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Leese C, Gupte D, Christogianni A, Higgins C, Adair P, Dall P, Cameron P, Smith BH, Colvin L. Barriers and facilitators for physical activity in people living with chronic pain: a systematic review and combined analysis. Pain 2024:00006396-990000000-00646. [PMID: 38981051 DOI: 10.1097/j.pain.0000000000003314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Chronic pain is a prevalent and complex health issue associated with physical, emotional, and social consequences. Management of pain is multifactorial and challenging; however, physical activity (PA) has consistently been shown to be beneficial. Despite this, PA levels among people with chronic pain are low. This study aimed to identify facilitators and barriers to PA among adults with chronic pain and analyse these using the structure of a validated behaviour change model: the capability, opportunity, and motivation behaviour change model (COM-B). We performed a systematic review of 6 databases and subsequent combined analysis including peer-reviewed primary research published in English up to November 15, 2023. Search terms consisted of 3 components: pain, PA, and facilitators/barriers. Quality appraisal of studies was conducted using appropriate tools. The systematic search yielded 40 eligible studies with a total of 2164 participants. The studies represented various chronic pain conditions, locations, and study designs. The key barriers to engagement in PA were the impact of pain severity, comorbidities, lack of knowledge about PA benefits, and time constraints. Key facilitators were a personalised approach, social support, and awareness of the benefits. The findings were categorised according to the COM-B model, allowing for the identification of modifiable factors. Person-centred approaches, education, and accessible environments were identified as important aspects to consider for successful PA promotion among people with chronic pain. Utilising the factors identified in the COM-B model is crucial for successful future interventions to increasing PA uptake and adherence in this population.
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Affiliation(s)
- Callum Leese
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Devashri Gupte
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | | | - Cassie Higgins
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Pauline Adair
- Psychology, School of Psychology, Queen's University, Belfast, United Kingdom
| | - Philippa Dall
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Paul Cameron
- Pain Rehabilitation, Cardiff University, Cardiff, United Kingdom
| | - Blair H Smith
- Population Health Science, University of Dundee, Dundee, Scotland
| | - Lesley Colvin
- Population Health Science, University of Dundee, Dundee, Scotland
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Sibilia J, Berna F, Bloch JG, Scherlinger M. Mind-body practices in chronic inflammatory arthritis. Joint Bone Spine 2024; 91:105645. [PMID: 37769800 DOI: 10.1016/j.jbspin.2023.105645] [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] [Accepted: 05/03/2023] [Indexed: 10/03/2023]
Abstract
Mind-body practices are complementary approaches recognized by the World Health Organization (WHO). While these practices are very diverse, they all focus on the interaction between mind and body. These include mindful meditation, yoga, Tai Chi, sophrology, hypnosis and various relaxation techniques. There is growing interest in incorporating these strategies in the management of chronic rheumatic diseases including rheumatoid arthritis. The aim of this review is to describe the main mind-body practices and analyze the existing evidence in chronic rheumatic diseases. In rheumatoid arthritis, the Mindfulness-Based Stress Reduction program, yoga, Tai Chi and relaxation may improve patient-reported outcomes, but the benefit on inflammation and structural progression is unclear. In spondyloarthritis, very few studies are available but similar evidence exist. Further evaluations of these practices in chronic rheumatic diseases are needed since their risk/benefit ratio appears excellent.
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Affiliation(s)
- Jean Sibilia
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Fabrice Berna
- Service de Psychiatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Gérard Bloch
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marc Scherlinger
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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Roseen EJ, Pinheiro A, Lemaster CM, Plumb D, Wang S, Elwy AR, Streeter CC, Lynch S, Groessl E, Sherman KJ, Weinberg J, Saper RB. Yoga Versus Education for Veterans with Chronic Low Back Pain: a Randomized Controlled Trial. J Gen Intern Med 2023; 38:2113-2122. [PMID: 36650329 PMCID: PMC10361953 DOI: 10.1007/s11606-023-08037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans. OBJECTIVE Determine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP. DESIGN, SETTING, AND PARTICIPANTS Veterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015. INTERVENTIONS Twelve weekly hatha yoga classes or education using The Back Pain Helpbook. MEASURES Co-primary outcomes were changes from baseline at 12 weeks in back-related disability on the modified Roland Morris Disability Questionnaire and pain on the Defense & Veterans Pain Rating Scale. Secondary outcomes were global improvement, patient satisfaction, pain medication use, and post-traumatic stress symptoms. An intention-to-treat approach was used in primary analyses. RESULTS One hundred twenty Veterans (mean age, 55.5 [SD = 16.9]; 11 [9%] women; mean number of chronic conditions, 5.5) were randomized to yoga (n = 62) and education (n = 58). At 12 weeks, reductions in back-related disability in yoga (mean difference [MD] = - 3.50, 95% CI: - 5.03, - 1.97) were not significantly different than education (MD = - 2.55, 95% CI: - 4.10, - 0.99; between-group difference: - 0.95 [95% CI: - 3.14, 1.23], p = 0.39). For pain, there was no significant difference between yoga (MD = - 1.01, 95% CI: - 1.67, - 0.35) and education (MD = - 0.81, 95% CI: - 1.36, - 0.27; between-group difference: - 0.20, 95% CI: - 1.06, 0.66, p = 0.65). More yoga than education participants reported being very much or extremely improved (39% vs 19%, OR = 3.71, 95% CI: 1.37, 10.02, p = 0.01) and very satisfied with treatment (60% vs 31%, OR = 4.28, 95% CI: 1.70, 10.77, p = 0.002). No differences in pain medication use or post-traumatic stress symptoms were observed at 12 weeks. No serious adverse events were reported in either group. CONCLUSION Twelve weekly yoga classes were not more effective than an education intervention for improving pain or disability outcomes among mostly older male Veterans with cLBP and multiple comorbid health conditions. CLINICALTRIALS GOV IDENTIFIER NCT02224183.
