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Choudry E, Rofé KL, Konnyu K, Marshall BDL, Shireman TI, Merlin JS, Trivedi AN, Schmidt C, Bhondoekhan F, Moyo P. Treatment Patterns and Population Characteristics of Nonpharmacological Management of Chronic Pain in the United States' Medicare Population: A Scoping Review. Innov Aging 2023; 7:igad085. [PMID: 38094932 PMCID: PMC10714895 DOI: 10.1093/geroni/igad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Clinical practice guidelines recommend noninvasive nonpharmacological pain therapies; however, reviews that assess the literature pertaining to nonpharmacological pain management among older adults and people with long-term disabilities who are disproportionately affected by pain are lacking. This scoping review aimed to systematically map and characterize the existing studies about the receipt of noninvasive, nonpharmacological pain therapies by Medicare beneficiaries. Research Design and Methods We conducted a literature search in MEDLINE (PubMed), CINAHL (EBSCO), SocINDEX (EBSCO), Cochrane Library, Web of Science citation indices, and various sources of gray literature. The initial search was conducted on November 2, 2021, and updated on March 9, 2022. Two independent reviewers screened titles, abstracts, and full texts for inclusion and extracted the characteristics of the studies, studied populations, and nonpharmacological pain therapies. Data were summarized using tabular and narrative formats. Results The final review included 33 studies. Of these, 24 were quantitative, 7 were qualitative, and 2 were mixed-methods studies. Of 32 studies that focused on Medicare beneficiaries, 10 did not specify the Medicare type, and all but one of the remaining studies were restricted to fee-for-service enrollees. Back and neck pain and arthritis were the most commonly studied pain types. Chiropractic care (n = 19) and physical therapy (n = 17) appeared frequently among included studies. The frequency and/or duration of nonpharmacological treatment were mentioned in 13 studies. Trends in the utilization of nonpharmacological pain therapies were assessed in 6 studies but none of these studies went beyond 2008. Discussion and Implications This scoping review found that manipulative therapies, mainly chiropractic, have been the most widely studied approaches for nonpharmacological pain management in the Medicare population. The review also identified the need for future research that updates trend data and addresses contemporary issues such as rising Medicare Advantage enrollment and promulgation of practice guidelines for pain management.
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Affiliation(s)
- Erum Choudry
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Kara L Rofé
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Kristin Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Division of Infectious Disease, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amal N Trivedi
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Catherine Schmidt
- Department of Physical Therapy, Massachusetts General Hospital Institute of Health Professions, School of Health and Rehabilitation Sciences, Boston, Massachusetts, USA
| | - Fiona Bhondoekhan
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Patience Moyo
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
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Chen YY, Weng LC, Li YT, Huang HL. Mediating effect of self-efficacy on the relationship between social support and self-management behaviors among patients with knee osteoarthritis: a cross-sectional study. BMC Geriatr 2022; 22:635. [PMID: 35918645 PMCID: PMC9344710 DOI: 10.1186/s12877-022-03331-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Good self-management behaviors in patients with knee osteoarthritis can improve disease awareness, treatment effectiveness, quality of life, and reduce medical costs. However, there is a paucity of studies focusing on patients with knee osteoarthritis. Therefore, the purpose of this study was to explore the mediating effect of self-efficacy on aspects of social support and self-management behaviors in this population. METHODS This study employed a cross-sectional design and convenience sampling to survey patients with knee osteoarthritis in an outpatient department of a regional hospital in northern Taiwan from February 22, 2021, to April 15, 2021. The inclusion criteria for patients were (1) those diagnosed by a physician with knee osteoarthritis and (2) who could communicate in Chinese or Taiwanese. Participants were asked to complete a demographic questionnaire, the Arthritis Self-Efficacy Scale (ASE), the Inventory of Socially Supportive Behavior (including enacted support and perceived social support), and the Arthritis Self-Management Assessment Tool (ASMAT). In addition, the Kellgren-Lawrence Grading Scale was obtained from a chart review. Data were analyzed with descriptive statistics, t-test, one-way analysis of variance, Pearson product-moment correlation, and mediation analysis. RESULTS A total of 140 patients met the inclusion criteria. The mean age of participants was 70.21 ± 10.84years; most (73.6%) were female. The mean total score of the ASMAT was 64.27 ± 14.84. Scores for the ASE, enacted support, and perceived social support were significantly positively correlated with ASMAT (all p < .001). The standardized coefficient for total effect and direct effect of perceived social support on ASMAT was 0.899 (p < .001) and 0.754 (p < .05), respectively. After introducing the ASE into the model, the indirect effect was 0.145 (p < .05), which indicated that ASE had a partial mediating effect on the relationship between perceived social support and ASMAT. CONCLUSION Our findings might suggest that perceived social support indirectly affected ASMAT through ASE. Therefore, interventions designed to increase self-efficacy and social support could enhance self-management behaviors for patients with knee osteoarthritis.
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Affiliation(s)
- Yi-Yi Chen
- Department of Preventive Healthcare and Community Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yang-Tzu Li
- Department of Long Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Hsiu-Li Huang
- Department of Long Term Care, College of Health Technology, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
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Vina ER, Tsoukas PH, Abdollahi S, Mody N, Roth SC, Redford AH, Kwoh CK. Racial and ethnic differences in the pharmacologic management of osteoarthritis: rapid systematic review. Ther Adv Musculoskelet Dis 2022; 14:1759720X221105011. [PMID: 35794906 PMCID: PMC9251972 DOI: 10.1177/1759720x221105011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Racial and ethnic disparities in osteoarthritis (OA) patients' disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments. Objectives The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA. Data sources and methods A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations. Conclusion This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.
