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Haas M, Boiché J, Chevance G, Latrille C, Brusseau M, Courbis AL, Dupeyron A. Motivation toward physical activity in patients with chronic musculoskeletal disorders: a meta-analysis of the efficacy of behavioural interventions. Sci Rep 2024; 14:18740. [PMID: 39138217 PMCID: PMC11322353 DOI: 10.1038/s41598-024-67948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
Musculoskeletal disorders (MDs) represent a global health issue, which can lead to disability. Physical activity (PA) reduces pain and increases physical function among patients with MDs. To promote behavioural changes, it seems important to focus on modifiable factors, such as motivation. Thus, this review aims to assess effects of interventions targeting PA on motivation towards PA. Searches used terms referring to "physical activity", "motivation" and "chronic musculoskeletal disorders" on the databases PubMed, PsychINFO, MEDLINE, EMBASE, PEDro and Web of Science. All types of intervention-including but not limited to RCTs-were eligible for inclusion. Risk of bias was assessed with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Among 6 489 abstracts identified, there were 387 eligible studies and 19 were included, reporting in total 34 effect sizes. The meta-analysis concerned 1 869 patients and indicated a small effect of interventions on change in motivation towards PA (d = 0.34; 95% CI [0.15; 0.54]; p < .01; k = 33). Behavioural interventions positively impact PA motivation in patients with MDs. In the literature, most studies focused on intervention's effect on fear of movement. Future research should assess other explicit motivational constructs, as well as implicit processes.
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Affiliation(s)
- Matthieu Haas
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France.
| | - Julie Boiché
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | | | - Christophe Latrille
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, Montpellier, France
| | - Mathis Brusseau
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Anne-Lise Courbis
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Arnaud Dupeyron
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
- Department of Physical Medicine and Rehabilitation, CHU de Nîmes, Univ de Montpellier, Nîmes, France
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Vera-Saura P, Agudo-Pavón J, Velázquez-Torres DM, Martín-Alemán M, León-Morillas F, Infante-Guedes A, Cruz-Díaz D. The Importance of Mind-Body in Pilates Method in Patients with Chronic Non-Specific Low Back Pain-A Randomized Controlled Trial. J Clin Med 2024; 13:4731. [PMID: 39200873 PMCID: PMC11355723 DOI: 10.3390/jcm13164731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Chronic non-specific low back pain (CNSLBP) is a prevalent condition causing significant distress and healthcare costs globally. Despite various treatments, effective management remains challenging. Pilates, recognized for its focus on core strength and postural alignment, has emerged as a promising intervention. This study investigates the impact of mind-body in Pilates for directing participants on CNSLBP outcomes. Methods: A randomized controlled trial was conducted with 67 participants, aged 18 to 65 years, suffering from CNSLBP. They were allocated into two groups: Pilates with mind-body cueing (n = 34) and Pilates without cueing (n = 33). Both groups underwent 60 min sessions twice weekly for 8 weeks. Outcome measures included pain intensity (Visual Analogue Scale), functional disability (Roland Morris Disability Questionnaire), fear of movement (Tampa Scale of Kinesiophobia), and adherence (percentage of sessions attended). Statistical significance was determined through repeated measures ANOVA. Results: Both groups showed significant improvement in pain reduction, functional ability, and kinesiophobia. However, the mind-body group demonstrated a statistically significant reduction in kinesiophobia compared to the non-cueing group (p = 0.048), indicating the potential additional benefit of mind-body cueing in managing movement-related fear in CNSLBP. Conclusions: This study underscores the effectiveness of an 8-week Pilates intervention in managing CNSLBP, highlighting the added value of mind-body cueing in reducing fear of movement. These findings suggest incorporating mind-body cueing in Pilates could enhance the therapeutic benefits, particularly for patients with high levels of movement-related fear, potentially improving long-term adherence to physical activity and rehabilitation outcomes.
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Affiliation(s)
- Pablo Vera-Saura
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (P.V.-S.); (J.A.-P.); (D.C.-D.)
| | - Jesús Agudo-Pavón
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (P.V.-S.); (J.A.-P.); (D.C.-D.)
| | | | | | - Felipe León-Morillas
- Department of Physiotherapy, Faculty of Physiotherapy, Podiatry and Therapy Occupational, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
| | - Aday Infante-Guedes
- Faculty of Health Sciences, University of Atlántico Medio, 35017 Las Palmas de Gran Canaria, Spain;
| | - David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (P.V.-S.); (J.A.-P.); (D.C.-D.)
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3
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Roberts KE, Ho E, Gassen-Fritsch C, Halliday M, Mattinty MM, Ferreira P. Perceived social support impacts on exercise adherence in patients with chronic low back pain. J Back Musculoskelet Rehabil 2024:BMR230239. [PMID: 39240623 DOI: 10.3233/bmr-230239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
BACKGROUND Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP). OBJECTIVE This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise). METHODS This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis. RESULTS A positive relationship was found between participants' perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: -258.08 to 746.01). CONCLUSION Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People's self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.
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Affiliation(s)
- Katharine E Roberts
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carolina Gassen-Fritsch
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark Halliday
- Concord Repatriation General Hospital, Sydney, Australia
| | | | - Paulo Ferreira
- Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ninneman JV, Roberge GA, Stegner AJ, Cook DB. Exercise Training for Chronic Pain: Available Evidence, Current Recommendations, and Potential Mechanisms. Curr Top Behav Neurosci 2024. [PMID: 39120812 DOI: 10.1007/7854_2024_504] [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: 08/10/2024]
Abstract
Chronic pain conditions pose a significant global burden of disability, with epidemiological data indicating a rising incidence. Exercise training is commonly recommended as a standalone or complementary approach for managing various chronic pain conditions like low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, and neuropathic pain. Regardless of the specific condition or underlying cause (e.g., autoimmune disease, chronic inflammation), exercise training consistently leads to moderate to large reductions in pain. Moreover, exercise yields numerous benefits beyond pain alleviation, including small-to-moderate improvements in disability, quality of life, and physical function. Despite its efficacy, there is a lack of comprehensive research delineating the optimal intensity, duration, and type of exercise for maximal benefits; however, evidence suggests that sustained engagement in regular exercise or physical activity is necessary to achieve and maintain reductions in both clinical pain intensity ratings and the level that pain interferes with activities of daily living. Additionally, the precise mechanisms through which exercise mitigates pain remain poorly understood and likely vary based on the pathophysiological mechanisms underlying each condition.
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Affiliation(s)
- Jacob V Ninneman
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gunnar A Roberge
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron J Stegner
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
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Lee A, Wyckoff E, Farcas E, Godino J, Patrick K, Spiegel S, Yu R, Kumar A, Loh KJ, Gombatto S. Preliminary Validity and Acceptability of Motion Tape for Measuring Low Back Movement: Mixed Methods Study. JMIR Rehabil Assist Technol 2024; 11:e57953. [PMID: 39093610 PMCID: PMC11329853 DOI: 10.2196/57953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a significant public health problem that can result in physical disability and financial burden for the individual and society. Physical therapy is effective for managing LBP and includes evaluation of posture and movement, interventions directed at modifying posture and movement, and prescription of exercises. However, physical therapists have limited tools for objective evaluation of low back posture and movement and monitoring of exercises, and this evaluation is limited to the time frame of a clinical encounter. There is a need for a valid tool that can be used to evaluate low back posture and movement and monitor exercises outside the clinic. To address this need, a fabric-based, wearable sensor, Motion Tape (MT), was developed and adapted for a low back use case. MT is a low-profile, disposable, self-adhesive, skin-strain sensor developed by spray coating piezoresistive graphene nanocomposites directly onto commercial kinesiology tape. OBJECTIVE The objectives of this study were to (1) validate MT for measuring low back posture and movement and (2) assess the acceptability of MT for users. METHODS A total of 10 participants without LBP were tested. A 3D optical motion capture system was used as a reference standard to measure low back kinematics. Retroreflective markers and a matrix of MTs were placed on the low back to measure kinematics (motion capture) and strain (MT) simultaneously during low back movements in the sagittal, frontal, and axial planes. Cross-correlation coefficients were calculated to evaluate the concurrent validity of MT strain in reference motion capture kinematics during each movement. The acceptability of MT was assessed using semistructured interviews conducted with each participant after laboratory testing. Interview data were analyzed using rapid qualitative analysis to identify themes and subthemes of user acceptability. RESULTS Visual inspection of concurrent MT strain and kinematics of the low back indicated that MT can distinguish between different movement directions. Cross-correlation coefficients between MT strain and motion capture kinematics ranged from -0.915 to 0.983, and the strength of the correlations varied across MT placements and low back movement directions. Regarding user acceptability, participants expressed enthusiasm toward MT and believed that it would be helpful for remote interventions for LBP but provided suggestions for improvement. CONCLUSIONS MT was able to distinguish between different low back movements, and most MTs demonstrated moderate to high correlation with motion capture kinematics. This preliminary laboratory validation of MT provides a basis for future device improvements, which will also involve testing in a free-living environment. Overall, users found MT acceptable for use in physical therapy for managing LBP.
