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Zhou S, Liu Y, Zhang Y, Luo N, Chen Q, Ge M, Shen B. Association between persistent musculoskeletal pain and incident sarcopenia in China: the mediating effect of depressive symptoms. Front Public Health 2024; 12:1416796. [PMID: 39296844 PMCID: PMC11408356 DOI: 10.3389/fpubh.2024.1416796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Objective To evaluate the association between musculoskeletal pain and incident sarcopenia and further explore the mediating effect of depressive symptoms among middle-aged and older Chinese adults. Methods Using the data from the China Health and Retirement Longitudinal Study 2011 and 2015, we included 12,788 participants in the cross-sectional analysis and 8,322 for the longitudinal analysis. Musculoskeletal pains located in the neck, back, waist, shoulder, arm, wrist, leg, knee, and ankle were self-reported at baseline and follow-up. The diagnosis criteria of sarcopenia was based on the Asian Working Group for Sarcopenia 2019. Multivariable logistic regression models were used to evaluate the association between musculoskeletal pain, and the Karlson-Holm-Breen (KHB) method was used to explore the mediating effect of depressive symptoms. Results Over the 4-year follow-up, 445 participants were identified with incident sarcopenia. In the longitudinal analysis, participants with baseline musculoskeletal pain (adjusted odds ratio (OR): 1.37, 95% confidence interval (CI): 1.07-1.76), persistent musculoskeletal pain (OR:1.68, 95%CI: 1.28-2.24), and persistent waist pain (OR:1.46, 95%CI: 1.04-2.03) were significantly associated with increased the risk of incident sarcopenia. Furthermore, depressive symptoms were found to partially mediate the association between musculoskeletal pain and incident sarcopenia. Conclusion Persistent musculoskeletal pain, especially in waist area, was positively associated with a higher risk of sarcopenia among the middle-aged and older Chinese. Depressive symptoms played a partial mediating role in this association.
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Affiliation(s)
- Shengliang Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Naijia Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Meiling Ge
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Ebbesen BD, Giordano R, Hedegaard JN, Calero JAV, Fernández-de-Las-Peñas C, Rasmussen BS, Nielsen H, Schiøttz-Christensen B, Petersen PL, Castaldo M, Arendt-Nielsen L. Prevalence and Risk Factors of Multitype Post-COVID Pain in a Cohort of Previously Hospitalized COVID-19 Survivors: A Danish Cross-Sectional Survey. THE JOURNAL OF PAIN 2024; 25:104579. [PMID: 38796126 DOI: 10.1016/j.jpain.2024.104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/06/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
This population-based study investigated the prevalence of de novo, multitype, post-coronavirus disease (COVID) pain and its associated risk factors in previously hospitalized coronavirus disease 2019 (COVID-19) survivors. The nationwide, cross-sectional study included a cohort of Danish residents previously hospitalized due to severe acute respiratory syndrome coronavirus-2 infection between March 2020 and December 2021. Demographic data, preexisting medical comorbidities, previous pain-related symptoms, medication use for pain management, pain intensity (4-point scale), and development of de novo, multitype, post-COVID pain were collected by a self-reported survey distributed via e-Boks (a secured national digital mail system used in Denmark to provide public information to residents). The sample comprised 4,712 previously hospitalized COVID-19 survivors (48.6% women, mean age: 60.1 ± 15.6 years). At the time of the study (21 ± 6 months after hospitalization), 18.0% (847) reported the presence of de novo, multitype, post-COVID pain, and 38.6% of any pain. A multivariate analysis revealed that female sex (Odds Ratio (OR) 1.711, 95% Confidence Interval (CI) 1.444-2.023), higher body mass index (OR 1.032, 95% CI 1.019-1.045), intensive care unit admission (OR 1.597, 95% CI 1.324-1.926), previous history of whiplash (OR 2.471, 95% CI 1.004-6.081), anxiety (OR 3.626, 95% CI 1.335-9.708), and younger age (OR .982, 95% CI .976-.987) were factors associated with development of de novo, multitype, post-COVID pain. High income (OR .635, 95% CI .494-.817) and high educational level (OR .774, 95% CI .609-.984) were protective factors. In conclusion, multitype pain as a de novo post-COVID symptom was present in 18.0% of previously hospitalized COVID-19 survivors more than 1 year after hospital discharge and as such can be considered as adding to the global burden of chronic pain. PERSPECTIVE: The study investigates the prevalence of de novo, multitype, post-COVID pain in previously hospitalized COVID-19 survivors. This article presents potential risk factors associated with developing new pain symptoms. The results will contribute to understanding the possibility of predicting postinfectious pain from COVID-19 for future analysis.