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Affiliation(s)
- Ernest R Vina
- Section of Rheumatology, Lewis Katz School of Medicine, Temple University, 201 MOB, 3322 N. Broad Street, Philadelphia, PA 19140, USA
| | - Philip H Tsoukas
- Section of Rheumatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shahrzad Abdollahi
- Section of Rheumatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Nidhi Mody
- Section of Rheumatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Stephanie C Roth
- Health Sciences Library, Temple University, Philadelphia, PA, USA
| | - Albert H Redford
- The University of Arizona Arthritis Center and Division of Rheumatology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - C Kent Kwoh
- The University of Arizona Arthritis Center and Division of Rheumatology, College of Medicine, University of Arizona, Tucson, AZ, USA
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Patel M, Johnson AJ, Booker SQ, Bartley EJ, Palit S, Powell-Roach K, Terry EL, Fullwood D, DeMonte L, Mickle AM, Sibille KT. Applying the NIA Health Disparities Research Framework to Identify Needs and Opportunities in Chronic Musculoskeletal Pain Research. THE JOURNAL OF PAIN 2021; 23:25-44. [PMID: 34280570 DOI: 10.1016/j.jpain.2021.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
Disparities in the experience of chronic musculoskeletal pain in the United States stem from a confluence of a broad array of factors. Organized within the National Institute on Aging Health Disparity Research Framework, a literature review was completed to evaluate what is known and what is needed to move chronic musculoskeletal pain research forward specific to disproportionately affected populations. Peer-reviewed studies published in English, on human adults, from 2000 to 2019, and conducted in the United States were extracted from PubMed and Web of Science. Articles were reviewed for key words that focused on underrepresented ethnic/race groups with chronic musculoskeletal pain applying health factor terms identified in the NIAHealth Disparity Research Framework four levels of analysis: 1) environmental, 2) sociocultural, 3) behavioral, and 4) biological. A total of 52 articles met inclusion criteria. There were limited publications specific to underrepresented ethnic/race groups with chronic musculoskeletal pain across all levels with particular research gaps under sociocultural and biological categories. Current limitations in evidence may be supplemented by a foundation of findings specific to the broader topic of "chronic pain" which provides guidance for future investigations. Study designs including a focus on protective factors and multiple levels of analyses would be particularly meritorious. PERSPECTIVE: Chronic musculoskeletal pain unequally burdens underrepresented ethnic/race groups. In order to move research forward and to systematically investigate the complex array of factors contributing toward health disparities, an organized approach is necessary. Applying the NIA Health Disparities Research Framework, an overview of the current state of evidence specific to chronic musculoskeletal pain and underrepresented ethnic/race groups is provided with future directions identified.
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Affiliation(s)
- Monika Patel
- Department of Anesthesiology, Division of Pain Medicine, University of Florida Health at Jacksonville, Jacksonville, Florida
| | - Alisa J Johnson
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Shreela Palit
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Dottington Fullwood
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida
| | - Lucas DeMonte
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Angela M Mickle
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida; Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, Florida.
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Houlding-Braunberger E, Petkovic J, Lebel N, Tugwell P. Experts prioritize osteoarthritis non-surgical interventions from Cochrane systematic reviews for translation into "Evidence4Equity" summaries. Int J Equity Health 2021; 20:136. [PMID: 34112156 PMCID: PMC8193871 DOI: 10.1186/s12939-021-01477-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Osteoarthritis generates substantial health and socioeconomic burden, which is particularly marked in marginalized groups. It is imperative that practitioners have ready access to summaries of evidence-based interventions for osteoarthritis that incorporate equity considerations. Summaries of systematic reviews can provide this. The present study surveyed experts to prioritize a selection ofinterventions, from which equity focused summaries will be generated. Specifically, the prioritized interventions will be developed into Cochrane Evidence4Equity (E4E) summaries. METHODS Twenty-seven systematic reviews of OA interventions were found. From these, twenty-nine non-surgical treatments for osteoarthritis were identified, based on statistically significant findings for desired outcome variables or adverse events. Key findings from these studies were summarised and provided to 9 experts in the field of osteoarthritis.. Expert participants were asked to rate interventions based on feasibility, health system effects, universality, impact on inequities, and priority for translation into equity based E4E summaries. Expert participants were also encouraged to make comments to provide context for each rating. Free text responses were coded inductively and grouped into subthemes and themes. RESULTS Expert participants rated the intervention home land-based exercise for knee OA highest for priority for translation into an E4E summaries, followed by the interventions individual land-based exercise for knee OA, class land-based exercise for knee OA, exercise for hand OA and land-based exercise for hip OA. Upon qualitative analysis of the expert participants' comments, fifteen subthemes were identified and grouped into three overall themes: (1) this intervention or an aspect of this intervention is unnecessary or unsafe; (2) this intervention or an aspect of this intervention may increase health inequities; and (3) experts noted difficulties completing rating exercise. CONCLUSION The list of priority interventions and corresponding expert commentary generated information that will be used to direct and support knowledge translation efforts.
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Affiliation(s)
- Elizabeth Houlding-Braunberger
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Science, University of Ottawa, Ottawa, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
- WHO Collaborating Centre for knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Nicholas Lebel
- Faculty of Science, University of Ottawa, Ottawa, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- WHO Collaborating Centre for knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada.
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
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Johnson AJ, Palit S, Terry EL, Thompson OJ, Powell-Roach K, Dyal BW, Ansell M, Booker SQ. Managing osteoarthritis pain with smart technology: a narrative review. Rheumatol Adv Pract 2021; 5:rkab021. [PMID: 33928214 PMCID: PMC8068316 DOI: 10.1093/rap/rkab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Osteoarthritis (OA) is a highly prevalent musculoskeletal condition worldwide. More than 300 million individuals are affected by OA, and pain is the most common and challenging symptom to manage. Although many new advances have led to improved OA-related pain management, smart technology offers additional opportunities to enhance symptom management. This narrative review identifies and describes the current literature focused on smart technology for pain management in individuals with OA. In collaboration with a health sciences librarian, an interdisciplinary team of clinician-scientists searched multiple databases (e.g. PubMed, CINAHL and Embase), which generated 394 citations for review. After inclusion criteria were met, data were extracted from eight studies reporting on varied smart technologies, including mobile health, wearables and eHealth tools to measure or manage pain. Our review highlights the dearth of research in this crucial area, the implications for clinical practice and technology development, and future research needs.