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Affiliation(s)
- Audrey Lee
- Department of Bioengineering, San Diego State University, San Diego, CA, United States
| | - Elijah Wyckoff
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, Department of Structural Engineering, University of California San Diego, La Jolla, CA, United States
| | - Emilia Farcas
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
| | - Job Godino
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Kevin Patrick
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- School of Public Health, University of California San Diego, La Jolla, CA, United States
| | - Spencer Spiegel
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, United States
| | - Rose Yu
- Computer Science and Engineering and Halicioglu Data Science Institute, University of California San Diego, La Jolla, CA, United States
| | - Arun Kumar
- Computer Science and Engineering and Halicioglu Data Science Institute, University of California San Diego, La Jolla, CA, United States
| | - Kenneth J Loh
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, Department of Structural Engineering, University of California San Diego, La Jolla, CA, United States
| | - Sara Gombatto
- School of Physical Therapy, San Diego State University, San Diego, CA, United States
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Francisco IM, Tozzo MC, Martins J, de Oliveira AS. Adherence of individuals with shoulder pain to home exercise booklets: Barriers, facilitators, and the impact of disability, self-efficacy, and treatment expectations. Musculoskelet Sci Pract 2024; 72:102956. [PMID: 38691980 DOI: 10.1016/j.msksp.2024.102956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND home exercise booklets offer several benefits to individuals with shoulder pain. However, it is necessary to investigate the factors that determine adherence to home exercises. OBJECTIVES 1) To investigate the level of adherence of individuals with chronic shoulder pain to a home exercise booklet conducted without the mediation of a healthcare professional, 2) To describe the barriers and facilitators to adherence, and 3) to determine if shoulder disability, self-efficacy, and treatment expectations are predictors of the level of adherence. DESIGN prospective longitudinal study. METHODS A total of 47 individuals with chronic shoulder pain were recruited. The Numeric Pain Rating Scale (NPRS) was used to assess pain intensity, the Shoulder Pain and Disability Index (SPADI) to measure shoulder disability, the Pain Self-Efficacy Questionnaire (PSEQ-10) for self-efficacy, and a likert scale to measure treatment expectations. Adherence was measured by Exercise Adherence Assessment Scale (EAAE-Br). RESULTS A total of 23 individuals (48.93%) adhered to the home exercise program. The most commonly cited barriers were pain and health-related issues, while the most cited facilitators were pain improvement and symptom relief. Barriers associated with adherence were time constraints and other commitments, while the facilitator associated with adherence was enjoying the exercises. Binary logistic regression analysis revealed that shoulder disability, self-efficacy, and treatment expectations were unable to predict adherence to home exercises in individuals with shoulder pain [F (1,47) = 2.384; p = 0.130; R2 = 0.056]. CONCLUSION The study revealed barriers and facilitators to home exercise in individuals with shoulder pain. Disability, self-efficacy, and treatment expectations were not able to predict adherence.
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Affiliation(s)
- Isabela Maria Francisco
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcela Camargo Tozzo
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jaqueline Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Macedo L, Di Pelino S, Santos VS, Richardson J, MacDermid J, Hancock M, Battie MC, Saragiotto BT, Hayden JA, Rushton A, Packham T, Freman M, Bray S, Griffin M, Hladysh G, Miller P, Attwell S. Implementation of back to living well, a community-based program for the tertiary prevention of low back pain: a study protocol. BMC Musculoskelet Disord 2024; 25:593. [PMID: 39068385 PMCID: PMC11283700 DOI: 10.1186/s12891-024-07712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives. METHODS This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application. DISCUSSION The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society. TRIAL REGISTRATION ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354.
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Affiliation(s)
- Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | | | - Veronica Souza Santos
- School of Rehabilitation Science, McMaster University and Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Bruno T Saragiotto
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | | | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Matt Freman
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Steven Bray
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Meridith Griffin
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Pat Miller
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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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, Rizzo RRN, Sharma S, Venter M, McAuley JH, Jones MD. A Qualitative Study Identifying Barriers and Enablers to Exercise Adherence in People with Chronic Low Back Pain. "It's a personal journey". THE JOURNAL OF PAIN 2024; 25:104488. [PMID: 38336028 DOI: 10.1016/j.jpain.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Exercise leads to clinically meaningful pain reductions in people with chronic low back pain and is recommended as a first line treatment. The benefits of exercise for chronic low back pain decrease over time with a lack of long-term exercise adherence as a potential reason for this decreasing effect. We aimed to identify the barriers and enablers to exercise adherence from the perspective of people with chronic low back pain. This qualitative study was underpinned by a constructivist epistemology and used a critical realist ontological perspective. Adults (18-65 years) with chronic low back pain who had exercised since the onset of their back pain were recruited to participate in focus groups and individual interviews. Audio data were transcribed and then analysed in 2 stages 1) inductive coding using reflexive thematic analysis, followed by 2) deductive analysis through mapping codes onto the Theoretical Domains Framework. Five enablers and 3 barriers were identified across 6 of the 14 Theoretical Domain Framework domains. Exercise identity and confidence in deciding to self-manage pain were enablers, whereas beliefs about the consequences of exercise, exercise context, and relationships could function as either barriers or enablers. These barriers and enablers were complex and fluid, with participants reporting conflicting barriers and enablers that varied, depending on context. These findings improve our understanding of the barriers and enablers to exercise adherence from the individual perspective of people with chronic low back pain and can be utilised for more effective exercise treatment in this population. PERSPECTIVE: This article presents the barriers and enablers to exercise adherence from the perspective of people with chronic low back pain. These perspectives may aid to individualise and optimise exercise treatment, improve its long-term adherence and therefore its effectiveness for chronic low back pain.
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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
| | - Rodrigo R N Rizzo
- 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
| | - Saurab Sharma
- 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
| | - Martjie Venter
- 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
| | - 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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Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, Sharma S, Rose JM, Devonshire JJ, Ferraro MC, Wewege MA, McAuley JH. The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study. J Orthop Sports Phys Ther 2024; 54:477-485. [PMID: 38630543 DOI: 10.2519/jospt.2024.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE: To identify the smallest worthwhile effect (SWE) of exercise therapy for people with non-specific chronic low back pain (CLBP). DESIGN: Discrete choice experiment. METHODS: The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email obtained from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. RESULTS: Two-hundred and thirteen participants completed the survey. The mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. CONCLUSION: This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.