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Affiliation(s)
- Brian Duborg Ebbesen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark
| | - Rocco Giordano
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark
| | - Jakob Nebeling Hedegaard
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark
| | - Juan Antonio Valera Calero
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Clinical Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark
| | - Berit Schiøttz-Christensen
- Department of Regional Health Research, University of Southern Denmark, Region of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Central Denmark Region, Aarhus, Denmark
| | - Pernille Lykke Petersen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Capital Region of Denmark, Copenhagen, Denmark
| | - Matteo Castaldo
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, North Denmark Region, Aalborg, Denmark; Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark; Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, North Denmark Region, Aalborg, Denmark.
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Walker J, Payne N. Promoting musculoskeletal health and preventing ill health. Nurs Older People 2024:e1474. [PMID: 38957053 DOI: 10.7748/nop.2024.e1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 07/04/2024]
Abstract
Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.
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Affiliation(s)
- Jennie Walker
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, England
| | - Nicola Payne
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, England
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Puto G, Repka I, Gniadek A. Gender differences in the quantitative and qualitative assessment of chronic pain among older people. Front Public Health 2024; 12:1344381. [PMID: 38915749 PMCID: PMC11194344 DOI: 10.3389/fpubh.2024.1344381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
Background Pain, regardless of its causes, is a subjective and multidimensional experience that consists of sensory, emotional and cognitive factors that cannot be adequately captured by a single number on a pain scale. The aim of the study was to understand gender differences in the assessment of quantitative and qualitative chronic pain among older people. Methods The study used a questionnaire that included questions about demographic and social characteristics as well as the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Depression Scale (GDS-15), McGill Pain Questionnaire (MPQ). Results The pain rating index based on rank values of adjectives was higher among women than men (18.36 ± 7.81 vs. 17.17 ± 9.69, p = 0.04). The analysis of the frequency of selection of individual adjectives describing the sensory aspects of pain showed that men described the pain as "stabbing" more often than women (26.1% vs. 14.3%, p < 0.05). Women chose adjectives from the emotional category more often than men (59.8% vs. 75.4%, p < 0.05), describing the pain as "disgusting" (8.9% vs. 1.4%, p < 0.05), "unbearable" (19.6 vs. 4.3, p < 0.05). In the subjective category, there was a difference between women and men in terms of describing pain as "terrible" (23.2% vs. 7.2%, p < 0.05) and as "unpleasant" (11.6% vs. 23.3%, p < 0 0.05). Conclusion When referring to pain, women tend to employ more detailed and factual language, indicative of heightened emotional sensitivity. Men tend to use fewer words and focus on the sensory aspects of pain. Subjective aspects of pain were demonstrated by both women and men.
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Affiliation(s)
- Grażyna Puto
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Cracow, Poland
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Zakel J, Chae J, Wilson RD. Innovations in Stroke Recovery and Rehabilitation: Poststroke Pain. Phys Med Rehabil Clin N Am 2024; 35:445-462. [PMID: 38514229 DOI: 10.1016/j.pmr.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Pain can be a significant barrier to a stroke survivors' functional recovery and can also lead to a decreased quality of life. Common pain conditions after stroke include headache, musculoskeletal pain, spasticity-related pain, complex regional pain syndrome, and central poststroke pain. This review investigates the evidence of diagnostic and management guidelines for various pain syndromes after stroke and identifies opportunities for future research to advance the field of poststroke pain.