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Affiliation(s)
- Alisa J Johnson
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Shreela Palit
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Osheeca J Thompson
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
| | - Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing
| | - Margaret Ansell
- George A. Smathers Libraries, Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry
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Vina ER, Hannon MJ, Quinones C, Hausmann LRM, Ibrahim SA, Dagnino J, Kwoh CK. The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use. ACR Open Rheumatol 2021; 3:154-163. [PMID: 33570233 PMCID: PMC7966879 DOI: 10.1002/acr2.11235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA). METHODS Surveys of 334 adults with knee and/or hip OA were analyzed in this cross-sectional study. Familiarity with and perceptions of benefits/risks of NSAID use were measured to assess associations with the use of prescription and nonprescription oral NSAIDs. Multinomial logistic regression models were adjusted for sociodemographic and clinical variables. RESULTS In this sample, 35.9% and 35.6% reported use of oral prescription and nonprescription-only NSAIDs, respectively. Hispanic participants, compared with non-Hispanic White participants, had lower perceived benefit (P = 0.005) and risk (P = 0.001) of prescription NSAIDs. The following were associated with prescription NSAID use instead of no NSAID use: having family/friends who used prescription (relative risk ratio [RRR] 3.91; 95% confidence interval [CI] 2.05-7.47) and over-the-counter (OTC) (RRR 3.10; 95% CI 1.65-5.83) NSAIDs for OA, understanding the consequences of using both prescription (RRR 3.50; 95% CI 1.79-6.86) and OTC (RRR 2.80; 95% CI 1.39-5.65) NSAIDs, higher perceived benefit of both prescription (RRR 2.51; 95% CI 1.71-3.66) and OTC (RRR 1.44; 95% CI 1.01-2.06) NSAIDs, and lower perceived risk of both types of NSAIDs (prescription: RRR 0.63 [95% CI 0.46-0.87]; OTC: RRR 0.53 [95% CI 0.37-0.75]). Similar results were found when we assessed the relationship between these variables and OTC NSAID use versus no oral NSAID use. CONCLUSION Adults with knee and/or hip OA were more likely to use NSAIDs if they were more familiar with, had an increased perceived benefit of, and had a decreased perceived risk of these drugs. Patients' perceptions and beliefs about NSAIDs should be evaluated when considering them for treatment.
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Affiliation(s)
| | | | | | - L. R. M. Hausmann
- US Department of Veterans Affairs Pittsburgh Healthcare System and University of PittsburghPittsburghPennsylvania
| | - S. A. Ibrahim
- Weill Cornell MedicineCornell UniversityNew YorkNew York
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Abstract
This article reviews the literature on racial and socioeconomic disparities in the management of osteoarthritis. Treatments investigated include arthritis education, dietary weight management, exercise/physical therapy, pharmacologic therapy with nonsteroidal antiinflammatory drugs and opioids, intra-articular steroid injections, and total joint replacement. The amount of evidence for each treatment modality varied, with the most evidence available for racial and socioeconomic disparities in total joint arthroplasty. Black patients, Hispanic patients, and patients with low socioeconomic status (SES) are less likely to undergo total joint replacement than white patients or patients with high SES, and generally have worse functional outcomes and more complications.
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Affiliation(s)
- Angel M Reyes
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, BWH Orthopaedics, OrACORe Group, 75 Francis Street, BTM Suite 5016, Boston, MA 02115, USA.
| | - Jeffrey N Katz
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, BWH Orthopaedics, OrACORe Group, 75 Francis Street, BTM Suite 5016, Boston, MA 02115, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Booker S, Herr K, Tripp-Reimer T. Patterns and Perceptions of Self-Management for Osteoarthritis Pain in African American Older Adults. PAIN MEDICINE 2020; 20:1489-1499. [PMID: 30541043 DOI: 10.1093/pm/pny260] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore and describe older African Americans' patterns and perceptions of managing chronic osteoarthritis pain. METHODS A convergent parallel mixed-methods design incorporating cross-sectional surveys and individual, semistructured interviews. SETTING One hundred ten African Americans (≥50 years of age) with clinical osteoarthritis (OA) or provider-diagnosed OA from communities in northern Louisiana were enrolled. RESULTS Although frequency varied depending on the severity of pain, older African Americans actively used an average of seven to eight self-management strategies over the course of a month to control pain. The average number of self-management strategies between high and low education and literacy groups was not statistically different, but higher-educated adults used approximately one additional strategy than those with high school or less. To achieve pain relief, African Americans relied on 10 self-management strategies that were inexpensive, easy to use and access, and generally perceived as helpful: over-the-counter (OTC) topicals, thermal modalities, land-based exercise, spiritual activities, OTC and prescribed analgesics, orthotic and assistive devices, joint injections, rest, and massage and vitamins. CONCLUSIONS This is one of the first studies to quantitatively and qualitatively investigate the self-management of chronic OA pain in an older African American population that happened to be a predominantly higher-educated and health-literate sample. Findings indicate that Southern-dwelling African Americans are highly engaged in a range of different self-management strategies, many of which are self-initiated. Although still an important component of chronic pain self-management, spirituality was used by less than half of African Americans, but use of oral nonsteroidal anti-inflammatory drugs and opioids was relatively high.
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Affiliation(s)
- Staja Booker
- Pain Research and Intervention Center of Excellence, The University of Florida, Gainesville, Florida
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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Johnson AJ, Sibille KT, Cardoso J, Terry EL, Powell-Roach KL, Goodin B, Staud R, Redden D, Fillingim RB, Booker SQ. Patterns and Correlates of Self-Management Strategies for Osteoarthritis-Related Pain Among Older Non-Hispanic Black and Non-Hispanic White Adults. Arthritis Care Res (Hoboken) 2020; 73:1648-1658. [PMID: 32741127 DOI: 10.1002/acr.24396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a leading source of pain and disability among older adults. Self-management (SM) strategies are recommended to manage OA symptoms. Sociodemographic and clinical characteristics, along with other factors, may influence SM utilization rate. This study sought to examine the prevalence and correlates of SM use for pain among non-Hispanic Black patients (NHB) and non-Hispanic White patients (NHW) older adults with or at risk for knee OA. METHODS A secondary data analysis was conducted on the Understanding Pain and Limitations in Osteoarthritic Disease multisite observational study, which included NHB (n = 104) and NHW (n = 98) community-dwelling older adults with or at risk for knee OA. Participants completed measures of sociodemographics, pain SM use, coping, and clinical and experimental pain. RESULTS Clinical and experimental pain were significantly greater among NHBs compared to NHWs. There were no significant differences in use of total SM by ethnicity/race. Interestingly, multiple linear regression revealed that clinical and experimental pain indices, as well as coping, number of pain sites, age, and sex were differentially associated with total SM use between NHBs and NHWs. There were significant ethnicity/race by type of pain management interaction effects for pain measures. CONCLUSION SM is common among older adults with or at risk for knee OA pain, and the prevalence of SM does not differ by ethnicity/race, but many guideline-recommended interventions for OA are underutilized. Importantly, different factors were associated with the use of SM, highlighting distinct biopsychosocial mechanisms contributing to SM use in NHBs and NHWs.