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Affiliation(s)
- Harrison J Hansford
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, location Vrije Universiteit, Amsterdam Movement Sciences, The Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sam A Williams
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - John M Rose
- Neil Smith Research Chair in Sustainable Transport Futures, Institute of Transport and Logistics Studies, The University of Sydney Business School, Sydney, New South Wales, 2006, Australia
| | - Jack J Devonshire
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael C Ferraro
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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11
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Fritsch CG, Ferreira ML, Halliday MH, Roberts K, Comachio J, Mittinty M, Sharpe L, Foster NE, Stamatakis E, Mork PJ, McLachlan AJ, Ferreira PH. Health coaching intervention with or without the support of an exercise buddy to increase physical activity of people with chronic low back pain compared to usual care: a feasibility and pilot randomised controlled trial. Musculoskelet Sci Pract 2024; 71:102941. [PMID: 38513337 DOI: 10.1016/j.msksp.2024.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Exercise buddies (people to exercise together with) might support people with low back pain (LBP) to become active. However, involving buddies in randomised controlled trials (RCT) might challenge recruitment, data collection and follow-up. OBJECTIVES To explore the feasibility of the intervention, recruitment and data collection approaches and potential effects of a health coaching intervention (focused on physical activity) with or without exercise buddies' support on physical activity of people with chronic LBP versus usual discharge care. DESIGN Feasibility and pilot RCT. METHODS Adults (n = 30) discharged from LBP treatment were randomised to the Buddy-Assisted (health coaching intervention with exercise buddy's support), Individual-Only (health coaching only), or usual care groups. Data were collected at baseline, three and six months. The feasibility of trial's procedures was assessed through recruitment rate (acceptable if >70%), data completion rate (acceptable if ≤ 20% missing data), and follow-up rate (successful if ≥ 85%). The intervention's acceptability was assessed via feedback questionnaires. Preliminary effects on physical activity and other outcomes were also explored. RESULTS Recruitment and baseline data completion were acceptable. However, data collection and follow-up rates post-randomisation were not. 85% of the Buddy-Assisted Group believed the buddies helped them to increase physical activity and would recommend the intervention. 70% of the Individual-Only and Control groups believed exercise buddies would help them to become further active. CONCLUSION The data collection and follow-up approaches were not successful and need amending before a large-scale RCT. Nonetheless, the buddy-assisted intervention was well-accepted. A future RCT will focus on differences in clinical outcomes. TRIAL REGISTRATION The study was registered at the Australian New Zealand Clinical Trial Registry (ACTRN12620001118998).
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Affiliation(s)
- Carolina G Fritsch
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Sydney, NSW, Australia.
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Sydney, NSW, Australia
| | - Mark H Halliday
- Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia
| | - Katharine Roberts
- Faculty of Medicine and Health, Musculoskeletal Health Research Group, Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Sydney, NSW, Australia
| | - Josielli Comachio
- Faculty of Medicine and Health, Musculoskeletal Health Research Group, Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Sydney, NSW, Australia
| | - Manasi Mittinty
- Faculty of Medicine and Health, Northern Clinical School, Sydney, NSW, Australia
| | - Louise Sharpe
- Faculty of Medicine and Health, School of Psychology, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health Brisbane, QLD, Australia
| | - Emmanuel Stamatakis
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, Sydney, NSW, Australia
| | - Paul J Mork
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Trondelag, Norway
| | - Andrew J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Paulo H Ferreira
- Faculty of Medicine and Health, Musculoskeletal Health Research Group, Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Sydney, NSW, Australia
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12
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Montgomery G, Tobias JH, Paskins Z, Khera TK, Huggins CJ, Allison SJ, Abasolo D, Clark EM, Ireland A. Daily Pain Severity but Not Vertebral Fractures Is Associated With Lower Physical Activity in Postmenopausal Women With Back Pain. J Aging Phys Act 2024; 32:428-437. [PMID: 38527456 DOI: 10.1123/japa.2023-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 03/27/2024]
Abstract
Back pain lifetime incidence is 60%-70%, while 12%-20% of older women have vertebral fractures (VFs), often with back pain. We aimed to provide objective evidence, currently lacking, regarding whether back pain and VFs affect physical activity (PA). We recruited 69 women with recent back pain (age 74.5 ± 5.4 years). Low- (0.5 < g < 1.0), medium- (1.0 ≤ g < 1.5), and high-impact (g ≥ 1.5) PA and walking time were measured (100 Hz for 7 days, hip-worn accelerometer). Linear mixed-effects models assessed associations between self-reported pain and PA, and group differences (VFs from spine radiographs/no-VF) in PA. Higher daily pain was associated with reduced low (β = -0.12, 95% confidence interval, [-0.22, -0.03], p = .013) and medium-impact PA (β = -0.11, 95% confidence interval, [-0.21, -0.01], p = .041), but not high-impact PA or walking time (p > .11). VFs were not associated with PA (all p > .2). Higher daily pain levels but not VFs were associated with reduced low- and medium-impact PA, which could increase sarcopenia and falls risk in older women with back pain.
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Affiliation(s)
- Gallin Montgomery
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Zoe Paskins
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Tarnjit K Khera
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Cameron J Huggins
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, United Kingdom
| | - Sarah J Allison
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
- Department of Nutrition, Food & Exercise Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Daniel Abasolo
- Centre for Biomedical Engineering, School of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma M Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
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13
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LaRowe LR, Williams DM. Activity-Induced Pain as a Predictor of Sedentary Behavior Among Midlife Adults. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:391-397. [PMID: 37466695 DOI: 10.1080/02701367.2023.2222783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/24/2023] [Indexed: 07/20/2023]
Abstract
Purpose: Midlife adults have been estimated to spend over half of their waking time engaging in sedentary behavior, and greater sedentary behavior has been associated with a reduced likelihood of successful aging. Moreover, more than one-quarter of midlife adults report chronic pain, and there is reason to believe that pain may contribute to sedentary behavior among this population. The goal of these analyses was to test associations between self-reported increases in pain during activity and subsequent sedentary behavior among a sample of midlife adults with chronic pain. Methods: Participants included 200 midlife adults (age 50-64) who reported chronic pain and completed an online prospective survey. Activity-induced pain was assessed at baseline and total time spent engaging in sedentary behavior was assessed at baseline, 1-week, and 4-week follow-up assessments. Results: Activity-induced pain predicted greater sedentary behavior at 1-week (p < .05) and 4-week (p < .01) follow-up assessments, even after controlling for chronic pain intensity and baseline sedentary behavior. Conclusions: Activity-induced pain may represent an important mechanism underlying sedentary behavior among midlife adults with chronic pain, and programs designed to reduce sedentary behavior among this population may benefit from tailoring to account for the antithetical influence of activity-induced pain. Indeed, the current findings suggest that mitigating the extent to which pain increases during activity may be more important than reducing overall pain intensity when attempting to decrease sedentary behavior among this population. This and future work have the potential to inform the refinement of tailored interventions.
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14
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Kawaguchi K, Moriuchi T, Takita R, Yoshimura K, Kozu R, Yanagita Y, Origuchi T, Matsuo T, Higashi T. Effects of Different Visual Flow Velocities on Psychophysiological Responses During Virtual Reality Cycling. Cureus 2024; 16:e62397. [PMID: 39011205 PMCID: PMC11247245 DOI: 10.7759/cureus.62397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Virtual reality cycling (VRC) is simulated outdoor cycling with changes in scenery in virtual reality (VR) with rotating ergometer pedals. The speed at which the scenery changes, which is the visual flow velocity, can shift according to the same pedal rotation speed. OBJECTIVES This study investigated the effects of different visual flow velocities on the psychophysiological responses of cyclists using the VRC. METHODS Participants were asked to cycle for 20 min at 30% of their maximum exercise load under four conditions: (1) bicycle ergometer without VR (control), (2) VRC at normal visual flow velocity (VRC-normal), (3) VRC at 0.5 times the visual flow velocity of VRC-normal (VRC-slow), and (4) VRC at 1.5 times the visual flow velocity of VRC-normal (VRC-fast). The order of the four conditions was randomized in a counterbalanced design. The heart rate and rating of perceived exertion were recorded during the exercise. Participants graded their enjoyment of the task using the physical activity enjoyment scale (PACES). The measured data were analyzed by comparing the visual flow velocity conditions (VRC-slow, VRC-normal, and VRC-fast), and comparing the VRC and bicycle ergometer (VRC-normal and control). RESULTS A total of 24 participants were enrolled in the study. There was a significant main effect observed in the PACES score (F(2,46)=20.129, p<0.001, partial η2=0.467). In the post-hoc test for the PACES, significant differences were found in the following combinations: VRC-normal > VRC-slow (p=0.005); VRC-fast > VRC-normal (p=0.003); and VRC-fast > VRC-slow (p<0.001). In the modified Borg scale for lower-limb fatigue, there were significant differences in time factor (F(2,46)=134.048, p<0.001, partial η2=0.854) and interaction effects (F(4,92)=3.156, p=0.018, partial η2=0.121). In the post-hoc test for the modified Borg scale, significant trends were found in the following combinations: VRC-normal > VRC-fast (p=0.068) and VRC-slow > VRC-fast (p=0.083). CONCLUSION The results suggest that a slower visual flow velocity may reduce the enjoyment of exercise, whereas a faster visual flow velocity may make the exercise feel less fatigued and more enjoyable.
