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Fatoye F, Fatoye C, Lawoe J, Mbada C, Gebrye T. Does COVID-19 Related Lockdown Restrictions Impact People With Musculoskeletal Disorders? A Systematic Review. Musculoskeletal Care 2024; 22:e1920. [PMID: 39126136 DOI: 10.1002/msc.1920] [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: 06/21/2024] [Revised: 07/04/2024] [Accepted: 07/14/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND As a result of coronavirus disease 2019 (COVID-19) related lockdown restrictions, people with musculoskeletal (MSK) disorders could be at increased risk of physical and psychological disabilities. This review aimed to summarise the impact of COVID-19 related lockdown restrictions on people with MSK disorders. METHODS Six electronic databases were searched for studies in the English language published until June 10, 2024. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify, select, and critically appraise relevant research. Two reviewers independently abstracted data from the included studies. Data were summarised using narrative synthesis, and the Newcastle-Ottawa Scale was used for quality assessment. RESULTS The search strategy identified 637 articles, 129 of which were removed as duplicates. Fifteen studies that met the inclusion criteria were analysed. The sample size the studies reviewed ranged from 40 to 1800. Having MSK disorders during COVID-19 related lockdown restrictions led to increased risk of pain, stress, depression, anxiety, MSK related injuries, decreased quality of life and increased use of emergency department. CONCLUSIONS This is the first study to report that COVID-19 related lockdown restrictions led to increased risk of pain, MSK injuries and healthcare resource utilisation as well as decreased quality of life among patients with MSK disorders. These results may help inform policy and management strategies in future for people with MSK disorders to mitigate the negative impact of pandemic.
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Affiliation(s)
- Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Lifestyle Diseases, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Clara Fatoye
- Department of Health and Social Care, University Campus Oldham, Manchester, UK
| | - Joyceline Lawoe
- Department of Visual and Industrial Art, Sunyani Technical University, Sunyani, Ghana
| | - Chidozie Mbada
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Tadesse Gebrye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Lam CM, Sanderson M, Vu DT, Sayed D, Latif U, Chadwick AL, Staats P, York A, Smith G, Velagapudi V, Khan TW. Musculoskeletal and Neuropathic Pain in COVID-19. Diagnostics (Basel) 2024; 14:332. [PMID: 38337848 PMCID: PMC10855145 DOI: 10.3390/diagnostics14030332] [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: 12/25/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic pain constitutes a significant disease burden globally and accounts for a substantial portion of healthcare spending. The COVID-19 pandemic contributed to an increase in this burden as patients presented with musculoskeletal or neuropathic pain after contracting COVID-19 or had their chronic pain symptoms exacerbated by the virus. This extensive literature review analyzes the epidemiology of pain pre-pandemic, the costs associated with the COVID-19 pandemic, the impact of the virus on the body, mechanisms of pain, management of chronic pain post-pandemic, and potential treatment options available for people living with chronic pain who have had or are currently infected with COVID-19.
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Affiliation(s)
- Christopher M. Lam
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Miles Sanderson
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Dan T. Vu
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Dawood Sayed
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Usman Latif
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Peter Staats
- National Spine and Pain Centers, Frederick, MD 21702, USA;
| | - Abigail York
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
| | - Gabriella Smith
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (G.S.); (V.V.)
| | - Vivek Velagapudi
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (G.S.); (V.V.)
| | - Talal W. Khan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (C.M.L.); (M.S.); (D.T.V.); (D.S.); (U.L.); (A.L.C.); (A.Y.)