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Booker SQ, Tripp-Reimer T, Herr KA. "Bearing the Pain": The Experience of Aging African Americans With Osteoarthritis Pain. Glob Qual Nurs Res 2020; 7:2333393620925793. [PMID: 32548212 PMCID: PMC7271276 DOI: 10.1177/2333393620925793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022] Open
Abstract
Studies document that osteoarthritis-related joint pain is more severe in
African American older adults, but research on the personal experience
of osteoarthritis pain self-management in this population is limited.
Using a qualitative descriptive design, our objective was to extend
our understanding of the experience of life with osteoarthritis pain.
Eighteen African Americans (50 years and older) were recruited from
Louisiana to participate in a single semi-structured, in-depth
interview. A conventional content analysis revealed that “Bearing the
pain” characterized how older African Americans dealt with
osteoarthritis. Bearing the pain comprised three actions: adjusting to
pain, sharing pain with others, and trusting God as healer. We
discovered that a metapersonal experience subsumes the complex
biopsychosocial-cultural patterns and the intricate interaction of
self, others, and God in living with and managing osteoarthritis pain.
Study findings have implications for application of more inclusive
self-management frameworks and interventions.
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Vina ER, Hannon MJ, Masood HS, Hausmann LRM, Ibrahim SA, Dagnino J, Arellano A, Kwoh CK. Nonsteroidal Anti-Inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity. Am J Med 2020; 133:733-740. [PMID: 31862331 PMCID: PMC7293947 DOI: 10.1016/j.amjmed.2019.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Our objective was to determine if there are ethnic differences in the use of over-the-counter (OTC) and prescription oral nonsteroidal anti-inflammatory drugs (NSAIDs) and if observed ethnic differences persist after adjustment for sociodemographic and clinical factors. METHODS Knee and hip osteoarthritis study participants were identified. Surveys were administered to collect sociodemographics, clinical information, and oral treatment methods for arthritis. Multivariable logistic regression models were created using a fully conditional method. RESULTS Hispanics (n = 130), compared to non-Hispanic whites (n = 204), were less likely to have a high school education (26.9% vs 63.2%, P <0.001), less likely to have private medical insurance (P <0.001), and more likely to have worse health (P = 0.004). OTC oral NSAID use was less common (52.9% vs 66.3%, P = 0.019), whereas prescription oral NSAID use was more common (43.4% vs 31.7%, P = 0.042) among Hispanics than non-Hispanic whites in the last 6 months. The ethnic difference in using an OTC NSAID instead of not using any oral NSAID was attenuated and no longer significant when adjusted for age, sex, education, and medical insurance (odds ratio [OR] 0.54 [95% confidence interval [CI]: 0.28-1.02]). The odds of using a prescription instead of an OTC NSAID remained significantly higher among Hispanics than non-Hispanic whites when adjusted for the same variables (odds ratio 2.17 [95% confidence interval: 1.16-4.05]). CONCLUSIONS Among patients with osteoarthritis, OTC NSAIDs were less commonly used but prescription NSAIDs were more commonly used by Hispanics than non-Hispanic whites. Sociodemographic factors partially mediate ethnic differences in the use of oral NSAIDs.
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Affiliation(s)
- Ernest R Vina
- University of Arizona Arthritis Center, Tucson, Arizona; College of Medicine, Department of Medicine, Division of Rheumatology, University of Arizona, Tucson, Arizona.
| | | | - Hana S Masood
- College of Medicine, Department of Medicine, Division of Rheumatology, University of Arizona, Tucson, Arizona
| | - Leslie R M Hausmann
- Pinney Associates, Pittsburgh, Pennsylvania; Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
| | - Said A Ibrahim
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | | | | | - C Kent Kwoh
- University of Arizona Arthritis Center, Tucson, Arizona; College of Medicine, Department of Medicine, Division of Rheumatology, University of Arizona, Tucson, Arizona
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Booker S, Herr K, Tripp-Reimer T. Black American older adults' motivation to engage in osteoarthritis treatment recommendations for pain self-management: A mixed methods study. Int J Nurs Stud 2019; 116:103510. [PMID: 32169337 PMCID: PMC7314646 DOI: 10.1016/j.ijnurstu.2019.103510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Osteoarthritis is a long-term condition, and four core treatments are recommended to minimize the interference of pain and symptoms on their daily function. However, older Black Americans have traditionally been at a disadvantage in regard to knowledge of and engagement in chronic disease self-management and self-care. Surprisingly, minimal research has addressed understanding motivational factors key to self-management behaviors. Thus, it is important to understand if older Black Americans' self-management is supported by current recommendations for the management of symptomatic osteoarthritis and what factors limit or motivate engagement in recommended treatments. OBJECTIVE Our objectives are to: (1) identify stage of engagement in four core recommended treatments for osteoarthritis, (2) describe the barriers and motivators to these recommended treatments, and (3) construct an understanding of the process of pain self-management motivation. DESIGN A mixed-methods concurrent parallel design. SETTING Participants were recruited from communities in northern Louisiana, USA. PARTICIPANTS Black Americans (≥50 years of age) with clinical osteoarthritis and/or provider-diagnosed osteoarthritis were enrolled. One hundred ten participants completed the study, and 18 of these individuals were also interviewed individually. METHODS Data were collected using in-person surveys and interviews. Over a period of 11 months, close- and open-ended surveys and in-depth interviews were conducted with participants. Descriptive statistics describe utilization/engagement level as well as barriers and motivators of recommended treatments for non-surgical osteoarthritis. Content and thematic analyses of interviews summarized perspectives on the process and role of motivation in pain self-management. RESULTS Overall, engagement levels in treatments ranged from very low to high. Over 55% of older Black Americans were actively engaged in two of the recommended treatments: land-based exercise and strength training. Major motivators included reduction in pain and stiffness and maintenance of mobility and good health. The majority of participants were not using water-based exercise and self-management education. Primary barriers were lack of access, time, and knowledge of resources. CONCLUSIONS In order to maximize the benefits of osteoarthritis pain self-management, older Black Americans must be equipped with the motivation, resources, information and skills, and time to engage in recommended treatment options. Their repertoire of behavioral self-management did not include two key treatments and is inconsistent with what is recommended, predominantly due to barriers that are difficult to overcome. In these cases, motivation alone is not optimal in promoting self-management. Providers, researchers, and community advocates should work collaboratively to expand access to self-management resources, particularly when personal and community motivation are high.
