1
|
Beyera GK. Choosing a health behaviour theory or model for related research projects: a narrative review. J Res Nurs 2022; 27:436-446. [PMID: 36131698 PMCID: PMC9483222 DOI: 10.1177/17449871211051566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background Theories are integral to a research project, providing the logic underlying what, how, and/or why a particular phenomenon happens. Alternatively, models are used to guide a research project by representing theories and visualising the structural framework of causal pathways by showing the different levels of analysis. With the rise in chronic and behaviour-related diseases, health behaviour theories and models have a particular importance in designing appropriate and research led behavioural intervention strategies. However, there is a dearth of papers that explain the role of behavioural theories and models in research projects. Aims The aim of this paper is to synthesise existing evidence on the relevance of health behaviour theories and models in research projects. Methods This paper reviews health behaviour theories and models commonly underpinning research projects in public health and clinical practices. The electronic databases, such as MEDLINE, CINAHL, and Scopus, as well as the search engines Google and Google Scholar were searched to identify health behaviour theories and models. Results Theories and models are essential in a research project. Theories provide the underlying reason for the occurrence of a phenomenon by explaining what the key drivers and outcomes of the target phenomenon are and why, and what underlying processes are responsible for causing that phenomenon. Models on the other hand provide guidance to a research project and assist in visualising the structural framework of causal pathways by showing the different levels of analysis. Health behaviour theories and models in particular offer valuable insights for designing effective and sustainable research projects for improved public health practice. Conclusions By employing appropriate health behaviour theory and/or model as a research framework, researchers will be able to identify relevant variables and translate these into clinical and public health practices.
Collapse
Affiliation(s)
- Getahun K Beyera
- Getahun K Beyera, School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, Tasmania 7250, Australia
| |
Collapse
|
2
|
Are Psychosocial Factors Determinant in the Pain and Social Participation of Patients with Early Knee Osteoarthritis? A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094575. [PMID: 33925879 PMCID: PMC8123481 DOI: 10.3390/ijerph18094575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
The main objective of this research is to determine the psychosocial differences between patients with knee pain or early osteoarthritis (EOA) and healthy subjects at risk of developing osteoarthritis. The secondary objective is to determine how psychosocial factors might influence pain and social participation in patients with EOA. A cross-sectional study was performed. Participants were divided according to the presence of pain or EOA. Pain intensity both at rest and walking, psychological variables such as anxiety and depression, and social participation were evaluated. A total of 105 participants were included (64 with knee pain and 41 without pain), with a mean age of 51.42 ± 5.92 (35 men and 70 women). Patients with knee pain had higher levels of anxiety (MD = −2.35; p < 0.01; d = 0.66) and depression (MD = −2.45; p < 0.01; d = 0.87), regardless of the presence of EOA. In addition, patients with higher depression levels had lower levels of social participation. The results revealed a relationship between the psychological variables, anxiety and depression, with knee pain and the onset of symptomatic OA, as well as an influence of depression levels on social participation. Improving these psychological characteristics may be useful in delaying the onset of symptomatic OA and enhancing social participation.
Collapse
|
3
|
Health-Related Quality of Life and Medical Resource Use in Patients with Osteoporosis and Depression: A Cross-Sectional Analysis from the National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031124. [PMID: 32050694 PMCID: PMC7037867 DOI: 10.3390/ijerph17031124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/27/2022]
Abstract
Background: Patients with either osteoporosis or depression are prone to develop other diseases and require more medical resources than do the general population. However, there are no studies on health-related quality of life (HRQoL) and medical resource use by osteoporosis patients with comorbid depression. We conducted this study for clarifying it. Methods: This cross-sectional study from 2005 to 2010 (6 years) analyzed 9776 National Health and Nutrition Examination Survey (NHANES) patients > 40 years old. Each patient was assigned to one of four groups: osteoporosis-positive(+) and depression-positive(+) (O+/D+); O+/D−; O−/D+; O−/D−. We used multivariate linear and logistic regression model to analyze the HRQoL and medical resource use between groups. Results: The O+/D+ group reported more unhealthy days of physical health, more unhealthy days of mental health, and more inactive days during a specified 30 days. The adjusted odds ratios (AORs) of O+/D+ patients who had poor general health (7.40, 95% CI = 4.80–11.40), who needed healthcare (3.25, 95% CI = 2.12–5.00), and who had been hospitalized overnight (2.71, 95% CI = 1.89–3.90) were significantly highest. Conclusions: Low HRQoL was significantly more prevalent in D+/O+ patients. We found that depression severity more significantly affected HRQoL than did osteoporosis. However, both diseases significantly increased the risk of high medical resource use.