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Affiliation(s)
- Kyosuke Kawaguchi
- Occupational Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Takefumi Moriuchi
- Occupational Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | | | | | - Ryo Kozu
- Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Yorihide Yanagita
- Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Tomoki Origuchi
- Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Takashi Matsuo
- Health Sciences, Graduate School of Health Sciences, Kumamoto Health Science University, Kumamoto, JPN
| | - Toshio Higashi
- Occupational Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
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15
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Kühn L, Rosen D, Reiter NL, Prill R, Choi KEA. Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany. BMC Musculoskelet Disord 2024; 25:422. [PMID: 38811932 PMCID: PMC11137918 DOI: 10.1186/s12891-024-07505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In Germany, exercise therapy represents the most commonly prescribed physiotherapy service for non-specific, chronic low back pain (NSCLBP). So far, little is known about current practice patterns of German physiotherapists in delivering this intervention. Thus, the aim of this study was to investigate the appropriateness of exercise therapy delivered to NSCLBP patients in German physiotherapy care and to identify practitioner-related drivers of appropriate exercise delivery. METHODS We used a vignette-based, exploratory, cross-sectional, online-survey study design (76-items; data collection between May and July 2023). Eligible participants were required to hold a professional degree in physiotherapy and were required to be practicing in Germany. Access links to anonymous online surveys were spread via established German physiotherapy networks, educational platforms, social media, e-mail lists, and snowball sampling. Appropriateness of exercise therapy was calculated by an equally weighted total score (400 points) including scales on shared-decision-making, exercise dose selection, pain knowledge and self-management promotion. "Appropriate exercise delivery" was determined by a relative total score achievement of > 80%. "Partly appropriate exercise delivery" was determined by a relative total score achievement of 50-79%, and "inappropriate exercise delivery" by a score achievement of < 50%. Practitioner-related drivers of exercise appropriateness were calculated by bivariate and multiple linear regression analyses. RESULTS 11.9% (N = 35) of 298 physiotherapists' exercise delivery was considered "appropriate", 83.3% (N = 245) was "partly appropriate", and 4.8% (N = 14) was "inappropriate". In the final multiple regression model, most robust parameters positively influencing appropriate delivery of exercise therapy were increased scientific literacy (B = 10.540; 95% CI [0.837; 20.243]), increased average clinical assessment time (B = 0.461; 95% CI [0.134; 0.789]), increased self-perceived treatment competence (B = 7.180; 95% CI [3.058; 11.302], and short work experience (B = - 0.520; 95% CI [-0.959; - 0.081]). CONCLUSION Appropriate exercise delivery in NSCLBP management was achieved by only 11.9% of respondents. However, the vast majority of 95.2% of respondents was classified to deliver exercise therapy partly appropriate. Long work experience seemed to negatively affect appropriate exercise delivery. Positive influences were attributed to scientific literacy, the average clinical assessment time per patient as well as the perceived treatment competence in NSCLBP management. REGISTRATION Open science framework: https://doi.org/10.17605/OSF.IO/S76MF .
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Affiliation(s)
- Lukas Kühn
- Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Neuruppin, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
| | - Diane Rosen
- Alice Salomon University of Applied Sciences, Alice-Salomon Platz 5, 12627, Berlin, Germany
| | - Nils Lennart Reiter
- Alice Salomon University of Applied Sciences, Alice-Salomon Platz 5, 12627, Berlin, Germany
- PhysioBib GbR, Johanniterstraße 26, 10961, Berlin, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Neuruppin, Germany
| | - Kyung-Eun Anna Choi
- Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Neuruppin, Germany
- Health Services Research, Medical Imaging and Artificial Intelligence, Faculty of Medicine/Dentistry, Danube Private University, Steiner Landstraße 124, Krems-Stein, 3500, Austria
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16
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Vaegter HB, Kinnunen M, Verbrugghe J, Cunningham C, Meeus M, Armijo-Olivo S, Bandholm T, Fullen BM, Wittink H, Morlion B, Reneman MF. Physical activity should be the primary intervention for individuals living with chronic pain A position paper from the European Pain Federation (EFIC) 'On the Move' Task Force. Eur J Pain 2024. [PMID: 38703009 DOI: 10.1002/ejp.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non-exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles. METHODS This position paper was prepared by the 'On The Move' Task Force of the European Pain Federation EFIC. Final recommendations were endorsed by the European Pain Forum, Pain Alliance Europe and the Executive Board of EFIC. RESULTS We recommend that all health professionals (1) Take a history of the persons' PA levels, and put PA on the agenda, (2) Advise that PA is important and safe for individuals living with chronic pain, (3) Deliver a brief PA intervention and support individuals living with chronic pain in becoming physically active, (4) Discuss acceptable levels of PA-related soreness and pain and (5) Provide ongoing support in staying physically active. SIGNIFICANCE Physical activity is safe and offers several advantages, including general health benefits, low risk of side effects, low cost and not requiring access to healthcare. Adoption of these recommendations can improve the quality of care and life of individuals living with chronic pain and reduce their overall health risks.
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Affiliation(s)
- Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Marja Kinnunen
- Patient Representative Pain Alliance Europe (PAE), Brussels, Belgium
- Finnish Musculoskeletal Association, Helsinki, Finland
| | - Jonas Verbrugghe
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hogescholl Utrecht, Hasselt, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Caitriona Cunningham
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), www.paininmotion.be, Brussels, Belgium
| | - Susan Armijo-Olivo
- University of Applied Sciences Osnabrück, Faculty of Economics and Social Sciences, Osnabrück, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Thomas Bandholm
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Department of Orthopedic Surgery, Department of Clinical Research, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Brona M Fullen
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Harriet Wittink
- Research Group Lifestyle and Health, Hogeschool Utrecht University of Applied Sciences Utrecht
| | - Bart Morlion
- The Leuven Centre for Algology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Unit Anaesthesiology and Algology, KU Leuven, Leuven, Belgium
| | - Michiel F Reneman
- University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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17
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Pelters P. The good, the bad and the ugly - a Swedish qualitative interview study about the landscape of meaning-imbued, exercise-related physical pain, as experienced by 'normal' gym-users. BMC Public Health 2024; 24:1167. [PMID: 38664787 PMCID: PMC11047003 DOI: 10.1186/s12889-024-18623-6] [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: 01/10/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The gym is a well-known place for health promoting or rehabilitating exercise whose availability to all is regarded significant for people's personal health work and the public's health. In this context, physical pain is usually discussed as something negative that people seek to dispose of. However, certain painful experiences appear to be an appreciated part of the gym experience. To investigate this seemingly contradictory landscape of meaning-imbued physical pain, the study aims to explore the different kinds of physical pain present at the gym and their significance for exercising, as experienced by 'normal' gym-users. METHODS 24 semi-structured in-depth interviews with active, dedicated, reasonably healthy (= normal) adult gym-users have been analyzed using qualitative content analysis from a hermeneutical stance. RESULTS Participants differentiate between three kinds of physical pain: the good pain of enhancement (often connected to muscle soreness and effort burn), the bad pain of impediment (primarily related to acute damage) and the composite, neutral pain of acceptance (potentially linked to all pains). CONCLUSION When pursuing the goal of personal health development, normal gym-users argue that exercising at the gym means to expose yourself to pain and to do so willingly, even longingly. Refusing to share this understanding may diminish people's chances to occupy the gym space and, hence, reduce their chances to promote their health.