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Affiliation(s)
- Juliet Zakel
- MetroHealth Rehabilitation Institute, MetroHealth System, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA.
| | - John Chae
- MetroHealth Rehabilitation Institute, MetroHealth System, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA
| | - Richard D Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA
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Haas JW, Berry RH, Oakley PA, Harrison DE. A 13-Year Long-Term Follow-Up of a Case Report With Continued Improvement in Severe Chronic Neck and Head Pain Alleviated With Chiropractic BioPhysics® Spinal Rehabilitation Protocols. Cureus 2024; 16:e59024. [PMID: 38680820 PMCID: PMC11052517 DOI: 10.7759/cureus.59024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/01/2024] Open
Abstract
Alleviation of headaches (HAs), neck pain (NP), and disability is a desirable clinical outcome for the billions globally who suffer from these conditions. Chiropractic BioPhysics® (CBP®) methods may provide an option for head and neck-injured patients. A 62-year-old female historically injured multiple times including two motor vehicle collisions (MVC), and a strike to the face with a hockey puck; all resulting in chronic pain and suffering. The subject sought and received successful treatment in 2016 using this conservative protocol at a facility in the USA. The resolution of symptoms following 36 treatments was previously reported. Following 13 years without treatment beyond home exercises, the subject was re-evaluated and found to be stable in the long term for pain, structural and functional assessment. Thirty-six treatments over 12 weeks in 2016 led to an improvement in numerical pain rating scale (NPRS) for NP (5/10 to 1/10), and HA (9+/10 to 0/10), resolution of NP disability (6/100 to 0/100) as well as normalization of ROM without pain and resumption of all activities of daily living including high-level athletics without pain and disability. A 13-year follow-up found continued stability objectively and subjectively. We provide a case of successful conservative treatment using specific traction, exercises, and spine manipulation procedures. CBP® provides an option to treat pain and this case adds to growing evidence.
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Affiliation(s)
| | | | - Paul A Oakley
- Kinesiology and Health Science, York University, Toronto, CAN
- Chiropractic, CBP Non-Profit, Inc, Newmarket, CAN
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Baek W, Kang M. The moderating effect of oral health on the association between exercise and frailty in patients with musculoskeletal disorders: Findings from the Korean Longitudinal Study of Aging. Arch Gerontol Geriatr 2024; 117:105180. [PMID: 37690257 DOI: 10.1016/j.archger.2023.105180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE This study aimed to examine the effects of exercise and oral health on frailty and to investigate the moderating effect of oral health on the relationship between exercise and frailty among patients with musculoskeletal disorders. METHODS This descriptive, cross-sectional study used data from the seventh wave of the Korean Longitudinal Study of Aging. Frailty index based on 41 deficits across seven domains was used, and oral health was assessed using the Geriatric Oral Health Assessment Index. Hierarchical regression analysis was performed to confirm the moderating effect of oral health, and PROCESS macro model 1 by Hayes was applied to examine an inference test of the conditional effect of the moderator. RESULTS Data on 1,812 participants with musculoskeletal disorders (mean age 75.0 ± 8.6 years) was analyzed. Compared with no exercise, regular exercise (β= -2.39, 95% confidence interval [CI]= -3.42; -1.34) was significantly associated with lower frailty level. Good oral health (β= -0.38, 95% CI= -0.44, -0.32) was significantly associated with lower frailty level. A significant moderating effect of oral health on the relationship between regular exercise and frailty was detected (β= 0.18, 95% CI= 0.05, 0.30). CONCLUSIONS The beneficial effects of regular exercise on frailty were greater in participants with poor oral health than in those with good oral health. Healthcare providers should actively encourage older patients with musculoskeletal disorders and poor oral health to exercise regularly. Combined exercise and oral healthcare interventions may be the most effective strategy for managing frailty in older patients with musculoskeletal disorders.