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Kapos FP, Vandeleur DM, Tham SW, Palermo TM, Groenewald CB. Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic. Pain 2024; 165:233-242. [PMID: 37556380 PMCID: PMC10841312 DOI: 10.1097/j.pain.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
ABSTRACT The coronavirus disease 19 (COVID-19) pandemic negatively affected children's health in the United States (US), with more severe disruption for marginalized groups. However, potential impact on pediatric chronic pain has not been assessed at the population level. This study aimed to (1) estimate differences in the US national prevalence of pediatric chronic pain during the first year of the COVID-19 pandemic (2020), relative to one year earlier (2019); (2) determine whether differences in prevalence varied across sociodemographic groups; and (3) explore changes in child, caregiver, and family factors associated with chronic pain prevalence. Using data of children 6 to 17 years from the National Survey of Children's Health 2019 and 2020 (n = 50,518), we compared weighted percentages of sample characteristics by year and conducted a series of directed-acyclic graph-informed survey-weighted Poisson regressions. The estimated national prevalence (95% CI) of pediatric chronic pain was 10.8% (9.9, 11.9%) in 2019, decreasing to 7.6% (6.9, 8.3%) in 2020. Contrary to hypotheses, the adjusted prevalence of chronic pain was 31% lower in 2020 than in 2019 (aPR = 0.69, 95% CI: 0.61, 0.79), adjusting for child age, sex, race or ethnicity, caregiver education, neighborhood park or playground, and census region. The 2019 to 2020 change in chronic pain prevalence was similar by age ( P = 0.34), sex ( P = 0.94), race or ethnicity ( P = 0.41), caregiver education ( P = 0.49), neighborhood park or playground ( P = 0.22), and census region ( P = 0.20). Exploratory analyses identified 3 potential contributors to the unexpected decrease in the national prevalence of pediatric chronic pain: lower prevalence of bullying, more frequent family meals, and higher family resilience.
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Affiliation(s)
- Flavia P. Kapos
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
| | - Daron M. Vandeleur
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - See Wan Tham
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Tonya M. Palermo
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Cornelius B. Groenewald
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
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Parsirad M, Oomen-Lochtefeld S, Suerig B, Wang C. Has the COVID 19 Pandemic Impacted the Management of Chronic Musculoskeletal Pain? Curr Rheumatol Rep 2023; 25:128-143. [PMID: 37133652 PMCID: PMC10155143 DOI: 10.1007/s11926-023-01103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has affected the management of chronic musculoskeletal pain; however, the extent of its impact has not been established. We conducted a comprehensive review of the pandemic's impact on clinical outcomes and healthcare accessibility for osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia (FM), lower back pain (LBP), and other musculoskeletal disorders and chronic pain syndromes to better inform clinical decision-making. RECENT FINDINGS We examined 30 studies (n = 18,810) from 36 countries investigating the impact of the COVID-19 pandemic on chronic musculoskeletal pain outcomes. The available evidence suggests that the pandemic significantly impacted pain levels, mental health, quality of life and healthcare accessibility in patients with chronic musculoskeletal pain. Of 30 studies, 25 (83%) reported symptom worsening, and 20 (67%) reported reduced healthcare accessibility. Patients were unable to access necessary care services during the pandemic, including orthopedic surgeries, medications, and complementary therapies, leading to worsened pain, psychological health, and quality of life. Across conditions, vulnerable patients reported high pain catastrophizing, psychological stress, and low physical activity related to social isolation. Notably, positive coping strategies, regular physical activity, and social support were associated with positive health outcomes. Most patients with chronic musculoskeletal pain had greatly affected pain severity, physical function, and quality of life during the COVID-19 pandemic. Moreover, the pandemic significantly impacted treatment accessibility, preventing necessary therapies. These findings support further prioritization of chronic musculoskeletal pain patient care.
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Affiliation(s)
- Mahdokht Parsirad
- Center For Complementary and Integrative Medicine, Division of Rheumatology, Allergy & Immunology, Tufts Medicine/Tufts Medical Center, Boston, MA, 02111, USA
| | - Samon Oomen-Lochtefeld
- Center For Complementary and Integrative Medicine, Division of Rheumatology, Allergy & Immunology, Tufts Medicine/Tufts Medical Center, Boston, MA, 02111, USA
| | - Brigette Suerig
- Center For Complementary and Integrative Medicine, Division of Rheumatology, Allergy & Immunology, Tufts Medicine/Tufts Medical Center, Boston, MA, 02111, USA
| | - Chenchen Wang
- Center For Complementary and Integrative Medicine, Division of Rheumatology, Allergy & Immunology, Tufts Medicine/Tufts Medical Center, Boston, MA, 02111, USA.
