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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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Taylor SL, Elwy AR, Bokhour BG, Coggeshall SS, Cohen A, Der-Martirosian C, Haderlein T, Haun J, Kligler B, Kloehn AT, Lorenz KA, Lott B, Shin MH, Schult T, Toyama J, Whitehead AM, Zhang X, Zeliadt SB. Measuring Patient-Reported Use and Outcomes From Complementary and Integrative Health Therapies: Development of the Complementary and Integrative Health Therapy Patient Experience Survey. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241241259. [PMID: 38585239 PMCID: PMC10998493 DOI: 10.1177/27536130241241259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/06/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
Background Assessing the use and effectiveness of complementary and integrative health (CIH) therapies via survey can be complicated given CIH therapies are used in various locations and formats, the dosing required to have an effect is unclear, the potential health and well-being outcomes are many, and describing CIH therapies can be challenging. Few surveys assessing CIH therapy use and effectiveness exist, and none sufficiently reflect these complexities. Objective In a large-scale Veterans Health Administration (VA) quality improvement effort, we developed the "Complementary and Integrative Health Therapy Patient Experience Survey", a longitudinal, electronic patient self-administered survey to comprehensively assess CIH therapy use and outcomes. Methods We obtained guidance from the literature, subject matter experts, and Veteran patients who used CIH therapies in designing the survey. As a validity check, we completed cognitive testing and interviews with those patients. We conducted the survey (March 2021-April 2023), inviting 15,608 Veterans with chronic musculoskeletal pain with a recent CIH appointment or referral identified in VA electronic medical records (EMR) to participate. As a second validity check, we compared VA EMR data and patient self-reports of CIH therapy utilization a month after survey initiation and again at survey conclusion. Results The 64-item, electronic survey assesses CIH dosing (amount and timing), delivery format and location, provider location, and payor. It also assesses 7 patient-reported outcomes (pain, global mental health, global physical health, depression, quality of life, stress, and meaning/purpose in life), and 3 potential mediators (perceived health competency, healthcare engagement, and self-efficacy for managing diseases). The survey took 17 minutes on average to complete and had a baseline response rate of 45.3%. We found high degrees of concordance between self-reported and EMR data for all therapies except meditation. Conclusions Validly assessing patient-reported CIH therapy use and outcomes is complex, but possible.
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Affiliation(s)
- Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine and Department of Health Policy and Management, UCLA, Los Angeles, CA, USA
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, VA Bedford, Bedford, MA, USA and VA Boston Healthcare Systems, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford, Bedford, MA, USA and VA Boston Healthcare Systems, Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Scott S Coggeshall
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Amy Cohen
- Division of Education, American Psychiatric Association, Washington, DC, USA
| | - Claudia Der-Martirosian
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center, Office of Patient Care Services, North Hills, CA, USA
| | - Taona Haderlein
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center, Office of Patient Care Services, North Hills, CA, USA
| | - Jolie Haun
- James A. Haley Veterans Hospital, Tampa, FL, USA
- College of Public Health at University of South Florida, Tampa, FL, USA
| | - Benjamin Kligler
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Alex T Kloehn
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA, USA
| | - Briana Lott
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research, VA Bedford, Bedford, MA, USA and VA Boston Healthcare Systems, Boston, MA, USA
| | - Tammy Schult
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Joy Toyama
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Alison M Whitehead
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Xiaoyi Zhang
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Taylor SL, Gelman HM, DeFaccio R, Douglas J, Hawrilenko MJ, McGinty NK, Resnick A, Tomlanovich NC, Toyama J, Whitehead AM, Kligler B, Zeliadt SB. We Built it, But Did They Come: Veterans' Use of VA Healthcare System-Provided Complementary and Integrative Health Approaches. J Gen Intern Med 2023; 38:905-912. [PMID: 36451011 PMCID: PMC9713140 DOI: 10.1007/s11606-022-07889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Interest in complementary and integrative health (CIH) approaches, such as meditation, yoga, and acupuncture, continues to grow. The evidence of effectiveness for some CIH approaches has increased in the last decade, especially for pain, with many being recommended in varying degrees in national guidelines. To offer nonpharmacological health management options and meet patient demand, the nation's largest integrated healthcare system, the Veterans Health Administration (VA), greatly expanded their provision of CIH approaches recently. OBJECTIVE This