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Affiliation(s)
- Wonhee Baek
- College of Nursing, Gyeongsang National University, South Korea
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8
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Auer U, Kelemen Z, Vogl C, von Ritgen S, Haddad R, Torres Borda L, Gabmaier C, Breteler J, Jenner F. Development, refinement, and validation of an equine musculoskeletal pain scale. FRONTIERS IN PAIN RESEARCH 2024; 4:1292299. [PMID: 38312997 PMCID: PMC10837853 DOI: 10.3389/fpain.2023.1292299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/08/2023] [Indexed: 02/06/2024] Open
Abstract
Musculoskeletal disease is a common cause of chronic pain that is often overlooked and inadequately treated, impacting the quality of life of humans and horses alike. Lameness due to musculoskeletal pain is prevalent in horses, but the perception of pain by owners is low compared with veterinary diagnosis. Therefore, this study aims to establish and validate a pain scale for chronic equine orthopaedic pain that is user-friendly for horse owners and veterinarians to facilitate the identification and monitoring of pain in horses. The newly developed musculoskeletal pain scale (MPS) was applied to 154 horses (mean age 20 ± 6.4 years SD) housed at an equine sanctuary, of which 128 (83%) suffered from chronic orthopaedic disease. To complete the MPS, the horses were observed and videotaped from a distance while at rest in their box or enclosure. In addition, they received a complete clinical and orthopaedic exam. The need for veterinary intervention to address pain (assessed and executed by the sanctuary independent from this study) was used as a longitudinal health outcome to determine the MPS's predictive validity. To determine the interrater agreement, the MPS was scored for a randomly selected subset of 30 horses by six additional blinded raters, three equine veterinary practitioners, and three experienced equestrians. An iterative process was used to refine the tool based on improvements in the MPS's correlation with lameness evaluated at the walk and trot, predictive validity for longitudinal health outcomes, and interrater agreement. The intraclass correlation improved from 0.77 of the original MPS to 0.88 of the refined version (95% confidence interval: 0.8-0.94). The refined MPS correlated significantly with lameness at the walk (r = 0.44, p = 0.001) and trot (r = 0.5, p < 0.0001). The refined MPS significantly differed between horses that needed veterinary intervention (mean MPS = 8.6) and those that did not (mean MPS = 5.0, p = 0.0007). In summary, the MPS showed good interrater repeatability between expert and lay scorers, significant correlation with lameness at the walk and trot, and good predictive validity for longitudinal health outcomes, confirming its ability to identify horses with orthopaedic health problems.
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Affiliation(s)
- Ulrike Auer
- Anaesthesiology and Perioperative Intensive Care Medicine Unit, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Zsofia Kelemen
- Equine Surgery Unit, Department of Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Claus Vogl
- Department of Biomedical Sciences, Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Stephanie von Ritgen
- Anaesthesiology and Perioperative Intensive Care Medicine Unit, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Rabea Haddad
- Equine Surgery Unit, Department of Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Laura Torres Borda
- Equine Surgery Unit, Department of Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Christopher Gabmaier
- Anaesthesiology and Perioperative Intensive Care Medicine Unit, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - John Breteler
- Equine Surgery Unit, Department of Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Florien Jenner
- Equine Surgery Unit, Department of Companion Animals and Horses, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna, Austria
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Areias AC, Janela D, Molinos M, Moulder RG, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study. JMIR Rehabil Assist Technol 2023; 10:e49673. [PMID: 37465960 PMCID: PMC10466151 DOI: 10.2196/49673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). OBJECTIVE This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. METHODS We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 years old (young adults), 45-64 years old (middle-aged adults), and ≥65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity, and non-work-related activity impairment. RESULTS Of 16,229 patients, 12,082 started the program: 38.3% (n=4629) were young adults, 55.7% (n=6726) were middle-aged adults, and 6% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95% CI 1.45-2.06; P<.001 and OR 2.40, 95% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95% CI 1.03-1.45; P=.03 and OR 1.38, 95% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6%; middle-aged adults: 1848/2834, 65.2%; and older adults: 241/387, 62.3%; P=.17). CONCLUSIONS Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population.