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Affiliation(s)
- Staja Booker
- University of Florida, College of Nursing, PO Box 100197, Gainesville, FL 32610, United States.
| | - Keela Herr
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, United States.
| | - Toni Tripp-Reimer
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, United States.
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14
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Vina E, Hausmann L, Obrosky D, Youk A, Ibrahim S, Weiner D, Gallagher R, Kwoh C. Social & psychological factors associated with oral analgesic use in knee osteoarthritis management. Osteoarthritis Cartilage 2019; 27:1018-1025. [PMID: 30716537 PMCID: PMC6579618 DOI: 10.1016/j.joca.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/02/2019] [Accepted: 01/23/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA. METHODS Patients were categorized based on use of the following oral medications: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study scale), health literacy ("How confident are you filling out medical forms by yourself?"), and depressive symptoms (Patient Health Questionnaire-8). Models were adjusted for demographic and clinical characteristics. RESULTS In this sample (mean age 64.2 years, 23.6% women), 30.6% (n = 110) reported taking opioid analgesics for OA, 54.2% (n = 195) reported non-opioid use, and 15.3% (n = 55) reported no oral analgesic use. Opioid users had lower mean social support scores (10.0 vs 10.5 vs 11.9, P = 0.007) and were more likely to have moderate-severe depressive symptoms (42.7% vs 24.1% vs 14.5%, P < 0.001). Health literacy did not differ by treatment group type. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95%CI 1.08-8.07) when adjusted for sociodemographic and clinical factors. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. CONCLUSIONS Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid analgesics for OA.
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Affiliation(s)
- E.R. Vina
- College of Medicine and UA Arthritis Center, University of Arizona (UA), Tucson, AZ, USA,Address correspondence and reprint requests to: Ernest R. Vina, MD, MS, University of Arizona Arthritis Center, 1501 N. Campbell Ave., PO Box 245093, Tucson, AZ 85724-5093. Tel.#: (520) 626-4206. Fax #: (520) 626-2587.
| | - L.R.M. Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, USA,School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - D.S. Obrosky
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, USA
| | - A. Youk
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, USA,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - S.A. Ibrahim
- Weill Cornell Medicine, Department of Healthcare Policy & Research, Cornell University, New York, NY, USA
| | - D.K. Weiner
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Geriatric Research, Education & Clinical Center, VAPHS, Pittsburgh, PA, USA
| | - R.M. Gallagher
- CHERP, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA,School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C.K. Kwoh
- College of Medicine and UA Arthritis Center, University of Arizona (UA), Tucson, AZ, USA
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Pain Treatment Practices of Community-Dwelling Black Older Adults. Pain Manag Nurs 2018; 19:46-53. [DOI: 10.1016/j.pmn.2017.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/17/2022]
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16
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Rezakhani Moghaddam H, Nadrian H, Abbagolizadeh N, Babazadeh T, Aghemiri M, Fathipour A. Mental Health-Ill Health Differences in Disease Severity and Its Sociodemographic Biobehavioral Predictors Among Patients With Knee Osteoarthritis. Clin Nurs Res 2018; 28:886-904. [PMID: 29325433 DOI: 10.1177/1054773817751527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our aim in this cross-sectional study was to investigate mental health-ill health differences in disease severity and its sociodemographic biobehavioral predictors among patients with knee osteoarthritis (OA). Applying convenient sampling, 180 patients with knee OA in Tabriz, Iran, were recruited to participate in completing a three-section questionnaire (SF-12, Lequesne Algofunctional Index and Self-Management Behaviors Scale). Separate hierarchical multiple linear regressions were performed with OA severity as dependent variable: one for OA patients with positive mental health and other for OA patients with mental disorders symptoms. Among the patients with positive mental health, but not those with symptoms of mental disorder, pain management, duration of OA, physical activity management, living alone, and level of education were significant predictors of disease severity. Health care providers with a better understanding on the determinants of disease severity by mental health status may identify vulnerable patients and develop targeted interventions to foster disease management behaviors among OA patients.
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17
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Lo-Ciganic WH, Floden L L, Lee JK, Ashbeck EL, Zhou L, Chinthammit C, Purdy AW, Kwoh CK. Analgesic use and risk of recurrent falls in participants with or at risk of knee osteoarthritis: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2017; 25:1390-1398. [PMID: 28385483 PMCID: PMC5989560 DOI: 10.1016/j.joca.2017.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Few studies have compared the risk of recurrent falls across different types of analgesic use, and with limited adjustment for potential confounders (e.g., pain/depression severity). We assessed analgesic use and the subsequent risk of recurrent falls, among participants with or at risk of knee osteoarthritis (OA). METHODS A longitudinal analysis included 4231 participants aged 45-79 years at baseline with 4-year follow-up from the Osteoarthritis Initiative (OAI) cohort study. We grouped participants into six mutually exclusive subgroups based on annually assessed analgesic use in the following hierarchical order of analgesic/central nervous system (CNS) potency: use of (1) opioids, (2) antidepressants, (3) other prescription pain medications, (4) over-the-counter (OTC) pain medications, (5) nutraceuticals, and (6) no analgesics. We used multivariable modified Poisson regression models with a robust error variance to estimate the effect of analgesic use on the risk of recurrent falls (≥2) in the following year, adjusted for demographics and health status/behavior factors. RESULTS Opioid use increased from 2.7% at baseline to 3.6% at the 36-month visit (>80% using other analgesics/nutraceuticals), while other prescription pain medication use decreased from 16.7% to 11.9% over this time period. Approximately 15% of participants reported recurrent falls. Compared to those not using analgesics, participants who used opioids and/or antidepressants had a 22-25% increased risk of recurrent falls (opioids: RRadjusted = 1.22, 95% CI = 1.04-1.45; antidepressants: RRadjusted = 1.25, 95% CI = 1.10-1.41). CONCLUSION Participants with or at risk of knee OA who used opioids and antidepressants with/without other analgesics/nutraceuticals may have an increased risk of recurrent falls after adjusting for potential confounders. Use of opioids and antidepressants warrants caution.