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Affiliation(s)
- Pelle Pelters
- Department of Education, University of Stockholm, Stockholm, SE-106 91, Sweden.
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18
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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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19
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Pita-Martínez C, Justo-Cousiño LA. [Does patient communication influence kinesiophobia? A systematic review]. Rehabilitacion (Madr) 2024; 58:100837. [PMID: 38316098 DOI: 10.1016/j.rh.2024.100837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
The aim of the present systematic review was to determine the effect of communication in the health care setting on kinesiophobia. To this end, a literature search was conducted in seven databases between November 2022 and February 2023. The review was carried out following the PRISMA statement and for the analysis of methodological quality we used: PEDro Scale, Van Tulder criteria and risk of bias analysis of the Cochrane Collaboration. A total of 13 articles were included with a mean methodological quality of 7.1 out of 10. Significant results were obtained for at least one variable (kinesiophobia, disability or level of physical activity) in 12 articles. There is strong evidence that communication can influence a subject's kinesiophobia. This influence is most likely to be in a negative or disabling sense, but it can also act in a positive sense by decreasing it.
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Affiliation(s)
- C Pita-Martínez
- Unidad de Investigación en Cuidados (SERGAS Área Sanitaria de Vigo), Galicia, España; Grupo de Investigación Traslacional en Cuidados (INVESTIC), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España
| | - L A Justo-Cousiño
- Universidade de Vigo, Facultade de Fisioterapia, Campus A Xunqueira, Galicia, España; Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Galicia, España.
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20
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Alt A, Luomajoki H, Roese K, Luedtke K. How do non-specific back pain patients think about their adherence to physiotherapy, and what strategies do physiotherapists use to facilitate adherence? A focus group interview study. J Man Manip Ther 2024; 32:150-158. [PMID: 37725067 PMCID: PMC10956927 DOI: 10.1080/10669817.2023.2258699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Long-term effectiveness of physiotherapy (PT) for low back pain (LBP) depends on the adherence of patients. Objectives: (1) Identify aspects associated with the adherence of patients with LBP to physiotherapy, and (2) identify factors to facilitate adherence of patients with LBP to PT. METHOD Focus group interviews were conducted with 10 patients with LBP (n = 10, 5 women) and 11 physiotherapists (5 women) from Germany and Switzerland, treating patients with LBP. Data analysis was based on structured content analysis. Deductive and inductive categories were identified and coded. RESULTS Patients with LBP requested more and effective home programs, long-term rehabilitation management, and individualized therapy to achieve a higher level of adherence. Physiotherapists requested more time for patient education. Communication, quality of the therapist-patient relationship, and individualized therapy were identified as essential factors by both representatives. CONCLUSION Patients and physiotherapists identified aspects contributing to adherence. These may guide the development of multidimensional measurement tools for adherence. In addition, this information can be used to develop PT approaches to facilitate the level of adherence.
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Affiliation(s)
- A Alt
- Department of Physiotherapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
| | - H Luomajoki
- Institute of physiotherapy, Zürich University of applied Sciences ZHAW, Winterthur, Switzerland
| | - K Roese
- Department of Occupational Therapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
| | - K Luedtke
- Department of Physiotherapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
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21
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Janik F, Fabre C, Seichepine AL, Masquelier B, Barbier F, Toulotte C. Middle-term effects of education programme in chronic low back pain patients to an adherence to physical activity: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2024; 119:108081. [PMID: 38000153 DOI: 10.1016/j.pec.2023.108081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE This study was to measure the impact of an education programme in Chronic Low Back Pain (CLBP) patients on their changing behaviour; particularly on the resumption or maintenance of physical activity (PA) at three and six months after care. METHODS A two-group, randomised controlled clinical trial was conducted on 68 patients as the control group (CG) and 68 as the experimental group (EG). All patients benefited from a four-week multidisciplinary programme, with an educative programme for the EG. The dropouts of patients during the follow-up period and the PA level were measured at three and six months after the end of care. RESULTS At 3-months, the EG presented a significant higher level of physical activity (91% of EG versus 77% of CG, p < 0.001) and at six months, this group presented a lower dropout rate than CG (60% of EG versus 73% of CG, p = 0.017). CONCLUSION The educative programme, added to a multidisciplinary care plan, can improve adherence to the care programme and the continuum of PA. PRACTICE IMPLICATIONS Add an educative programme focused on motivation, physical activity, stress management and daily activities seems necessary to accompany CLBP patient towards the maintenance of a regular PA.
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Affiliation(s)
- Frédérick Janik
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France; Centre de Réadaptation Fonctionnelle " Les Hautois " - Groupe AHNAC, F-62590 Oignies, France.
| | - Claudine Fabre
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France
| | - Anne Laure Seichepine
- Centre de Réadaptation Fonctionnelle " Les Hautois " - Groupe AHNAC, F-62590 Oignies, France
| | - Bernadette Masquelier
- Centre de Réadaptation Fonctionnelle " Les Hautois " - Groupe AHNAC, F-62590 Oignies, France
| | - Fabienne Barbier
- Centre de Réadaptation Fonctionnelle " Les Hautois " - Groupe AHNAC, F-62590 Oignies, France
| | - Claire Toulotte
- Univ. Artois, Univ. Lille, Univ. Littoral Côte d'Opale, ULR 7369, Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSSS), F-62800 Liévin, France
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22
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Stubbs C, McAuliffe S, Chimenti RL, Coombes BK, Haines T, Heales L, de Vos RJ, Lehman G, Mallows A, Michner LA, Millar NL, O'Neill S, O'Sullivan K, Plinsinga M, Rathleff M, Rio E, Ross M, Roy JS, Silbernagel KG, Thomson A, Trevail T, van den Akker-Scheek I, Vicenzino B, Vlaeyen JWS, Pinto RZ, Malliaras P. Which Psychological and Psychosocial Constructs Are Important to Measure in Future Tendinopathy Clinical Trials? A Modified International Delphi Study With Expert Clinician/Researchers and People With Tendinopathy. J Orthop Sports Phys Ther 2024; 54:14-25. [PMID: 37729020 DOI: 10.2519/jospt.2023.11903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/researchers and people with tendinopathy. Using a 9-point Likert scale (1 = not important to include, 9 = critical to include), consensus for construct inclusion required ≥70% of respondents rating "extremely critical to include" (score ≥7) and ≤15% rating "not important to include" (score ≤3). Consensus for exclusion required ≥70% of respondents rating "not important to include" (score ≤3) and ≤15% of rating "critical to include" (score ≥7). RESULTS: Thirty-six participants (95% of 38) completed round 1, 90% (n = 34) completed round 2, and 87% (n = 33) completed round 3. Four constructs were deemed important to include as part of a core outcome set: kinesiophobia (82%, median: 8, interquartile range [IQR]: 1.0), pain beliefs (76%, median: -7, IQR: 1.0), pain-related self-efficacy (71%, median: 7, IQR: 2.0), and fear-avoidance beliefs (73%, median: -7, IQR: 1.0). Six constructs were deemed not important to include: perceived injustice (82%), individual attitudes of family members (74%), social isolation and loneliness (73%), job satisfaction (73%), coping (70%), and educational attainment (70%). Clinician/researchers and people with tendinopathy reached consensus that kinesiophobia, pain beliefs, pain self-efficacy, and fear-avoidance beliefs were important psychological constructs to measure in tendinopathy clinical trials. J Orthop Sports Phys Ther 2024;54(1):1-12. Epub 20 September 2023. doi:10.2519/jospt.2023.11903.