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Affiliation(s)
| | - Dora Janela
- Sword Health, Inc, Draper, UT, United States
| | | | - Robert G Moulder
- Sword Health, Inc, Draper, UT, United States
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Burton W, Ma Y, Manor B, Hausdorff JM, Kowalski MH, Bain PA, Wayne PM. The impact of neck pain on gait health: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:618. [PMID: 37516827 PMCID: PMC10385921 DOI: 10.1186/s12891-023-06721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Evidence exists demonstrating the negative impacts of chronic musculoskeletal pain on key measures of gait. Despite neck pain being the second most common musculoskeletal pain condition, there is a paucity of evidence exploring the impacts of neck pain specifically on these outcomes. The aims of this work were to systematically review the current evidence of the associations between chronic neck pain and measures of gait health and to conduct meta-analysis for quantitative assessment of the effect sizes under different walking conditions. METHODS Systematic review was conducted following PRISMA guidelines. Databases searched included MEDLINE, Embase, Web of Science, CINAHL, and PEDro. Eligible study designs included observational studies consisting of an exposure group with chronic neck pain and control group without chronic neck pain and primary outcomes relating to gait health. For outcomes amenable to meta-analysis, a random-effects model was used to derive summary estimates of Hedge's g depicted graphically with forest plots. Other gait outcomes were narratively summarized. Risk of bias was also assessed. RESULTS The original search yielded 1918 articles; 12 met final eligibility criteria including 10 cross-sectional studies. Outcomes were grouped first by the five domains of gait: pace, rhythm, asymmetry, variability, and postural control; and second by the tested walking conditions. Meta-analyses for gait speed revealed large effect-sizes indicating that individuals with chronic neck pain had slower measures of gait and lower measures of cadence. Gait outcomes that were narratively summarized supported these findings. CONCLUSION The quantitative and qualitative findings of this systematic review and meta-analysis suggest a negative impact of CNNP on measures of gait health, particularly gait speed, under various walking conditions. However, broad interpretation of these results should be cautious. Testing gait under dual task conditions may be particularly sensitive to the impact of CNNP, and future work is needed to better understand how pain disrupts this important functionality of the locomotor system. Additionally, consideration should be made to assess measures of variability and investigate these relationships in the older adult population.
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Affiliation(s)
- Wren Burton
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA.
- DC. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Yan Ma
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA
- DC. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv, Israel
- Sagol School of Neuroscience and Department of Physical Therapy, Sacker School of Medicine Tel Aviv University, Tel Aviv, Israel
- Department of Orthopedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Matthew H Kowalski
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Ave, Boston, MA, 02115, USA
- DC. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Su Zhang VR, Niu F, Lee EA, DiStasio C, Broder BI, Steinberg SG, Hui RL. Safety of baclofen versus tizanidine for older adults with musculoskeletal pain. J Am Geriatr Soc 2023. [PMID: 36989193 DOI: 10.1111/jgs.18349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/15/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Baclofen and tizanidine are both muscle relaxants that carry the risk for neuropsychiatric events in older adults but there is a lack of data directly comparing their safety. This study aimed to investigate the relative risk between these two medications in causing injury and delirium in older adults. METHODS This was a retrospective cohort study that was completed in an integrated healthcare system in the United States and included patients aged 65 years or older who started baclofen or tizanidine for the treatment of musculoskeletal pain from January 2016 through December 2018. Outcomes included new incidence of injury (concussion, contusion, dislocation, fall, fracture, or other injuries) and delirium. The cohort was followed from the initiation of therapy until the first occurrence of any of the following events: end of the index drug exposure, end of health plan membership, death, or the study end date of December 31st, 2019. Descriptive statistics were used to compare baseline patient characteristics between baclofen and tizanidine treatment groups. Cox proportional hazards model was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals. RESULTS The final study cohort included 12,101 and 6,027 older adults in the baclofen and tizanidine group respectively (mean age 72.2 ± 6.2 years old, 59% female). Older adults newly started on baclofen had a greater risk of injury (HR = 1.54, 95% CI = 1.21-1.96, P = < 0.001) and delirium (HR = 3.33, 95% CI = 2.11-5.26, p = <0.001) compared to those started on tizanidine. CONCLUSION The results of this study suggest that baclofen is associated with higher incidences of injury and delirium compared to tizanidine when used for the treatment of musculoskeletal pain. Future studies should investigate if these risks are dose-related and include a comparison group not exposed to either drug.