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Affiliation(s)
- Eric J. Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston University Medical Campus, 801 Massachusetts Ave, Second Floor, Boston, MA 02131 USA
- Department of Physical Medicine and Rehabilitation and New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA USA
| | - Adlin Pinheiro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Chelsey M. Lemaster
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ USA
| | - Dorothy Plumb
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA USA
| | - Shihwe Wang
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Chris C. Streeter
- Department of Psychiatry and Neurology, Boston University School of Medicine, Boston, MA USA
- Department of Psychiatry, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | | | - Erik Groessl
- Herbert Wertheim School of Public Health, University of California San Diego and VA San Diego Health Care System, San Diego, CA USA
| | - Karen J. Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle WA and Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Robert B. Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH USA
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Davergne T, Moe RH, Fautrel B, Gossec L. Development and initial validation of a questionnaire to assess facilitators and barriers to physical activity for patients with rheumatoid arthritis, axial spondyloarthritis and/or psoriatic arthritis. Rheumatol Int 2020; 40:2085-2095. [PMID: 32862307 DOI: 10.1007/s00296-020-04692-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
To develop and validate a self-administered questionnaire to identify in people with Inflammatory arthritis (IA) Facilitators And Barriers to Physical activity (PA): the IFAB questionnaire. The development of the questionnaire included a systematic review of barriers and facilitators to PA to identify key themes, face validity assessment by 11 experts, and cognitive debriefing with 14 patients. The psychometric properties of the questionnaire were assessed by convergent validity (Spearman correlation) against the modified Health Assessment Questionnaire (mHAQ), the Fear-Avoidance Beliefs Questionnaire subscale for PA and the Tampa Scale for Kinesiophobia, internal consistency (Cronbach α) in 63 IA patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA). Reliability and feasibility were assessed in 32 IA patients. The questionnaire comprises 10 items: 4 assessing either barriers or facilitators, 3 assessing barriers, and 3 assessing facilitators. The items are related to psychological status (N = 6), social support (N = 2), disease (N = 1), environmental factors (N = 1). The validation study included 63 patients: 26 RA, 24 axSpA, 13 PsA; with mean age 52.8 (standard deviation 16.5) years, mean disease duration 12.5 (12.3) years, and 53% of women. The questionnaire was correlated (rho = 0.24) with mHAQ. Internal consistency (Cronbach α 0.69) and reliability (interclass coefficient 0.79 [95% confidence interval 0.59; 0.88]) were satisfactory, as was feasibility (missing data 12%, mean completion time < 5 min). The questionnaire allows the assessment of barriers and facilitators to PA in patients with IA. This questionnaire may guide targeted interventions to increase levels of PA in these patients.
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Affiliation(s)
- Thomas Davergne
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 47-83 Boulevard de Hôpital, 75013, Paris, France.