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Núñez-Recio I, García-Iglesias JJ, Martín-López C, Navarro-Abal Y, Fagundo-Rivera J, Climent-Rodríguez JA, Gómez-Salgado J. Modulating factors of fibromyalgia in women during the COVID-19 pandemic: A protocol for systematic review. Medicine (Baltimore) 2022; 101:e32577. [PMID: 36596046 PMCID: PMC9803342 DOI: 10.1097/md.0000000000032577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fibromyalgia is a disease that affects mostly women and is related to stressors. The aim of this study was to assess how the Coronavirus disease 2019 pandemic has affected women with fibromyalgia. METHODS A systematic review was conducted in the PubMed, ScienceDirect, and Springer Link databases, following the recommendations of the preferred reporting items for systematic reviews and meta-analyses statement. The methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools for non-randomized studies. RESULTS A total of 6 studies were included. Most results indicated a worsening in the mental health of women with fibromyalgia during the pandemic, and this in turn impacted on physical health. CONCLUSION The mental health of women with fibromyalgia was more affected during the Coronavirus disease 2019 pandemic period than that of non-fibromyalgia sufferers. This was also reflected in the worsening of symptoms and weakness in performing daily activities.
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Affiliation(s)
| | - Juan Jesús García-Iglesias
- Department of Sociology, Social Work, and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
| | - Cristina Martín-López
- Physical Medicine and Rehabilitation Area, Riotinto Hospital, Minas de Riotinto, Huelva, Spain
| | - Yolanda Navarro-Abal
- Department of Social, Evolutionary and Educational Psychology, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
| | - Javier Fagundo-Rivera
- Centro Universitario de Enfermería Cruz Roja, Universidad de Sevilla, Sevilla, Spain
| | - José Antonio Climent-Rodríguez
- Department of Social, Evolutionary and Educational Psychology, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work, and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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Hügle T. Blood self-sampling: a missing link for remote patient care. RMD Open 2022; 8:rmdopen-2022-002728. [PMID: 36270745 PMCID: PMC9594585 DOI: 10.1136/rmdopen-2022-002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Thomas Hügle
- Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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Duculan R, Jannat-Khah D, Wang XA, Mancuso CA. Psychological Stress Reported at the Start of the COVID-19 Pandemic and Subsequent Stress and Successful Coping in Patients With Rheumatic Diseases: A Longitudinal Analysis. J Clin Rheumatol 2022; 28:250-256. [PMID: 35471418 PMCID: PMC9336210 DOI: 10.1097/rhu.0000000000001846] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In a cohort assembled during the height of mortality-associated coronavirus disease 2019 (COVID-19) in New York City, the objectives of this qualitative-quantitative mixed-methods study were to assess COVID-related stress at enrollment with subsequent stress and clinical and behavioral characteristics associated with successful coping during longitudinal follow-up. METHODS Patients with rheumatologist-diagnosed rheumatic disease taking immunosuppressive medications were interviewed in April 2020 and were asked open-ended questions about the impact of COVID-19 on psychological well-being. Stress-related responses were grouped into categories. Patients were interviewed again in January-March 2021 and asked about interval and current disease status and how well they believed they coped. Patients also completed the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) measuring physical and emotional health during both interviews. RESULTS Ninety-six patients had follow-ups; 83% were women, and mean age was 50 years. Patients who reported stress at enrollment had improved PROMIS-29 scores, particularly for the anxiety subscale. At the follow-up, patients reported persistent and new stresses as well as numerous self-identified coping strategies. Overall coping was rated as very well (30%), well (48%), and neutral-fair-poor (22%). Based on ordinal logistic regression, variables associated with worse overall coping were worse enrollment-to-follow-up PROMIS-29 anxiety (odds ratio [OR], 4.4; confidence interval [CI], 1.1-17.3; p = 0.03), not reporting excellent/very good disease status at follow-up (OR, 2.7; CI, 1.1-6.5; p = 0.03), pandemic-related persistent stress (OR, 5.7; CI, 1.6-20.1; p = 0.007), and pandemic-related adverse long-lasting effects on employment (OR, 6.1; CI, 1.9-20.0; p = 0.003) and health (OR, 3.0; CI, 1.0-9.0; p = 0.05). CONCLUSIONS Our study reflects the evolving nature of COVID-related psychological stress and coping, with most patients reporting they coped well. For those not coping well, multidisciplinary health care providers are needed to address long-lasting pandemic-associated adverse consequences.