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Affiliation(s)
- Vanessa R Su Zhang
- Department of Ambulatory Care Pharmacy, Kaiser Permanente, San Rafael, California, USA
| | - Fang Niu
- Pharmacy Outcomes Research Group, Kaiser Permanente, Downey, California, USA
| | - Eric A Lee
- Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, California, USA
| | - Christopher DiStasio
- Department of Neurology, Southern California Permanente Medical Group, Harbor City, California, USA
| | - Benjamin I Broder
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA
| | - Steven G Steinberg
- Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, California, USA
| | - Rita L Hui
- Pharmacy Outcomes Research Group, Kaiser Permanente, Oakland, California, USA
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12
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Heleno E, Andias R, Neto M, Silva AG. A Feasibility Study of Pain Neuroscience Education and Exercise for Community-Dwelling Older Adults With Chronic Pain. J Geriatr Phys Ther 2023; 46:26-35. [PMID: 34417415 DOI: 10.1519/jpt.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Pain prevalence in older adults is high and greatly impacts their functioning. The primary aim of this study was to determine the feasibility of an intervention consisting of pain neuroscience education (PNE) plus exercise for community-dwelling older adults attending primary care, by assessing recruitment rates (inclusion, refusal, and exclusion rates), adverse events, and acceptability of the intervention. Secondary aims were to establish suitable procedures for delivering the intervention and assess the feasibility of data collection for psychosocial and physical functioning. METHODS A mixed-methods feasibility study with 2 groups was conducted. One group received 8 weekly 75-minute sessions of PNE plus exercise (PNE+E) and the other received usual care (UC), which consisted of appointments with the general practitioner. Inclusion, refusal, exclusion, and retention rates, dropouts, and adverse events were assessed. The Brief Pain Inventory, the Pain Catastrophizing Scale, the Tampa Scale, the Geriatric Depression Scale, the World Health Organization Disability Assessment Schedule, the 4-meter walk gait speed test and the 5 times sit-to-stand tests were used for assessment. A focus group interview was conducted with participants from the PNE+E group. Descriptive statistics were used for quantitative data and thematic analysis for qualitative data. RESULTS AND DISCUSSION Of 61 participants recruited, 33 (PNE+E = 22; UC = 11) entered the study, and 24 completed the intervention (PNE+E = 15; UC = 9). The inclusion rate was 54%, the refusal rate was 21%, the exclusion rate was 35%, the dropout rate was 32% in the PNE+E and 18% in the UC, and the retention rate was 68% in the PNE+E group and 82% in the UC group. No adverse events were reported and the intervention was well accepted by participants. Data collection for the clinical outcomes was feasible and results suggested higher improvements in the PNE+E group than in the UC group. CONCLUSION PNE+E is possible to implement, safe, and well accepted by community-dwelling older adults independent of their education level. This study informs future studies on practical and methodological strategies that should be considered when designing a PNE+E intervention for older adults, such as adapting the language of the PNE to participants, using relatable metaphors, and encouraging written and exercise homework.
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Affiliation(s)
- Emanuel Heleno
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Rosa Andias
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
| | | | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
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13
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Nygaard NPB, Thomsen GF, Rasmussen J, Skadhauge LR, Gram B. Ergonomic and individual risk factors for musculoskeletal pain in the ageing workforce. BMC Public Health 2022; 22:1975. [PMID: 36303167 PMCID: PMC9615169 DOI: 10.1186/s12889-022-14386-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background The present study aimed to investigate the possible association between specific ergonomic and individual risk factors and musculoskeletal pain (MSP) in the back, shoulder, hip and knee region in workers aged 50-65y. Methods The study was a population based cross-sectional survey. The study population comprised citizens born between 1952–1966, living in Esbjerg municipality, Denmark, ultimo 2016 (n = 23,463). A questionnaire was sent electronically or by mail. The analysis included the working population only. A multivariate logistic regression was used for each of the following dependent variables; musculoskeletal pain for the past 3 months in the back, shoulder, hip and knee, where independent variables included ergonomic exposure, age, sex, body mass index (BMI) and leisure time physical activity (LTPA). Results The overall response rate was 58% and the data of individuals at work (n = 9,263) demonstrated several ergonomic exposures with increased odds for pain in specific regions. Exposure to back twisted or bend, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the back, whereas exposure to back twisted or bend, arms above shoulder and repeated arm movement were associated with pain in the shoulder. Exposure to back twisted or bend, repeated arm movement, squatting or lying on knees and to carrying or lifting were associated with musculoskeletal pain in the hip. Important individual risk factors were also identified. Increasing age was significantly associated with increased pain in the hip but associated with less risk for pain in the back and shoulder. Males had higher odds for pain in the back and knee compared to females but lower odds for pain in the hip. BMI was particularly important for knee pain. The level of LTPA did not have an important association with MSP in any region. Conclusion There is a significant positive association between ergonomic exposures and musculoskeletal pain, which were specific for the back, shoulder, hip and knee. In addition, the data demonstrated a differential association with age, sex and BMI. This needs to be considered for the treatment and classification of musculoskeletal pain and for future preventive initiatives.