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Affiliation(s)
- Wei-Hsuan Lo-Ciganic
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
| | - Lysbeth Floden L
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
| | - Jeannie K Lee
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
| | - Erin L. Ashbeck
- University of Arizona Arthritis Center, Tucson, Arizona, USA
| | - Lili Zhou
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
| | - Chanadda Chinthammit
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
| | - Abigail W Purdy
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
| | - C. Kent Kwoh
- University of Arizona Arthritis Center, Tucson, Arizona, USA,Department of Medicine, Division of Rheumatology, University of Arizona, Tucson, Arizona, USA
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18
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Hamilton CB, Wong MK, Gignac MAM, Davis AM, Chesworth BM. Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review. Pain Pract 2016; 17:99-114. [PMID: 26990402 DOI: 10.1111/papr.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/17/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. METHODS A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. RESULTS Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. CONCLUSIONS Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis.
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Affiliation(s)
- Clayon B Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Ming-Kin Wong
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Monique A M Gignac
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Aileen M Davis
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation, Rehabilitation Science Institute, Toronto, Ontario, Canada.,Departments of Physical Therapy and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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MacKay C, Badley EM, Jaglal SB, Sale J, Davis AM. "We're all looking for solutions": a qualitative study of the management of knee symptoms. Arthritis Care Res (Hoboken) 2014; 66:1033-40. [PMID: 24403242 PMCID: PMC4657457 DOI: 10.1002/acr.22278] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/27/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE While the prevalence of osteoarthritis (OA) increases with age, the first signs begin in the fourth or fifth decade. Little is known about how younger adults respond to OA. This study explores how people ages 35-65 years manage knee symptoms. METHODS Six focus groups were conducted with 41 participants (mean age 50.9 years, 63% women) who self-reported a diagnosis of OA or reported knee symptoms (i.e., pain, aching, or stiffness) on most days of the past month. Purposive sampling was used, seeking variation in age and sex. The principles of constructivist grounded theory guided data collection and analysis. Data were analyzed using a constant comparative method. RESULTS Participants engaged in a process of proactively trying to find ways to control knee symptoms and disease progression. Their approach to management was not linear, but rather a process that moved back and forth between searching for "solutions" and active management (ongoing use of strategies). During the process, participants consulted health care providers, but often perceived that medical care offered limited options and guidance. Management was constructed as a "never-ending" process that entailed effort and personal resources. CONCLUSION Participants were proactive in seeking ways to manage knee OA symptoms. There is a mismatch between participants' proactive approach and the reactive approach of the health care system that has focused on late-stage disease. Programs and supports within the formal and informal health care system are required to enable people to successfully manage knee symptoms across their lifespan.
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Affiliation(s)
- Crystal MacKay
- Toronto Western Research Institute and University of TorontoToronto, Ontario, Canada
| | - Elizabeth M Badley
- Toronto Western Research Institute and University of TorontoToronto, Ontario, Canada
| | - Susan B Jaglal
- University of Toronto and Toronto Rehab, University Health NetworkToronto, Ontario, Canada
| | - Joanna Sale
- University of Toronto and Li Ka Shing Knowledge Institute, St. Michael’s HospitalToronto, Ontario, Canada
| | - Aileen M Davis
- Toronto Western Research Institute and University of TorontoToronto, Ontario, Canada
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20
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Albert SM, Bix L, Bridgeman MM, Carstensen LL, Dyer-Chamberlain M, Neafsey PJ, Wolf MS. Promoting safe and effective use of OTC medications: CHPA-GSA National Summit. THE GERONTOLOGIST 2014; 54:909-18. [PMID: 24846884 DOI: 10.1093/geront/gnu034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Research on the ways older people use prescription medications (Rx) is a mainstay of the gerontological literature because use of Rx medications is common, and appropriate use is central to effective management of chronic disease. But older adults are also major consumers of over-the-counter (OTC) medications, which can be equally significant for self-care. Nearly half of older adults aged 75-85, for example, are regular users of an OTC product. Ensuring that consumers safely and effectively use OTC products is critical in order to minimize potential drug-drug interactions and unintentional misuse. Yet we know surprisingly little about the ways older adults select OTC medications and decide when to start or stop use, how older people actually take these medications, or how involved clinicians and family members are in older adult OTC behavior. Research in this area is critical for developing interventions to help ensure safe and appropriate OTC use. For this reason, The Gerontological Society of America (GSA), in partnership with the Consumer Healthcare Products Association (CHPA), convened a summit of experts to set an agenda for research in OTC behaviors among older adults. The panel suggested a need for research in 5 key areas: Health literacy and OTC behavior, decision making and OTC use, the role of clinicians in OTC medication behavior, older adult OTC behavior and family care, and technologies to promote optimal use of OTC medications.
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Affiliation(s)
- Steven M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania.
| | - Laura Bix
- School of Packaging, Michigan State University, Lansing
| | - Mary M Bridgeman
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Brunswick
| | - Laura L Carstensen
- Stanford Center on Longevity, Stanford University, Palo Alto, California
| | | | - Patricia J Neafsey
- School of Nursing and Center for Health Intervention and Prevention, University of Connecticut, Hartford
| | - Michael S Wolf
- General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois
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21
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Puia D, McDonald DD. Older black adult osteoarthritis pain communication. Pain Manag Nurs 2012; 15:229-35. [PMID: 23141080 DOI: 10.1016/j.pmn.2012.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 09/04/2012] [Accepted: 09/06/2012] [Indexed: 11/16/2022]
Abstract
A quantitative descriptive secondary data analysis design was used to describe older black adult communication of osteoarthritis pain and the communication strategies used to convey the pain information. Pain content from 74 older black adults with persistent osteoarthritis pain was analyzed using criteria from the American Pain Society arthritis pain management guidelines that included type of pain (nociceptive/neuropathic), quality of pain, source, location, intensity, duration/time course, pain affect, effect on personal lifestyle, functional status, current pain treatments, use of recommended glucosamine sulfate, effectiveness of prescribed treatments, prescription analgesic side effects, weight management to ideal body weight, exercise regimen or physical therapy and/or occupational therapy, and indications for surgery. Communication strategies were analyzed with criteria derived from Communication Accommodation Theory that included being clear, using medical syntax, using ethnic specific syntax, being explicit, and staying on topic when discussing pain. The majority of communicated pain content included pain location, intensity, and timing. Regarding communication strategies, most of the older black adults used specific descriptions of pain and remained on topic. Fewer used explicit descriptions of pain that produced a vivid mental image, and few used medical terminology. Use of medical syntax and more explicit descriptions might improve communication about pain between health care practitioners and patients. Practitioners might assist older black adults with persistent osteoarthritis pain to communicate important clinical pain information by helping them to use relevant medical terminology and more explicit pain descriptions when discussing pain management.