| | - Rikke H Moe
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bruno Fautrel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 47-83 Boulevard de Hôpital, 75013, Paris, France.,Rheumatology Department, Pitié Salpêtrière Hospital, APHP, 75013, Paris, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 47-83 Boulevard de Hôpital, 75013, Paris, France.,Rheumatology Department, Pitié Salpêtrière Hospital, APHP, 75013, Paris, France
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Shawahna R, Abdelhaq I. Exploring perceived benefits, motives, barriers, and recommendations for prescribing yoga exercises as a nonpharmacological intervention for patients with epilepsy: A qualitative study from Palestine. Epilepsy Behav 2020; 106:107041. [PMID: 32247178 DOI: 10.1016/j.yebeh.2020.107041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Yoga is believed to play a role in stabilizing the electroencephalogram and the autonomic nervous system, thus might help control seizures in people with epilepsy (PWE). This qualitative study was conducted to explore experiences of Palestinian PWE with regard to benefits, motives, barriers, and recommendations of prescribing yoga exercises as a nonpharmacological intervention. METHODS Purposive and snowball sampling techniques were used to recruit PWE who practiced yoga. Semi-structured in-depth interviews (n = 18) were conducted with the study participants. The interpretive description method was used to qualitatively analyze the data collected during the interviews. RESULTS Following the thematic analysis adopted for this study, four major themes emerged. These themes were as follows: perceived benefits of yoga, motives to practice yoga, barriers to practice yoga, and recommendations on effective yoga practice for PWE. The perceived benefits included improvements in management of seizures, psychological, physical, and social well-being. People with epilepsy were motivated by the health benefits of yoga. Barriers of adherence to practice included personal and logistic factors. The interviewees recommended tailoring yoga sessions to the needs of PWE. CONCLUSION This explorative qualitative study reported perceived benefits, motives, barriers, and recommendations of yoga as a nonpharmacological intervention for PWE. People with epilepsy used yoga as a beneficial nonpharmacological intervention to improve their health and reduce the negative effects of epilepsy on their physical and psychosocial well-being. Future studies are needed to investigate the health benefits of yoga when sessions are tailored to the needs of PWE.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| | - Imad Abdelhaq
- Department of Physical Education, Faculty of Educational Sciences and Teachers' Training, An-Najah National University, Nablus, Palestine
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Leisure Motivation and Satisfaction: A Text Mining of Yoga Centres, Yoga Consumers, and Their Interactions. SUSTAINABILITY 2018. [DOI: 10.3390/su10124458] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Understanding the motivation and satisfaction of yoga consumers is of critical importance for both leisure service providers and leisure researchers to enhance the sustainability of personal lives in terms of physical wellness and mental happiness. For this purpose, this study investigated 25,120 pairs of online ratings and reviews from 100 yoga centres in Shanghai, China using latent Dirichlet allocation (LDA)-based text mining, and successfully established the relationship between rating and review. Findings suggest that Chinese yogis are motivated by improving physical condition, improving psychological condition, gracing appearance, establishing social connection, and creating social isolation. In addition to teaching mainstream yoga, yoga centres also provide additional courses. From a consumer perspective, yogis are relatively satisfied with teachers, courses, and the environment, but complain about the supporting staff, membership price, and reservation service. Managerially, yoga centres are encouraged to continue attending to the motivations of yogis, specialising their guidance, and fostering strengths and circumventing weaknesses in their service. This study also contributes by verifying, elaborating on, and tentatively extending the framework of the Physical Activity and Leisure Motivation Scale (PALMS).
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DiRenzo D, Crespo-Bosque M, Gould N, Finan P, Nanavati J, Bingham CO. Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis. Curr Rheumatol Rep 2018; 20:75. [PMID: 30338418 PMCID: PMC6233984 DOI: 10.1007/s11926-018-0787-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To determine the efficacy of mindfulness-based interventions (MBIs) on clinical and patient-reported outcomes in rheumatoid arthritis (RA). RECENT FINDINGS We identified randomized clinical trials from inception through April 2018 from MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, the Cochrane Library, and hand searches. After screening 338 references, we included five trials with one post-hoc analysis that evaluated MBIs and collectively included 399 participants. Outcome instruments were heterogeneous across studies. Three studies evaluated RA clinical outcomes by a rheumatologist; one study found improvements in disease activity. A limited meta-analysis found no statistically significant difference in the levels of DAS28-CRP in the two studies that evaluated this metric (- 0.44 (- 0.99, 0.12); I2 0%). Four studies evaluated heterogeneous psychological outcomes, and all found improvements including depressive symptoms, psychological distress, and self-efficacy. A meta-analysis of pain Visual Analog Scale (VAS) levels post intervention from three included studies was not significantly different between MBI participants and control group (- 0.58 (- 1.26, 0.10); I2 0%) although other studies not included in meta-analysis found improvement. There are few trials evaluating the effect of MBIs on outcomes in patients with RA. Preliminary findings suggest that MBIs may be a useful strategy to improve psychological distress in those with RA.
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Affiliation(s)
- Dana DiRenzo
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
| | - Monica Crespo-Bosque
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Neda Gould
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick Finan
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
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Akyuz G, Kenis-Coskun O. The Efficacy of Tai Chi and Yoga in Rheumatoid Arthritis and Spondyloarthropathies: A narrative biomedical review. Rheumatol Int 2017; 38:321-330. [DOI: 10.1007/s00296-017-3867-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
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