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Affiliation(s)
- Roland Duculan
- From the Research Division
- Department of Orthopedic Surgery
| | - Deanna Jannat-Khah
- Division of Rheumatology
- Research Division, Biostatistics Core, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Xin A. Wang
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Carol A. Mancuso
- From the Research Division
- Division of Rheumatology
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Shanthanna H, Nelson AM, Kissoon N, Narouze S. The COVID-19 pandemic and its consequences for chronic pain: a narrative review. Anaesthesia 2022; 77:1039-1050. [PMID: 35848380 PMCID: PMC9350079 DOI: 10.1111/anae.15801] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID-19 pandemic for chronic pain. Publications were identified related to the COVID-19 pandemic influence on the burden of chronic pain, development of new-onset pain because of long COVID with proposed mechanisms and COVID-19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS-CoV-2 infection could be caused by 'systemic inflammatory-immune mechanisms', 'direct neuropathic mechanisms' or 'secondary mechanisms due to the viral infection or treatment'. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS-CoV-2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New-onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism-based treatments within the domain of multidisciplinary care.
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Affiliation(s)
- H Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - A M Nelson
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, CA, USA
| | - N Kissoon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - S Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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Morton L, Stelfox K, Beasley M, Jones GT, Macfarlane GJ, Walker-Bone K, Hollick RJ. Enabling work participation for people with musculoskeletal conditions: lessons from work changes imposed by COVID-19: a mixed-method study. BMJ Open 2022; 12:e057919. [PMID: 35393323 PMCID: PMC8990257 DOI: 10.1136/bmjopen-2021-057919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To understand what we can learn from the impact of the COVID-19 pandemic and lockdown about what enables work participation for people with inflammatory arthritis and chronic pain conditions. DESIGN Qualitative interviews embedded within an observational questionnaire study of individuals with musculoskeletal (MSK) conditions. SETTING UK primary care (general practices), and secondary care-based rheumatology services. PARTICIPANTS Individuals with axial spondyloarthritis, psoriatic arthritis and MSK pain from three established cohorts completed an online/paper-based questionnaire (July-December 2020). A subset of respondents were selected for semistructured interviews. PRIMARY AND SECONDARY OUTCOME MEASURES The survey quantified the effects of lockdown on work circumstances. Qualitative interviews explored the impacts of these changes and the advantages and disadvantages of changes in work circumstances. RESULTS 491 people (52% female, median age 49 years) who were employed at the time of lockdown responded to the questionnaire. The qualitative analysis included 157 free-text comments on work from the questionnaire and data collected within 18 interviews.Participants reported impacts on mental and physical health, and significant financial anxieties. The impact of work changes varied depending on individual and home circumstances. Some felt forced to ignore advice to shield and continue working. The flexibility offered by home working and changes in commuting enabled greater physical activity for some, while others missed the exercise normally undertaken as part of their commute. Others reported a constant need to be 'present' online, which heightened anxiety and worsened MSK symptoms. CONCLUSION Lockdown showed that flexible working arrangements, which consider the positive and negative aspects of commuting, posture, movement, and work environment matter for work participation, and can have wider benefits in terms of health and well-being for those with long-term MSK conditions. Incorporating these into new models of work will help make the workplace more equitable and inclusive for people with long-term MSK conditions.
