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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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Gilanyi YL, Shah B, Cashin AG, Gibbs MT, Bellamy J, Day R, McAuley JH, Jones MD. Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence. Pain 2024:00006396-990000000-00578. [PMID: 38635470 DOI: 10.1097/j.pain.0000000000003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.
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Affiliation(s)
- Yannick L Gilanyi
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Brishna Shah
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Mitchell T Gibbs
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Jessica Bellamy
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Richard Day
- St Vincent's Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Ames H, Hestevik CH, Briggs AM. Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatr 2024; 24:24. [PMID: 38182977 PMCID: PMC10768085 DOI: 10.1186/s12877-023-04608-4] [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] [Received: 03/29/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Chronic primary low back pain (CPLBP) and other musculoskeletal conditions represent a sizable attribution to the global burden of disability, with rates greatest in older age. There are multiple and varied interventions for CPLBP, delivered by a wide range of health and care workers. However, it is not known if these are acceptable to or align with the values and preferences of care recipients. The objective of this synthesis was to understand the key factors influencing the acceptability of, and values and preferences for, interventions/care for CPLBP from the perspective of people over 60 and their caregivers. METHODS We searched MEDLINE, CINAHL and OpenAlex, for eligible studies from inception until April 2022. We included studies that used qualitative methods for data collection and analysis; explored the perceptions and experiences of older people and their caregivers about interventions to treat CPLBP; from any setting globally. We conducted a best fit framework synthesis using a framework developed specifically for this review. We assessed our certainty in the findings using GRADE-CERQual. RESULTS All 22 included studies represented older people's experiences and had representation across a range of geographies and economic contexts. No studies were identified on caregivers. Older people living with CPLBP express values and preferences for their care that relate to therapeutic encounters and the importance of therapeutic alliance, irrespective of the type of treatment, choice of intervention, and intervention delivery modalities. Older people with CPLBP value therapeutic encounters that validate, legitimise, and respect their pain experience, consider their context holistically, prioritise their needs and preferences, adopt a person-centred and tailored approach to care, and are supported by interprofessional communication. Older people valued care that provided benefit to them, included interventions beyond analgesic medicines alone and was financially and geographically accessible. CONCLUSIONS These findings provide critical context to the implementation of clinical guidelines into practice, particularly related to how care providers interact with older people and how components of care are delivered, their location and their cost. Further research is needed focusing on low- and middle-income settings, vulnerable populations, and caregivers.
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Affiliation(s)
- Heather Ames
- The Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | | | - Andrew M Briggs
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
- Faculty of Health Sciences, Curtin University, PO Box U1987, Perth, 6845, Western Australia
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Lee DJ, Miller CA, Gambale A, Nisani M, Marra M, Leung ER, Chillianis D, Rodgers M. Survey of physical activity in persons with limb loss during the COVID-19 pandemic in the United States. Prosthet Orthot Int 2022; 46:220-226. [PMID: 35121718 DOI: 10.1097/pxr.0000000000000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Physical activity has been shown to be fundamental in the prevention of numerous diseases and disorders. Achieving and maintaining physical activity levels can be particularly challenging in those with impairments, such as those experiencing a lower limb amputation. To slow the spread of the virus, COVID-19 lockdown mandates imposed by the US state governments may have inadvertent consequences on physical activity levels of those dependent on specific forms of exercise. Understanding how physical activity levels may have affected persons with limb loss can inform intervention strategies for this vulnerable population. OBJECTIVES Examine the effects of the COVID-19 pandemic on physical activity levels in persons with limb loss. STUDY DESIGN Mixed-method design. METHODS A 20-item logic web-based survey and semistructured interviews were administered to individuals who were 18 years or older, spoke English, and had a history of lower limb loss. Quantitative data were analyzed using SPSS v25, whereas qualitative data were analyzed using constant comparison to formulate themes. RESULTS There were a significant effect on the amount of physical activity minutes performed per day, a negative effect on the ability to exercise and participate in societal engagements, and a series of barriers to performing physical activity because of the pandemic. CONCLUSION Physical activity was reduced significantly in persons with limb loss during the COVID-19 pandemic. A combination of health concerns, fitness center closures, and social distancing mandates were the primary drivers behind the decrease in activity.
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Affiliation(s)
| | - Carol A Miller
- Philadelphia College of Osteopathic Medicine, Suwanee, GA
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Lin TR, Huang XY, Hwu CM. Exercise Experiences of Older Adults with Diabetes and Sarcopenia: A Phenomenological Study. Clin Nurs Res 2021; 31:292-300. [PMID: 34382424 DOI: 10.1177/10547738211039381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcopenia is a common and progressive skeletal muscle condition, often described as an intermediate stage in the development of frailty and disability in patients with diabetes. This can be improved through physical activity and exercise. This descriptive phenomenological study explored the exercise experiences of older adults with diabetes and sarcopenia. Individual interviews were conducted following semi-structured interview guidelines, and narratives were analyzed using Giorgi's method. Data saturation was achieved after interviewing 14 purposively sampled older patients with diabetes and sarcopenia. The study identified three main themes: encountering difficulty during exercise, recognizing the advantages of exercise, and constructing a suitable exercise model. While older adults with diabetes and sarcopenia may encounter difficulty during exercise, they also experience positive feedback from exercise. Understanding the limitations of older adults, individualizing exercise models based on their exercise experiences, and providing appropriate interventions and necessary emotional support can effectively prevent diabetes and sarcopenia.
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Affiliation(s)
- Ting-Ru Lin
- National Taipei University of Nursing and Health Sciences, Taipei
| | - Xuan-Yi Huang
- National Taipei University of Nursing and Health Sciences, Taipei
| | - Chii-Min Hwu
- Taipei Veterans General Hospital, Metabolism Medicine, Taipei
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