Blame is not a game
Take home messages
Perceived injustice or blame is associated with poorer return to work outcomes.
Identifying blame or perceptions of injustice – and taking effective steps to promote reconciliation – may be effective in reducing long term disability.
The injustice experience questionnaire (IEQ) was developed to identify relevant issues and is useful for assessing psychosocial issues, including their perceptions of injustice, in people with chronic pain.
Why the research matters
It has been postulated that blame makes recovery less likely and suffering worse, but “blame” is an intangible concept. How can it be identified? The authors of this study sought to develop a method of assessing perceptions of injustice, by developing and testing a scored questionnaire.
What the research involved
This study was done in two parts. The first part involved the development of a series of questions aimed at identifying levels of blame, drawing on the authors’ experience of the field and focus group discussions with psychologists.
The second part of the study involved testing these questions, to see if they were reliable and capable of providing useful information. Patients entering a rehabilitation program completed the survey, along with other questionnaires, and the questionnaire was repeated at four weeks.
The study found that the questionnaire had a high level of reliability in statistical terms. It was consistent over the two tests, and the study correlated well with other surveys such as pain severity, catastrophising, depression and fear.
Summary of research findings
The researchers found that a reduction in levels of perceived injustice were associated with increased walking distance tolerance, a measure of functional ability.
The authors also found that perceived injustice was more strongly related to disability than pain severity. The questionnaire was a good predictor of occupational disability.
The development of the questionnaire or survey was done by developing a series of questions that would be assessed by the individual on a rating scale of 1-5.
The questions endeavoured to be as close as possible to actual words or phrases said by patients with chronic pain to make them as real as possible. After the focus groups have been completed there were twelve items that were considered relevant for the questionnaire.
According to the researchers, “The Injustice Experience Questionnaire (IEQ) is a 12-item questionnaire that addresses the degree to which individuals perceive their post-injury life as being characterized by injustice. The instructional set of the IEQ is as follows:
“When injuries happen, they can have profound effects on our lives. This scale was designed to assess how your injury has affected your life. Listed below are 12 statements describing different thoughts and feelings that you may experience when you think about your injury. Using the following scale, please indicate the degree to which you have these thoughts and feelings when you think about your injury.
“Respondents were asked to indicate the degree to which they experienced each of 12 different thoughts and feelings described in the item content on a 5-point scale with the endpoints (0) not at all and (4) all the time.”
The questions were:
- I am suffering because of someone else’s negligence.
- It all seems so unfair.
- Nothing will ever make up for what I have gone through.
- I feel as if I have been robbed of something very precious.
- I am troubled by fears that I may never achieve my dreams.
- I can’t believe this has happened to me.
- Most people don’t understand how severe my condition is.
- My life will never be the same.
- No one should have to live this way.
- I just want my life back.
- I feel that this has affected me in a permanent way.
- I worry that my condition is not being taken seriously.
Original research
"The role of perceived injustice in the experience of chronic pain and disability: scale development and validation."
Sullivan MJ, Adams H, Horan S, Maher D, Boland D, Gross R.
J Occup Rehabil. 2008 Sep;18(3):249-61.