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23
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Hamm-Faber TE, Vissers KCP, Kalkman JS, van Haren FGAM, Aukes HJA, Engels Y, Henssen DJHA. The Predicted Outcome of Spinal Cord Stimulation in Patients With a Psychopathological Disorder and Persistent Spinal Pain Syndrome Type 2: A Systematic Review From 2009 to 2021. Neuromodulation 2024; 27:59-69. [PMID: 38127048 DOI: 10.1016/j.neurom.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Psychologic screening is often included as a mandatory component of evaluation of the impact of psychopathology disorders on the predicted outcome of spinal cord stimulation (SCS) for patients with chronic pain due to persistent spinal pain syndrome type 2 (PSPS type 2). The conclusion of such screenings can influence the decision to offer SCS therapy to a patient. However, evidence on the impact of psychopathology on SCS outcomes is still scarce. MATERIALS AND METHODS To address this knowledge gap, we systematically reviewed the literature from 2009 to 2021 to explore the correlation between the presence of a psychopathological disorder and the predicted outcome of SCS in patients with PSPS type 2. The literature search was conducted using various online data bases with "failed back surgery syndrome," "psychopathology," and "spinal cord stimulation" used as essential keywords. The identified studies were organized in a Rayyan AI data base, and the quality was analyzed with the Critical Appraisal Skills Program tool. RESULTS Our search generated the identification of 468 original articles, of which two prospective and four retrospective studies met our inclusion criteria. These studies reported pain relief, a reduction of symptoms of anxiety and depression, and an improvement in rumination on the Pain Catastrophizing Scale in patients with PSPS type 2 after SCS therapy. The studies also found contradictory outcomes measured using the Oswestry Disability Index, and in terms of the impact of psychopathological disorder on the clinical outcome and revision rate of the SCS system. CONCLUSION In this systematic review, we found no convincing evidence that the presence of a psychopathological disorder affects the predicted outcome of SCS therapy in patients with PSPS type 2.
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Affiliation(s)
- Tanja E Hamm-Faber
- Department of Pain Medicine, Albert Schweitzer Hospital, Zwijndrecht, The Netherlands.
| | - Kris C P Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joke S Kalkman
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank G A M van Haren
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans J A Aukes
- Department of Pain Medicine, Albert Schweitzer Hospital, Zwijndrecht, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan J H A Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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24
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Wang J, Tong S, Niu Y, Lu B. Attitude and influencing factors on exercise in patients with moderately to severely active inflammatory bowel disease: a qualitative study. BMJ Open 2023; 13:e080084. [PMID: 38114281 DOI: 10.1136/bmjopen-2023-080084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVES To explore the attitudes towards exercise, factors influencing exercise and exercise-related needs of patients with moderately to severely active inflammatory bowel disease. DESIGN A qualitative phenomenological research. SETTING The study was conducted at a comprehensive tertiary hospital in Suzhou, China, which is a secondary care facility. PARTICIPANTS The study included 17 participants who met specific inclusion criteria: aged between 16 and 70 years, diagnosed with inflammatory bowel disease and in a state of moderate to severe disease activity. Participants were required to be capable of clear self-expression and provide voluntary consent. Exclusion criteria included the presence of cancer or severe physical illness, cognitive impairment or mental illness. INTERVENTIONS Semistructured interviews were used to collect data. RESULTS The exercise experiences of participants with moderate to severe inflammatory bowel disease yielded three themes: attitudes towards exercise, factors influencing exercise and exercise-related needs. CONCLUSION The majority of participants had negative attitudes towards exercise during periods of moderate to severe activity, largely influenced by disease activity, symptom management, inadequate knowledge of exercise and uncertainty about the value of exercise. Of particular note, professional guidance was generally recognised as stimulating a willingness to exercise positively, and participants demonstrated a strong need for professional guidance. Therefore, it is recommended that clear exercise guidelines for inflammatory bowel disease be constructed to ensure that patients receive safe and effective guidance to develop a healthy lifestyle in order to maximise the benefits of exercise.
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Affiliation(s)
- Jing Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Shuping Tong
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuehong Niu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bingqing Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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25
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Brown O, Newton-John TRO. The influence of the significant other on treatment adherence in chronic pain management: a qualitative analysis. Psychol Health 2023; 38:1572-1586. [PMID: 35094627 DOI: 10.1080/08870446.2022.2032058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
Objectives. Adherence to treatment recommendations is critical for optimising quality of life for individuals with chronic pain, however adherence rates are low. This study explores the role that significant others are perceived to play in supporting or impeding treatment adherence, as well as examining patient views of the impact of their adherence regimes on their significant others.Design. 25 treatment seeking adults with chronic pain, who were currently living with a romantic partner or adult family member, took part in individual semi-structured interviews.Main outcome measures Interviews were transcribed verbatim and analysed using thematic analysis.Results. Three treatment adherence support themes emerged: social support (emotional, instrumental), positive social control, and supporting autonomy. Participants did not perceive significant others as having any negative influence on their adherence. By contrast, patients perceived that their adherence behaviors had both positive and negative effects on their significant others.Conclusions. These data present an encouraging perspective on the interpersonal context of coping with chronic pain. Significant others facilitated adherence in a range of ways. Future research identifying how best to integrate significant other support into patient self-management programs is needed, in order to lift the poor treatment adherence rates that are noted in the literature.
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Affiliation(s)
- Olivia Brown
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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26
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Berger M, Bertrand AM, Robert T, Chèze L. Measuring objective physical activity in people with chronic low back pain using accelerometers: a scoping review. Front Sports Act Living 2023; 5:1236143. [PMID: 38022769 PMCID: PMC10646390 DOI: 10.3389/fspor.2023.1236143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Accelerometers can be used to objectively measure physical activity. They could be offered to people with chronic low back pain (CLBP) who are encouraged to maintain an active lifestyle. The aim of this study was to examine the use of accelerometers in studies of people with CLBP and to synthesize the main results regarding the measurement of objective physical activity. Methods A scoping review was conducted following Arksey and O'Malley's framework. Relevant studies were collected from 4 electronic databases (PubMed, Embase, CINHAL, Web of Science) between January 2000 and July 2023. Two reviewers independently screened all studies and extracted data. Results 40 publications out of 810 citations were included for analysis. The use of accelerometers in people with CLBP differed across studies; the duration of measurement, physical activity outcomes and models varied, and several limitations of accelerometry were reported. The main results of objective physical activity measures varied and were sometimes contradictory. Thus, they question the validity of measurement methods and provide the opportunity to discuss the objective physical activity of people with CLBP. Conclusions Accelerometers have the potential to monitor physical performance in people with CLBP; however, important technical limitations must be overcome.
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Affiliation(s)
- Mathilde Berger
- Occupational Therapy Department (HETSL | HES-SO), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Anne Martine Bertrand
- Occupational Therapy Department (HETSL | HES-SO), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Thomas Robert
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Laurence Chèze
- Université de Lyon, Université Claude Bernard Lyon 1, Univ Eiffel, LBMC UMR_T 9406, Lyon, France
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27
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McNeilage AG, Ashton-James CE, Scholz B. "We were all looking for the magic pill": A qualitative study of patient experiences using gabapentinoids for chronic pain. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104112. [PMID: 37453375 DOI: 10.1016/j.drugpo.2023.104112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Gabapentinoid medications are increasingly being used in chronic pain management, yet very little is known about the experiences of those using them. The aim of this study was to address this gap in the literature by qualitatively exploring the lived experiences of patients using gabapentinoids for chronic pain. METHODS Semi-structured interviews were conducted with 12 adults prescribed a gabapentinoid medication - either pregabalin or gabapentin - for chronic pain in Australia. Interviews were conducted in May 2022 via telephone or online video chat. Audio recordings of the interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis. The Medication Adherence Model was used as a framework for synthesising the data and organising themes. RESULTS For participants in this study, the initial decision to use gabapentinoids for chronic pain was driven by a level of desperation for pain relief, a perceived lack of pain management alternatives, and a belief that the medication was safer and easier to access than opioids. However, once using gabapentinoids, experiences varied considerably with some viewing the medication as effective and safe, and others viewing it as useless or harmful. Some participants expressed concern that they were not adequately informed by their prescribers about the risks of gabapentinoid use. CONCLUSION These findings emphasise the importance of patient-provider communication and taking a patient-centred approach to gabapentinoid prescribing and de-prescribing. Future qualitative research in this area should involve primary care providers to gain a better understanding of factors driving increased gabapentinoid prescribing in chronic pain management as well as barriers to patient education.