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Affiliation(s)
- LaKrista Morton
- Epidemiology Group, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Kevin Stelfox
- Epidemiology Group, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Marcus Beasley
- Epidemiology Group, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Karen Walker-Bone
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Rosemary J Hollick
- Epidemiology Group, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
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10
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Bronheim RS, Kebaish KM, Jain A, Neuman BJ, Skolasky RL. Worsening pain and quality of life for spine surgery patients during the COVID-19 pandemic: Roles of psychological distress and patient activation. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 9:100103. [PMID: 35187509 PMCID: PMC8840868 DOI: 10.1016/j.xnsj.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
Psychological distress compounds negative effects of COVID-19 on pain and HRQoL. Patient activation is protective from COVID-19 effects on pain and HRQoL. Providers should screen for psychological distress and patient activation. Enhanced patient supports to manage pain are needed for at-risk patients. Enhanced patient supports to maintain HRQoL are needed for at-risk patients.
Background Public health measures during the COVID-19 pandemic have disrupted access to basic resources (income, food, housing, healthcare). The effects may impact patients differently based on socioeconomic status (SES), pre-existing psychological distress, and patient activation (knowledge, skills, and motivation to manage healthcare). We examined changes in access to basic resources and in pain and health-related quality of life (HRQoL) during the pandemic and determined how pre-existing psychological distress and patient activation are associated with exacerbation or mitigation of effects on pain and HRQoL. Methods This cross-sectional study assessed 431 patients in a longitudinal-outcomes registry who underwent or scheduled spine surgery at our institution and were surveyed about COVID-19 effects on accessing basic resources. We assessed pain (numeric rating scale) and HRQoL (PROMIS 29-Item Profile). Information on preoperative SES, psychological distress, patient activation, pain, and HRQoL was collected previously. We compared access to basic resources by SES. We compared changes from pre-COVID-19 to COVID-19 assessments of pain and HRQoL and proportions of patients reporting worsened pain and HRQoL stratified by psychological distress. We analyzed associations between patient activation and negative effects on HRQoL using multivariable linear regression. Alpha=0.05. Results Respondents reported minor disruptions in accessing basic resources (no difference by SES) but significant worsening of back (p=.027) and leg pain (p=.013) and HRQoL (physical function, fatigue, p<0.001; satisfaction with participation in social roles, p=0.048) during COVID-19. Psychological distress was associated with clinically relevant worsening of back, pain, leg pain, and physical function all, (p<0.05). High patient activation was associated with less impairment of physical function (p=0.03). Conclusion Patients with pre-existing psychological distress experienced greater worsening of pain and HRQoL. High patient activation appeared to mitigate worsening of physical function. Providers should screen for psychological distress and patient activation and enhance supports to manage pain and maintain HRQoL in at-risk patients. Level of Evidence: III
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11
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Morton L, Stelfox K, Beasley M, Jones GT, Macfarlane GJ, Murchie P, Paton J, Hollick R. Lessons from experiences of accessing healthcare during the pandemic for remobilizing rheumatology services: a national mixed methods study. Rheumatol Adv Pract 2022; 6:rkac013. [PMID: 35350717 PMCID: PMC8946474 DOI: 10.1093/rap/rkac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To understand the impact of the coronavirus disease 2019 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory musculoskeletal (MSK) conditions. Methods Three established cohorts that included individuals with axial SpA, psoriatic arthritis and MSK pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semistructured interviews. Results A total of 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. A total of 57% of respondents had tried to access care since the start of the UK national lockdown. More than a quarter reported being unable to book any type of healthcare appointment. General practice appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinically vulnerable were associated with a greater likelihood of attempting to access healthcare. People not in work, those reporting anxiety or depression and poorer quality of life were less likely to be satisfied with remotely delivered healthcare. Participants valued clear, timely and transparent care pathways across primary care and specialist services. While remote consultations were convenient for some, in-person appointments enabled physical assessment and facilitated the development and maintenance of clinical relationships with care providers. Conclusions We identified patient factors that predict access to and satisfaction with care and aspects of care that patients value. This is important to inform remobilisation of rheumatology services to better meet the needs of patients.
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Affiliation(s)
- LaKrista Morton
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Kevin Stelfox
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Marcus Beasley
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Gareth T Jones
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Gary J Macfarlane
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen
| | - John Paton
- Scottish Patient Ambassador, National Rheumatoid Arthritis Society, Maidenhead, UK
| | - Rosemary Hollick
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
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