Collapse
|
4
|
Vina E, Hausmann L, Obrosky D, Youk A, Ibrahim S, Weiner D, Gallagher R, Kwoh C. Social & psychological factors associated with oral analgesic use in knee osteoarthritis management. Osteoarthritis Cartilage 2019; 27:1018-1025. [PMID: 30716537 PMCID: PMC6579618 DOI: 10.1016/j.joca.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/02/2019] [Accepted: 01/23/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA. METHODS Patients were categorized based on use of the following oral medications: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study scale), health literacy ("How confident are you filling out medical forms by yourself?"), and depressive symptoms (Patient Health Questionnaire-8). Models were adjusted for demographic and clinical characteristics. RESULTS In this sample (mean age 64.2 years, 23.6% women), 30.6% (n = 110) reported taking opioid analgesics for OA, 54.2% (n = 195) reported non-opioid use, and 15.3% (n = 55) reported no oral analgesic use. Opioid users had lower mean social support scores (10.0 vs 10.5 vs 11.9, P = 0.007) and were more likely to have moderate-severe depressive symptoms (42.7% vs 24.1% vs 14.5%, P < 0.001). Health literacy did not differ by treatment group type. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95%CI 1.08-8.07) when adjusted for sociodemographic and clinical factors. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. CONCLUSIONS Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid analgesics for OA.
Collapse
Affiliation(s)
- E.R. Vina
- College of Medicine and UA Arthritis Center, University of Arizona (UA), Tucson, AZ, USA,Address correspondence and reprint requests to: Ernest R. Vina, MD, MS, University of Arizona Arthritis Center, 1501 N. Campbell Ave., PO Box 245093, Tucson, AZ 85724-5093. Tel.#: (520) 626-4206. Fax #: (520) 626-2587.
| | - L.R.M. Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, USA,School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - D.S. Obrosky
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, USA
| | - A. Youk
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, USA,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - S.A. Ibrahim
- Weill Cornell Medicine, Department of Healthcare Policy & Research, Cornell University, New York, NY, USA
| | - D.K. Weiner
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Geriatric Research, Education & Clinical Center, VAPHS, Pittsburgh, PA, USA
| | - R.M. Gallagher
- CHERP, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA,School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C.K. Kwoh
- College of Medicine and UA Arthritis Center, University of Arizona (UA), Tucson, AZ, USA
| |
Collapse
|
5
|
Dorner TE, Stein KV, Hahne J, Wepner F, Friedrich M, Mittendorfer-Rutz E. How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey. Wien Klin Wochenschr 2017. [PMID: 28634778 PMCID: PMC5772122 DOI: 10.1007/s00508-017-1223-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain. METHODS A cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older. RESULTS The 1‑year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89-5.01), while such associations were found for lack of social support (range of ORs 1.33-1.65), female sex (range of ORs 1.38-2.34), higher age (range of ORs 1.09-1.18 for 5 year intervals), as well as low educational (range of ORs 1.47-2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50-2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38-2.10). CONCLUSIONS Psychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.
Collapse
Affiliation(s)
- Thomas Ernst Dorner
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria.