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Affiliation(s)
- Amy G McNeilage
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Claire E Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brett Scholz
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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28
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Kalın AS, Aytur YK. Physical activity levels of individuals with chronic musculoskeletal disorders: Their relationship with barriers and facilitators. Musculoskeletal Care 2023; 21:797-805. [PMID: 36876649 DOI: 10.1002/msc.1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Individuals with chronic musculoskeletal disorders (MSD) often avoid physical activity (PA) and exercise although these are the key factors in managing their condition and pain. OBJECTIVES To determine the PA levels of individuals with chronic MSD and their relationship with barriers and facilitators. DESIGN Three hundred and five subjects with five MSD groups; fibromyalgia, myofascial pain, osteoarthritis, periarticular regional pain and degenerative spine problems were included in the study. The visual analogue scale was used to assess pain, the Hospital Anxiety and Depression Scale to assess emotional impact, and the Nottingham Health Profile (NHP) to assess quality of life. PA levels were categorised by the International Physical Activity Questionnaire-Short Form. Perceived barriers and facilitators for PA/exercise were determined by questionnaire. RESULTS 66 (21.6%) were male, 239 (78.4%) were female. 196 (64.3%) of the subjects were physically inactive, 94 (31.1%) low-active, and 15 (4.6%) sufficiently active. The most frequently reported barriers for PA/exercise were fatigue/feeling too tired (72.1%), pain (66.2%), and lack of motivation/willingness (54.4%). The most frequently reported facilitators were the desire to be in good health (72.8%), enjoying exercise (59.7%), and the desire to keep fit and lose weight (59%). CONCLUSION The level of PA in individuals with MSD was quite low. Identifying the underlying causes of PA is important since PA/exercise is beneficial for musculoskeletal health. Yet, barriers and facilitators for PA were revealed for this study population. Identifying and understanding these barriers and facilitators would facilitate the individualised PA/exercise programs for both clinical practice and research.
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Affiliation(s)
- Ayse Sevim Kalın
- Department of Physical Medicine and Rehabilitation, Dağkapı State Hospital, Diyarbakır, Turkey
| | - Yesim Kurtais Aytur
- Department of Physical Medicine and Rehabilitation, Ankara University, Faculty of Medicine, Ankara, Turkey
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29
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Uzawa H, Akiyama K, Furuyama H, Takeuchi S, Nishida Y. Autonomic responses to aerobic and resistance exercise in patients with chronic musculoskeletal pain: A systematic review. PLoS One 2023; 18:e0290061. [PMID: 37578955 PMCID: PMC10424875 DOI: 10.1371/journal.pone.0290061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/01/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND It is unknown whether patients with chronic musculoskeletal pain (CMP) show autonomic dysregulation after exercise, and the interventional effects of exercise on the autonomic dysregulation have not been elucidated. The objectives of this study were to reveal acute autonomic responses after aerobic and resistance exercises and the interventional effects of both exercises on autonomic dysregulation in patients with CMP. METHODS A systematic search using nine electronic databases was performed based on three key search terms: "chronic musculoskeletal pain," "autonomic nervous system," and "exercise." Data were extracted from measurements of the autonomic nervous system and pain. RESULTS We found a total of 1170 articles; 17 were finally included, incorporating 12 observational and five interventional studies. Although a comparator has not been specified, healthy controls were compared to patients with CMP in observational studies. Three of five interventional studies were pre-post study with healthy controls as a comparator or no controls. The other two interventional studies were randomized controlled trial with a different treatment e.g., stretching. There were four good, 10 fair, and three poor-quality articles. The total number of participants was 617, of which 551 were female. There was high heterogeneity among the five disease conditions and nine outcome measures. Following one-time exposure to aerobic and resistance exercises, abnormal autonomic responses (sympathetic activation and parasympathetic withdrawal), which were absent in healthy controls, were observed in patients with CMP. The effects of aerobic and resistance exercise as long-term interventions were unclear since we identified both positive effects and no change in the autonomic activities in patients with CMP. CONCLUSIONS This study indicates dysfunctional autonomic responses following one-time exposure to exercise and inconsistent interventional effects in the autonomic activities in patients with CMP. Appropriate therapeutic dose is necessary for studying the management of autonomic regulation and pain after exercise.
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Affiliation(s)
- Hironobu Uzawa
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
| | - Kazuya Akiyama
- Rehabilitation Center, International University of Health and Welfare Narita hospital, Narita, Chiba, Japan
| | - Hiroto Furuyama
- Rehabilitation Center, International University of Health and Welfare Narita hospital, Narita, Chiba, Japan
| | - Shinta Takeuchi
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
| | - Yusuke Nishida
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
- Rehabilitation Center, International University of Health and Welfare Narita hospital, Narita, Chiba, Japan
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30
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Pinho H, Neves M, Costa F, Silva AG. Pain intensity and pain sensitivity are not increased by a single session of high-intensity interval aerobic exercise in individuals with chronic low back pain: A randomized and controlled trial. Musculoskelet Sci Pract 2023; 66:102824. [PMID: 37421759 DOI: 10.1016/j.msksp.2023.102824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Evidence on the acute impact of high-intensity interval aerobic exercise on pain is scarce. This type of exercise might be perceived as increasing pain intensity and pain sensitivity negatively impacting adherence. More evidence on the acute effects of high-intensity interval aerobic exercise in individuals with low back pain (LBP) is needed. OBJECTIVES To compare the acute effects of a single session of high-intensity interval aerobic exercise, continuous moderate-intensity aerobic exercise, and no exercise on pain intensity and pain sensitivity in patients with chronic non-specific LBP. DESIGN Randomized controlled trial with three arms. METHOD Participants were randomly assigned to one of three groups (i) continuous moderate-intensity aerobic exercise, ii) high-intensity interval aerobic exercise, and iii) no intervention. Measures of pain intensity and pressure pain threshold (PPT) at the lower back and at a distant body site (upper limb) were taken before and after 15 min of exercise. RESULTS Sixty-nine participants were randomized. A significant main effect of time was found for pain intensity (p = 0.011; η2p = 0.095) and for PPT at the lower back (p < 0.001; η2p = 0.280), but not a time versus group interaction (p > 0.05). For PPT at the upper limb, no main effect of time or interaction was found (p > 0.5). CONCLUSIONS Fifteen minutes of high-intensity interval aerobic exercise does not increase pain intensity or pain sensitivity compared to both moderate-intensity continuous aerobic exercise and no exercise, suggesting that high-intensity interval aerobic exercise can be used in clinical practice and patients reassured that it is unlikely to increase pain.