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Affiliation(s)
- Denise Puia
- University of Connecticut, School of Nursing, Storrs, Connecticut
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22
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Driban JB, Boehret SA, Balasubramanian E, Cattano NM, Glutting J, Sitler MR. Medication and supplement use for managing joint symptoms among patients with knee and hip osteoarthritis: a cross-sectional study. BMC Musculoskelet Disord 2012; 13:47. [PMID: 22458305 PMCID: PMC3337291 DOI: 10.1186/1471-2474-13-47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 03/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose was to determine the professionally-guided and self-guided medication and supplement use for joint symptom management among patients with knee and/or hip osteoarthritis (OA) in an urban hospital-based outpatient orthopedic practice. METHODS The study design was cross-sectional. Patients diagnosed by radiographs and clinical symptoms with knee and/or hip OA were recruited from an inner-city hospital-based outpatient orthopaedic office. A total of 184 patients were queried for their participation. Four investigator-generated, interview-based questionnaires were used. Sampling error was ±7.84%. Logistic regression models and Fisher Exact Tests were performed to determine factors that may be associated with negative behaviors related to medication or supplement use (e.g., reporting medication as ineffective, using multiple medications in the same day to manage symptoms). Odds ratios (OR) and 95% confidence intervals (CI) were calculated for significant findings. RESULTS Among the 162 participants, a majority reported professionally-guided recommendations and over 40% reported at least one self-guided intervention. 37 participants reported dual-use during the same day, and among those,15 reported dual-use at the same time. Among participants taking multiple interventions in the same day, 40.5% reported using prescription and over-the-counter medications. Use of multiple medications or supplements in one day was more common among participants who reported OA at multiple joints (OR [95% CI]=2.48 [1.03 to 5.96]) but less common among participants who did not complete high school (OR [95% CI]=0.26 [0.08 to 0.83]). Of the 15 participants who reported dual-use at the same time, 11 were professionally-guided, 5 were professional and self-guided, and 1 was solely self-guided. Overall, 28% of participants reported their intervention as ineffective, sought an alternative method to achieve symptomatic relief, or were prescribed a stronger medication. Participants who reported not always taking their medication consistently for 2 weeks were more likely to report their medication as ineffective (OR [95% CI]=2.87 [1.19 to 6.92]). CONCLUSIONS Both professional and self-guided medications and supplements are used by inner city OA patients to manage their joint symptoms. It is important for clinicians to discuss with these patients how to effectively manage multiple joint symptoms, the importance of taking medications as prescribed, and what they should if they believe a treatment is ineffective or their medication runs out.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111, USA.
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23
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Kjeken I, Darre S, Slatkowsky-Cristensen B, Hermann M, Nilsen T, Eriksen CS, Nossum R. Self-management strategies to support performance of daily activities in hand osteoarthritis. Scand J Occup Ther 2012; 20:29-36. [PMID: 22376127 DOI: 10.3109/11038128.2012.661457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The main aim of this study was to explore self-management strategies in persons with hand osteoarthritis (HOA). METHODS Self-management strategies were explored in semi-structured interviews, in which 125 participants described strategies, use of devices or equipment, and advice they would give to people with HOA concerning how to manage their daily life. RESULTS The participants made a total of 483 statements, which were classified into 27 discrete strategies, and thereafter grouped into 13 broader strategies within three categories: general behavioural strategies, HOA-specific behavioural strategies, and cognitive strategies. The broad strategy "activity accommodations" specifically addressed performance of daily activities in people with HOA, comprising "use assistive devices", "adapt tools, materials or working techniques", "practise activity pacing" and "stop or avoid certain activities", of which the two first were the most frequently stated by participants. CONCLUSIONS People with HOA use a wide variety of self-management strategies to support performance of daily activities, in which use of assistive devices and activity adaptation are the most frequently reported strategies. Patient-recommended self-management strategies should be included in written information material and patient education programmes, which should be developed in cooperation with patient representatives and made available for patients soon after they are diagnosed.
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Affiliation(s)
- Ingvild Kjeken
- National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Marcum ZA, Perera S, Donohue JM, Boudreau RM, Newman AB, Ruby CM, Studenski SA, Kwoh CK, Simonsick EM, Bauer DC, Satterfield S, Hanlon JT. Analgesic use for knee and hip osteoarthritis in community-dwelling elders. PAIN MEDICINE 2011; 12:1628-36. [PMID: 21992521 DOI: 10.1111/j.1526-4637.2011.01249.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA). DESIGN Cross-sectional. SETTING Health, Aging, and Body Composition Study. PATIENTS Six hundred and fifty-two participants attending the year 6 visit (2002-03) with symptomatic knee and/or hip OA. OUTCOME MEASURES Analgesic use was defined as taking ≥1 non-opioid and/or ≥1 opioid receptor agonist. Non-opioid and opioid doses were standardized across all agents by dividing the daily dose used by the minimum effective analgesic daily dose. Inadequate pain control was defined as severe/extreme OA pain in the past 30 days from a modified Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS Just over half (51.4%) reported taking at least one non-opioid analgesic and approximately 10% was taking an opioid, most (88.5%) of whom also took a non-opioid. One in five participants (19.3%) had inadequate pain control, 39% of whom were using <1 standardized daily dose of either a non-opioid or opioid analgesic. In adjusted analyses, severe/extreme OA pain was significantly associated with both non-opioid (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [95% CI] = 1.49-3.99) and opioid (AOR = 2.64; 95% CI = 1.26-5.53) use. CONCLUSIONS Although older adults with severe/extreme knee and/or hip OA pain are more likely to take analgesics than those with less severe pain, a sizable proportion takes less than therapeutic doses and thus may be undertreated. Further research is needed to examine barriers to optimal analgesic use.
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Affiliation(s)
- Zachary A Marcum
- Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Stoller EP, Grzywacz JG, Quandt SA, Bell RA, Chapman C, Altizer KP, Arcury TA. Calling the doctor: a qualitative study of patient-initiated physician consultation among rural older adults. J Aging Health 2011; 23:782-805. [PMID: 21311048 PMCID: PMC3130826 DOI: 10.1177/0898264310397045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Guided by Leventhal's self-regulatory model and Cockerham's theory of health lifestyles, we explore two questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants' accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time? METHOD We analyze data from semistructured in-depth interviews with 62 older rural adults. RESULTS Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment. DISCUSSION We characterize participants' responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham's emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal's conceptualization of illness behavior, including patient-initiated physician consultation.