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Affiliation(s)
- Niels-Peter Brøchner Nygaard
- Research Unit of Health Science, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Gert Frank Thomsen
- Department of Occupational Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jesper Rasmussen
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Rauff Skadhauge
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Occupational Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Bibi Gram
- Research Unit of Health Science, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Imai R, Imaoka M, Nakao H, Hida M, Tazaki F, Inoue T, Orui J, Nakamura M. Association between chronic pain with presarcopenia and central sensitization in Japanese community-dwelling older adults: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29998. [PMID: 35960105 PMCID: PMC9371568 DOI: 10.1097/md.0000000000029998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Older people with chronic pain are at higher risk of developing sarcopenia. Central sensitization (CS) has been implicated in chronic pain among community-dwelling older adults. However, a relationship between CS and chronic pain with sarcopenia has not been established. This cross-sectional study aimed to clarify the relationship between chronic pain with sarcopenia or presarcopenia and CS among community-dwelling older adults. We assessed chronic pain and sarcopenia in 104 older adults participating in community health checks. We defined sarcopenia using the Asian Working Group for Sarcopenia (AWGS) consensus recommendations based on the following outcomes: low muscle mass, low muscle strength, and slow gait speed. Pain-related assessments included pain intensity, the Pain Catastrophizing Scale, the CS Inventory-9, the pressure pain threshold, the Tampa Scale of Kinesiophobia-11, and the EuroQol 5-dimension 5-level (EQ5D-5L). Chronic pain was defined by related symptoms within the month prior to the health check that had continued for ≥ 3 months and corresponded to a numerical rating scale score of ≥ 1 at the site of maximum pain. The prevalence of chronic pain was 43.3%. In addition, the prevalence of chronic pain with sarcopenia or presarcopenia was 29.8%. A logistic regression analysis revealed that the pressure pain threshold (odds ratio: 0.82, 95% CI: 0.95-1.02) and the EQ5D-5L (odds ratio: 0.58, 95% CI: 0.36-0.76) were significantly associated with the presence of chronic pain with sarcopenia or presarcopenia. Chronic pain with sarcopenia or presarcopenia was affected by central sensitization. Therefore, CS should be evaluated in the elderly.