| | - Katharina Viktoria Stein
- International Foundation for Integrated Care, The Quorum, Oxford Business Park North, Garsington Road, 7200, Oxford, UK
| | - Julia Hahne
- Department of Orthopaedic Pain Management, Spine Unit, Centre of Excellence for Orthopaedic Pain Management, Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Florian Wepner
- Department of Orthopaedic Pain Management, Spine Unit, Centre of Excellence for Orthopaedic Pain Management, Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Martin Friedrich
- Department of Orthopaedic Pain Management, Spine Unit, Centre of Excellence for Orthopaedic Pain Management, Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Berzelius väg 3, 17177, Stockholm, Sweden
| |
Collapse
|
6
|
Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol 2016; 8:103-113. [PMID: 27843376 PMCID: PMC5098683 DOI: 10.2147/oarrr.s93516] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Anxiety and depression are common psychological comorbidities that impact the quality of life (QoL) of patients. In this systematic review, we 1) determined the impact of anxiety and depression on outcomes in patients with osteoarthritis (OA) and 2) summarized unique challenges these comorbidities present to current OA management. Patients and methods A systematic literature search was performed using the OVID Medline and EMBASE databases until April 2016. Full-text research articles published in English from the year 2000 onward with a sample size of >100 were included in this review. Eligible research articles were reviewed and the following data were extracted: study author(s), year of publication, study design, and key findings. Results A total of 38 studies were included in the present review. The present study found that both anxiety and/or depression were highly prevalent among patients with OA. Patients with OA diagnosed with these comorbidities experienced more pain, had frequent hospital visits, took more medication, and reported less optimal outcomes. Management strategies in the form of self-care, telephone support, audio/video education programs, and new pharmacotherapies were reported with favorable results. Conclusion Anxiety and depression adversely impact the QoL of patients with OA. Physicians/caregivers are highly recommended to consider these comorbidities in patients with OA. Ultimately, a holistic individualized management approach is necessary to improve patient outcomes.
Collapse
Affiliation(s)
- Anirudh Sharma
- Division of Genetics and Development, Krembil Research Institute
| | - Prtha Kudesia
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Qian Shi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, ON, Canada
| |
Collapse
|
7
|
Sukenaga N, Ikeda-Miyagawa Y, Tanada D, Tunetoh T, Nakano S, Inui T, Satoh K, Okutani H, Noguchi K, Hirose M. Correlation Between DNA Methylation of TRPA1 and Chronic Pain States in Human Whole Blood Cells. PAIN MEDICINE 2016; 17:1906-1910. [DOI: 10.1093/pm/pnv088] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/11/2015] [Accepted: 11/28/2015] [Indexed: 11/14/2022]
|
8
|
Singh JA, Yu S. Utilization due to chronic obstructive pulmonary disease and its predictors: a study using the U.S. National Emergency Department Sample (NEDS). Respir Res 2016; 17:1. [PMID: 26739476 PMCID: PMC4702346 DOI: 10.1186/s12931-015-0319-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/29/2015] [Indexed: 11/27/2022] Open
Abstract
Background Previous studies of healthcare utilization for chronic obstructive pulmonary disease (COPD) have focused on time-trends in COPD visits or COPD treatments, or the effect of hospital volume on mortality. Few data are available regarding outcomes after an ED visit (and subsequent hospitalization) for COPD, which are both very common in patients with COPD. Our objective was to assess time-trends and predictors of emergency department and subsequent inpatient health care utilization and charges associated with COPD in the U.S. Method We used the 2009-12 U.S. Nationwide Emergency Department Sample (NEDS) to study the incidence of ED visits and subsequent hospitalizations with COPD as the primary diagnosis. We used the 2012 NEDS data to study key patient/hospital factors associated with outcomes, including charges, hospitalization and dischage from hospital to home. Results ED visits for COPD as the primary diagnosis increased from 1.02 million in 2009 to 1.04 in 2010 to 1.10 million in 2012 (0.79–0.82 % of all ED visits); respective charges were $2.13, $2.32, and $3.09 billion. In 2012, mean ED charges/visit were $2,812, hospitalization charges/visit were $29,043 and the length of hospital stay was 4.3 days. 49 % were hospitalized after an ED visit. Older age, higher median income, metropolitan residence and comorbidities (diabetes, hypertension, HF, hyperlipidemia, CHD, renal failure and osteoarthritis) were associated with higher risk whereas male sex, Medicaid or self pay insurance status, hospital location in Midwest, South or West U.S. were associated with lower risk of hospitalization. 65.4 % of all patients hospitalized for COPD from ED were discharged home. Older age, comorbidities (diabetes, HF, CHD, renal failure, osteoarthritis) and metropolitan residence were associated with lower odds of discharge to home, whereas male sex, payer other than Medicare, Midwest, South or West U.S. hospital location were associated with higher odds. Conclusion Health care utilization and costs in patients with COPD are significant and increasing. COPD constitutes a major public health burden in the U.S. We identified risk factors for hospitalization, costs, and home discharge in patients with COPD that will allow future studies to investigate interventions to potentially reduce COPD-associated utilization. Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0319-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Shaohua Yu
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
| |
Collapse
|
9
|
Dorner TE, Alexanderson K, Svedberg P, Tinghög P, Ropponen A, Mittendorfer-Rutz E. Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden. Psychol Med 2016; 46:425-436. [PMID: 26467609 DOI: 10.1017/s003329171500197x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP). METHOD All 4,823,069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005]. RESULTS HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70). CONCLUSIONS Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.
