helsinki: ethical principles for medical research
involving human subjects. JAMA 2013; 310: 2191–2194.
22. Bryant FB, Yarnold PR. Principal-components analysis and
confirmatory factor analysis. In: Grimm LG, Yarnold PR,
editors. Reading and understanding multivariate statistics.
Washington, DC: American Psychological Association;
1995, p. 99–136.
23. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW,
Knol DL, et al. COSMIN checklist manual. In. Amsterdam,
The Netherlands: VU University Medical Center, Depart-
ment of Epidemiology and Biostatistics, EMGO Institute
for Health and Care Research; 2012.
24. Asparouhov T, Muthén B. SRMR in Mplus, Technical Report.
Los Angeles: Mplus; May 2, 2018. p. 1–15 Available from:
http://www.statmodel.com/download/SRMR2.pdf.
25. Kline RB. Principles and practice of structural equation
modeling. 4th edn. New York: The Guilford Press; 2016.
26. Bland JM, Altman DG. Cronbach’s alpha. BMJ 1997; 314:
572.
27. de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measure-
ment in medicine a practical guide. Cambridge: Cambridge
University Press; 2011.
28. Dawson B, Trapp RG. Basic and clinical biostatistics. 3rd
edn. New York: Lange Medical Books-McGraw-Hill; 2001.
29. de Vet HC, Ostelo RW, Terwee CB, van der Roer N, Knol
DL, Beckerman H, et al. Minimally important change de-
termined by a visual method integrating an anchor-based
and a distribution-based approach. Qual Life Res 2007;
16: 131–142.
30. Mead N, Bower P, Roland M. Factors associated with