paper addressed the questions of how many VA patients might use CIH approaches and chiropractic care if they were available at modest to no fee, and would patients with some health conditions or characteristics be more likely than others to use these therapies. DESIGN Using electronic medical records, we conducted a national, three-year, retrospective analysis of VA patients' use of eleven VA-covered therapies: chiropractic care, acupuncture, Battlefield Acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga. PARTICIPANTS We created a national cohort of veterans using VA healthcare from October 2016-September 2019. KEY RESULTS Veterans' use of these approaches increased 70% in three years. By 2019, use was 5.7% among all VA patients, but highest among patients with chronic musculoskeletal pain (13.9%), post-traumatic stress disorder (PTSD; 10.6%), depression (10.4%), anxiety (10.2%), or obesity (7.8%). The approach used varied by age and race/ethnicity, with women being uniformly more likely than men to use each approach. Patients having chronic musculoskeletal pain, obesity, anxiety, depression, or PTSD were more likely than others to use each of the approaches. CONCLUSIONS Veterans' use of some approaches rapidly grew recently and was robust, especially among patients most in need. This information might help shape federal/state health policy on the provision of evidence-based CIH approaches and guide other healthcare institutions considering providing them.
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Affiliation(s)
- Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, Greater Los Angeles VA Healthcare System, MC 151, 11301 Wilshire, Bldg. 206, 2nd Floor, Los Angeles, CA, 90073, USA.
- Department of Medicine and Department of Health Policy and Management, UCLA, Los Angeles, CA, USA.
| | - Hannah M Gelman
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Rian DeFaccio
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Jamie Douglas
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Matthew J Hawrilenko
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Nathan K McGinty
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Adam Resnick
- Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, Greater Los Angeles VA Healthcare System, MC 151, 11301 Wilshire, Bldg. 206, 2nd Floor, Los Angeles, CA, 90073, USA
| | - Nathan C Tomlanovich
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Joy Toyama
- Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, Greater Los Angeles VA Healthcare System, MC 151, 11301 Wilshire, Bldg. 206, 2nd Floor, Los Angeles, CA, 90073, USA
| | - Alison M Whitehead
- Integrative Health Coordinating Center, Office of Patient-Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Benjamin Kligler
- Integrative Health Coordinating Center, Office of Patient-Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Bokhour BG, Hyde J, Kligler B, Gelman H, Gaj L, Barker AM, Douglas J, DeFaccio R, Taylor SL, Zeliadt SB. From patient outcomes to system change: Evaluating the impact of VHA's implementation of the Whole Health System of Care. Health Serv Res 2022; 57 Suppl 1:53-65. [PMID: 35243621 DOI: 10.1111/1475-6773.13938] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/22/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe how a partnered evaluation of the Whole Health (WH) system of care-comprised of the WH pathway, clinical care, and well-being programs-produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change. DATA SOURCES Electronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers. STUDY DESIGN In partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR. DATA COLLECTION Pharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes. PRINCIPAL FINDINGS Opioid use decreased 23% (31.5-6.5) to 38% (60.3-14.4) among WH users depending on level of WH use compared to a secular 11% (12.0-9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0.025), and perceived stress (SMD = 0.191). CONCLUSIONS Evidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA.
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Affiliation(s)
- Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Benjamin Kligler
- Office of Patient Centered Care & Cultural Transformation, US Department of Veterans Affairs, Washington, District of Columbia, USA.,Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, Brooklyn, New York, USA
| | - Hannah Gelman
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Lauren Gaj
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Anna M Barker
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Jamie Douglas
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Rian DeFaccio
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA School of Public Health, Los Angeles, California, USA
| | - Steven B Zeliadt
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
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Elwy AR, Taylor SL. Progress of Veterans Health Administration Complementary and Integrative Health Research Along the Quality Enhancement Research Initiative Implementation Roadmap. Med Care 2020; 58 Suppl 2 9S:S75-S77. [PMID: 32826774 DOI: 10.1097/mlr.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Rani Elwy
- VA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Stephanie L Taylor
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles VA Medical Center
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA
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