Collapse
Affiliation(s)
- T E Dorner
- Institute of Social Medicine,Centre for Public Health,Medical University of Vienna,Vienna,Austria,Wien,Austria
| | - K Alexanderson
- Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden
| | - P Svedberg
- Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden
| | - P Tinghög
- Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden
| | - A Ropponen
- Finnish Institute of Occupational Health,Topeliuksenkatu,Helsinki,Finland
| | - E Mittendorfer-Rutz
- Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden
| |
Collapse
|
10
|
Dorner TE, Crevenna R. Preventive aspects regarding back pain. Wien Med Wochenschr 2015; 166:15-21. [PMID: 26695480 DOI: 10.1007/s10354-015-0413-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
Prevention, as the act of keeping from happening, aims to avert things that would occur if no intervention would be taken. From the epidemiology of back pain, consequences of the disease that are worth preventing can be derived. Biological, psychological, and social factors lead to back pain and chronification and ultimately to various adverse outcomes. The most important preventable consequences of back pain include loss of ability to function in daily life, loss of work productivity, sickness absence, and disability pension, excessive and inappropriate healthcare utilisation, impairments in quality of life, and disturbance of sexual life. The most important tools for prevention of back pain lie within rehabilitation after acute pain treatment and include exercise and physical training as well as health education and increasing health literacy. The bio-psycho-social nature of back pain must be taken into account in all preventive measures.
Collapse
Affiliation(s)
- Thomas E Dorner
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria.
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| |
Collapse
|
11
|
Pieber K, Stamm TA, Hoffmann K, Dorner TE. Synergistic effect of pain and deficits in ADL towards general practitioner visits. Fam Pract 2015; 32:426-30. [PMID: 26045545 DOI: 10.1093/fampra/cmv042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pain and activities of daily living (ADLs) deficits are common problems among elderly people who visit general practitioners (GPs). OBJECTIVE To examine whether the probability of visiting a GP is related to deficits in ADLs and pain, and whether these factors act synergistically towards GP visits. METHODS A total of 3097 subjects aged ≥65 years from the Austrian Health Interview Survey formed the cohort. Visiting the GP in the last 4 weeks, chronic pain (CP; pain for at least 3 months) and deficits in ADLs across 11 dimensions were reported. Binary logistic regression models were applied and were stepwise controlled for possible confounders. Based on odds ratios (OR), the synergy index (SI), population attributable fraction (PAF) and relative excess risk due to interaction (RERI) were calculated. RESULTS Overall, 61.0% visited their GP; 51.2% were affected by ADL deficits and 42.2% by CP. In subjects with ADL deficits, the OR for GP consultation was 1.32 (95% confidence interval [CI] 1.11-1.56) and in subjects with CP, 1.93 (95% CI 1.63-2.27) in the fully adjusted model. The OR for those affected by both was 2.56 (95% CI 2.08-3.15); SI was 1.82 (95% CI 1.04-3.18), PAF was 0.27 (95% CI 0.08-0.47) and RERI was 0.70 (95% CI 0.13-1.27). CONCLUSION There is a strong synergistic effect of CP and deficits in ADL in patients ≥65 years on visiting the GP. Prevention, screening, treatment and rehabilitation in this population should focus on both CP and ADL deficits.
Collapse
Affiliation(s)
- Karin Pieber
- Department of Physical Medicine and Rehabilitation, General Hospital of Vienna,
| | - Tanja A Stamm
- Division of Rheumatology, Department of Internal Medicine III
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Centre for Public Health and
| | - Thomas E Dorner
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| |
Collapse
|