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Affiliation(s)
- Eleanor Palo Stoller
- Research Professor, Department of Sociology, Box 7808, Wake Forest University, Winston-Salem, NC 27109, (336) 643-0973
| | - Joseph G. Grzywacz
- Associate Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157-1084, (336) 716-2237
| | - Sara A. Quandt
- Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, (336) 716-6015
| | - Ronny A. Bell
- Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences; Director, Maya Angelou Center for Health Equity, Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC 27157-1063, (336) 716-9736
| | - Christine Chapman
- Project Manager, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest university School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, (336) 713-4340
| | - Kathryn P. Altizer
- Associate Project Manager, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, (336) 716-1839
| | - Thomas A. Arcury
- Professor and Vice Chair for Research, Department of Family and Community Medicine; Director, Center for Worker Health, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, (336) 716-9438
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Brewer-Lowry AN, Arcury TA, Bell RA, Quandt SA. Differentiating approaches to diabetes self-management of multi-ethnic rural older adults at the extremes of glycemic control. THE GERONTOLOGIST 2010; 50:657-67. [PMID: 20110333 PMCID: PMC2937247 DOI: 10.1093/geront/gnq001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE OF THE STUDY This study identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes. Previous research has focused largely on persons participating in self-management interventions. DESIGN AND METHODS In-depth qualitative interviews were conducted with 48 adults, drawn from a population-based sample aged 65 years or older with diabetes. The sample was stratified by sex and ethnic group (African American, American Indian, and White) from the low (A1C <6%) and high (A1C >8%) extremes of the glycemic control distribution. Case-based text analysis was guided by a model, including six self-management domains and four resource types (self-care, informal support, formal services, and medical care). RESULTS A "structured" approach to self-management differentiated respondents in good glycemic control from those in poor glycemic control. Those in good glycemic control were more likely to practice specific food behaviors to limit food consumption and practice regular blood glucose monitoring with specific target values. This approach was facilitated by a greater use of home aides to assist with diabetes care. Respondents in poor glycemic control demonstrated less structure, naming general food categories and checking blood glucose in reaction to symptoms. IMPLICATIONS Results provide evidence that degree of structure differentiates self-management approaches of persons with good and poor glycemic control. Findings should provide a foundation for further research to develop effective self-management programs for older adults with diabetes.
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Affiliation(s)
- Aleshia Nichol Brewer-Lowry
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Tsai YF, Liu LL, Chung SC. Pain prevalence, experiences, and self-care management strategies among the community-dwelling elderly in Taiwan. J Pain Symptom Manage 2010; 40:575-81. [PMID: 20678896 DOI: 10.1016/j.jpainsymman.2010.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among community-dwelling elderly in Taiwan. A convenience sample of elderly persons (n=1054) was recruited from outpatient clinics of two hospitals in northern Taiwan. Participants' pain prevalence was 50.0%, and the average number of pain sites was 3.9 (standard deviation [SD]=5.8). Knees were the most commonly described pain site, but the most painful site was the spinal cord area. The mean pain intensity was 3.1 (SD=1.8) and pain interference was 2.8 (SD=2.1). Most participants took prescribed medications to deal with pain; doctors were the main information source for this self-care strategy. Although participants reported using various self-care pain management strategies, most still reported moderate-to-severe worst pain. Moreover, our participants identified far fewer self-care strategies than U.S. elders with chronic pain. These findings suggest that community-dwelling elders in Taiwan know little about managing pain symptoms or ascribe a different meaning to pain than their U.S. counterparts. Because health care providers play an important role in helping the elderly to manage pain, the authors recommend training health care providers about Taiwanese elders' perceptions of pain, to perform regular pain assessments, and provide current knowledge about pain assessment and pain management strategies.
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Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
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Townley S, Papaleontiou M, Amanfo L, Henderson CR, Pillemer K, Beissner K, Reid MC. Preparing to implement a self-management program for back pain in new york city senior centers: what do prospective consumers think? PAIN MEDICINE 2010; 11:405-15. [PMID: 20088858 DOI: 10.1111/j.1526-4637.2009.00783.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers' prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program, and 3) ascertain perceived barriers/facilitators to program participation. DESIGN Cross-sectional survey. SETTING Six senior centers located in New York City. PARTICIPANTS We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain. RESULTS While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (P = 0.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers. CONCLUSIONS These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success.
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Affiliation(s)
- Sarah Townley
- Division of Geriatrics, Weill Cornell Medical College, New York 10065, USA
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Albert SM, Musa D, Kwoh K, Silverman M. Defining optimal self-management in osteoarthritis: racial differences in a population-based sample. J Cross Cult Gerontol 2009; 23:349-60. [PMID: 18931898 DOI: 10.1007/s10823-008-9085-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to examine optimal self-management in osteoarthritis and its association with patient-reported outcomes. We recruited a population-based sample of Medicare beneficiaries (n = 551) residing in Allegheny County, PA, USA and elicited an expanded set of self-management behaviors using open-ended inquiry. We defined optimal self-management according to clinical recommendations, including use of hot compresses on affected joints, alteration of activity, and exercise. Only 20% practiced optimal self-management as defined by two or more of these criteria. Optimal and suboptimal self-managers did not differ in sociodemographic features. Both white and African-Americans who practiced optimal self-management reported significantly less pain, but the benefit was greatest in severe disease for whites and for mild-moderate disease among African-Americans. This backdrop of naturally occurring self-management behaviors may be important to recognize in planning programs that seek to bolster self-management skills.
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Affiliation(s)
- Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree, 130 DeSoto St., Pittsburgh, PA 15261, USA.
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Daily temporal self-care responses to osteoarthritis symptoms by older African Americans and whites. J Cross Cult Gerontol 2009; 23:319-37. [PMID: 18841454 DOI: 10.1007/s10823-008-9082-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the USA. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This patient-centered descriptive study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African Americans and whites, but African Americans used them in different proportions than whites. This study contributes to our knowledge of the dynamic and changing nature of self-care actions even within a single day. By defining how self-care is used in one illness by two different ethnic groups, we may be able to design appropriate educational programs that are more culturally specific to better meet the needs of patients with OA.
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