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Affiliation(s)
- Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
- *Correspondence: Ryota Imai, PhD, School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka, Osaka 597-0104, Japan (e-mail: )
| | - Masakazu Imaoka
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Hidetoshi Nakao
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Mitsumasa Hida
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Fumie Tazaki
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Takao Inoue
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Junya Orui
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
| | - Misa Nakamura
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan
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Delgado-Velandia M, Ortolá R, García-Esquinas E, Struijk EA, López-García E, Rodríguez-Artalejo F, Sotos-Prieto M. Adherence to a Mediterranean Lifestyle and Changes in Frequency, Severity, and Localization of Pain in Older Adults. Mayo Clin Proc 2022; 97:1282-1293. [PMID: 35461661 DOI: 10.1016/j.mayocp.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/16/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the association between adherence to a Mediterranean lifestyle and changes in pain, and its characteristics over time in older adults. PATIENTS AND METHODS We analyzed data from 864 and 862 community-dwelling individuals aged 65+ years from the Study on Cardiovascular Health, Nutrition and Frailty in Older Adults in Spain (Seniors-ENRICA) Seniors-ENRICA-1 (2008-2010 to 2012) and Seniors-ENRICA-2 (2015-2017 to 2019) cohorts, with a median follow-up of 2.8 and 2.4 years, respectively. Adherence to a Mediterranean lifestyle was assessed at baseline with the 27-item Mediterranean lifestyle (MEDLIFE) index. Pain changes over time were calculated with a pain scale that assessed the frequency, severity, and the number of pain locations both at baseline and follow-up. Multivariable-adjusted relative risk ratios (RRRs) were obtained using multinomial logistic regression. RESULTS In the pooled cohorts, after a median follow-up of 2.6 years, pain worsened for 697 participants, improved for 734, and did not change for 295. Compared with the lowest category of MEDLIFE adherence, those in the highest category showed an RRR of improvement vs worsening of overall pain of 1.85 (95% CI, 1.28 to 2.67; P-trend<.001). MEDLIFE adherence was also linked to improvement in pain frequency (RRR, 1.98; 95% CI, 1.31 to 3.01; P-trend=.001), pain severity (RRR, 2.00; 95% CI, 1.33 to 3.00; P-trend=.001), and a reduction in the number of pain locations (RRR, 1.68; 95% CI, 1.13 to 2.50; P-trend=.004). Limitations of this study are the use of self-reported lifestyle data. CONCLUSION A Mediterranean lifestyle was associated with improvement of pain characteristics in older adults. Experimental studies should assess the efficacy of an integral lifestyle approach for the management of pain in older adults.
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Affiliation(s)
- Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/ IdiPaz, Spain; Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA.
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16
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Heleno E, Andias R, Silva AG. What do community-dwelling older adults with chronic pain value in a program of combined pain neuroscience education plus exercise? PATIENT EDUCATION AND COUNSELING 2021; 104:3072-3078. [PMID: 33958256 DOI: 10.1016/j.pec.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/31/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the experience of older adults after a pain neuroscience education (PNE) and exercise intervention. METHODS Focus group interviews were conducted with 14 older adults after receiving 8-weekly sessions of PNE and exercise and encompassed older adults' perceptions of the intervention and its impact. Interviews were transcribed verbatim and analyzed by 3 researchers using thematic analysis in a five-step approach (compiling, disassembling, reassembling, interpreting, and concluding). RESULTS Three themes emerged: pain reconceptualization, motivational factors, and perceived improvements. Pain reconceptualization was illustrated by participants' ability to use language that related to PNE concepts (n = 12), increased self-efficacy (n = 5), and adjusted emotions (n = 2) and behaviors (n = 6). Motivational factors were the group-administered intervention (n = 6) and the physical therapists' communication skills (n = 10). The intervention was perceived as having a positive impact on sleep (n = 3), well-being (n = 6), and activity/ability to perform activities (n = 8). CONCLUSION Older adults understand PNE concepts and reconceptualize pain. PNE and exercise were perceived as having a positive impact on day-to-day life. PRACTICE IMPLICATIONS Mode of administration, communication skills, and rapport are aspects of the intervention that are valued by older adults. Also, PNE might be used as a strategy to increase older adults' adherence to physical activity.
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Affiliation(s)
- Emanuel Heleno
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - Rosa Andias
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
| | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.
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Impacts on patient-centered outcomes of a chronic pain self-management program in a rural community: A feasibility study. Geriatr Nurs 2021; 42:1198-1203. [PMID: 34425422 DOI: 10.1016/j.gerinurse.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022]
Abstract
This study explored if a self-management training program was feasible for a predominantly older rural Latino adults with chronic pain who had limited access to non-pharmacologically based pain treatment. Physical therapy doctoral students delivered the six-week low-literacy low-cost patient-centered program. The intervention was feasible to the participants (n=38) who showed improvement in a majority of the eight outcome measures at 6-week posttest and three measures at 18-week followup. The changes in pain severity, pain interference and pain-related physical functions reached minimally clinically important difference at follow-up. A randomized controlled trial with long-term follow-up is needed to test the program effectiveness in partnership with community health centers to increase access to pain management in rural communities.
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