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Affiliation(s)
- Helena Pinho
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3800-193, Aveiro, Portugal.
| | - Márcia Neves
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3800-193, Aveiro, Portugal.
| | - Fabíola Costa
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3800-193, Aveiro, Portugal.
| | - Anabela G Silva
- CINTESIS.RISE@UA, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
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31
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Alt A, Luomajoki H, Luedtke K. Which aspects facilitate the adherence of patients with low back pain to physiotherapy? A Delphi study. BMC Musculoskelet Disord 2023; 24:615. [PMID: 37501088 PMCID: PMC10375614 DOI: 10.1186/s12891-023-06724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The effectiveness of physiotherapy to reduce low back pain depends on patient adherence to treatment. Facilitators and barriers to patient adherence are multifactorial and include patient and therapist-related factors. This Delphi study aimed to identify an expert consensus on aspects facilitating the adherence of patients with back pain to physiotherapy. METHOD International experts were invited to participate in a three-round standard Delphi survey. The survey contained 49 items (32 original and 17 suggested by experts) which were rated on 5-point Likert scales. The items were assigned to six domains. The consensus level was defined as 60%. RESULTS Of 38 invited experts, 15 followed the invitation and completed all three rounds. A positive consensus was reached on 62% of the 49 proposed items to facilitate adherence. The highest consensus was achieved in the domains "Influence of biopsychosocial factors" (89%) and "Influence of cooperation between physiotherapists and patients" (79%). Additional important domains were the "Influence of competencies of physiotherapists" (71%) and "Interdisciplinary congruence" (78%). "Administration aspects" and the "Use of digital tools" did not reach expert consensus. CONCLUSIONS Biopsychosocial factors, therapeutic skills, and patient-physiotherapist collaboration should be considered in physiotherapy practice to facilitate adherence in patients with LBP. Future studies should prospectively evaluate the effectiveness of individual or combined identified aspects for their influence on patient adherence in longitudinal study designs.
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Affiliation(s)
- Andreas Alt
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
| | - Hannu Luomajoki
- Institute of physiotherapy, Zürich University of applied Sciences (ZHAW), Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland.
| | - Kerstin Luedtke
- Institute of Health Sciences, Department of Physiotherapy, Universität zu Lübeck, Lübeck, Germany
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Alt A, Luomajoki H, Lüdtke K. Strategies to facilitate and tools to measure non-specific low back pain patients' adherence to physiotherapy - A two-stage systematic review. J Bodyw Mov Ther 2023; 35:208-219. [PMID: 37330771 DOI: 10.1016/j.jbmt.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Sustainable management for non-specific low back pain relies on adherence. This requires effective strategies to facilitate but also tools to measure adherence to physiotherapy. OBJECTIVE This two-stage systematic review aims to identify (1) tools to measure non-specific back pain patients' adherence to physiotherapy and (2) the most effective strategy to facilitate patients' adherence to physiotherapy. METHOD PubMed, Cochrane, PEDro, and Web of Science were searched for English language studies measuring adherence in adults with low back pain. Following PRISMA recommendations, scoping review methods were used to identify measurement tools (stage 1). The effectiveness of interventions (stage 2), followed a predefined systematic search strategy. Two independent reviewers selected eligible studies (software Rayyan), analyzed these for risk of bias using the Downs and Black checklist. Data relevant to assess adherence were collected in a predesigned data extraction table. Results were heterogeneous and hence summarized narratively. RESULTS Twenty-one studies were included for stage 1 and 16 for stage 2. Identified were 6 different tools to measure adherence. The most used tool was an exercise diary; the most common more multidimensional tool was the Sports Injury Rehabilitation Adherence Scale. Most included studies were not designed to improve or measure adherence but used adherence as a secondary outcome for new exercise programs. The most promising strategies for facilitating adherence were based on cognitive behavioral principles. CONCLUSION Future studies should focus on the development of multidimensional strategies to facilitate adherence to physiotherapy and appropriate tools to measure all aspects of adherence.
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Affiliation(s)
- A Alt
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Ratzeburger Allee 160, Germany.
| | - H Luomajoki
- Zürich University of Applied Sciences, Institute of Physiotherapy, Katharina Sulzer Platz 95, 8401, Winterthur, Switzerland
| | - K Lüdtke
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Ratzeburger Allee 160, Germany
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Oyake K, Yamauchi K, Inoue S, Sue K, Ota H, Ikuta J, Ema T, Ochiai T, Hasui M, Hirata Y, Hida A, Yamamoto K, Kawai Y, Shiba K, Atsumi A, Nagafusa T, Tanaka S. A multicenter explanatory survey of patients' and clinicians' perceptions of motivational factors in rehabilitation. COMMUNICATIONS MEDICINE 2023; 3:78. [PMID: 37280319 DOI: 10.1038/s43856-023-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Therefore, we aimed to compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation. METHODS This multicenter explanatory survey research was conducted from January to March 2022. In 13 hospitals with an intensive inpatient rehabilitation ward, 479 patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and 401 clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were purposively selected using inclusion criteria. The participants were asked to choose the most important factor motivating patients for rehabilitation from a list of potential motivational factors. RESULTS Here we show that realization of recovery, goal setting, and practice related to the patient's experience and lifestyle are the three factors most frequently selected as most important by patients and clinicians. Only five factors are rated as most important by 5% of clinicians, whereas nine factors are selected by 5% of patients. Of these nine motivational factors, medical information (p < 0.001; phi = -0.14; 95% confidence interval = -0.20 to -0.07) and control of task difficulty (p = 0.011; phi = -0.09; 95% confidence interval = -0.16 to -0.02) are selected by a significantly higher proportion of patients than clinicians. CONCLUSIONS These results suggest that when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to using the core motivational factors supported by both parties.
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Affiliation(s)
- Kazuaki Oyake
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Keita Sue
- Department of Rehabilitation, JA Nagano Kouseiren Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Nagano, Japan
| | - Hironobu Ota
- Rehabilitation Center, Aichi Medical University Medical Center, Aichi, Japan
| | - Junichi Ikuta
- Division of Occupational Therapy, Department of Rehabilitation, Nakaizu Rehabilitation Center, Shizuoka, Japan
| | - Toshiki Ema
- Department of Rehabilitation, Suzukake Central Hospital, Shizuoka, Japan
| | - Tomohiko Ochiai
- Rehabilitation Center, Juzen Memorial Hospital, Shizuoka, Japan
| | - Makoto Hasui
- Department of Rehabilitation Medicine, JA Shizuoka Kohseiren Enshu Hospital, Shizuoka, Japan
| | - Yuya Hirata
- Department of Rehabilitation, Suzukake Healthcare Hospital, Shizuoka, Japan
| | - Ayaka Hida
- Department of Rehabilitation Medicine, Kakegawa Higashi Hospital, Shizuoka, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Toyoda Eisei Hospital, Shizuoka, Japan
| | - Yoshihiro Kawai
- Department of Rehabilitation, Tenryu Suzukake Hospital, Shizuoka, Japan
| | - Kiyoto Shiba
- Department of Rehabilitation Medicine, Hamakita Sakuradai Hospital, Shizuoka, Japan
| | - Akihito Atsumi
- Department of Rehabilitation, Hamamatsu-Kita Hospital, Shizuoka, Japan
| | - Tetsuyuki Nagafusa
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan.
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Lechauve JB, Dobija L, Pereira B, Grolier M, Goldstein A, Lanhers C, Coudeyre E. Evaluation of the impact of a smartphone application on adherence to home exercise program for people with chronic low back pain: research protocol for a pilot randomised controlled trial. BMJ Open 2023; 13:e062290. [PMID: 36963800 PMCID: PMC10040032 DOI: 10.1136/bmjopen-2022-062290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Multidisciplinary rehabilitation programmes are highly recommended for individuals with the most disabling low back pain (LBP). However, the long-term adherence to regular home exercise is often poor. We aim to perform a prospective, controlled, pilot, randomised study that will evaluate the impact of a smartphone application on adherence to exercise programme for people with chronic LBP (CLBP). METHODS AND ANALYSIS 120 participants with non-specific CLBP aged 18-65 years will be recruited and randomised in two groups: an experimental group benefitting from education in the application's use in addition to a conventional multidisciplinary rehabilitation programme (exercises and self-management education) and a control group who will only participate in the multidisciplinary rehabilitation programme. Both groups will undergo the programme 5 days a week for 3 weeks. The primary outcome will be a change in patient's adherence to physical exercise (Exercise Adherence Rating Scale) at 6 months. Secondary outcomes will be function (Oswestry Disability Index), beliefs concerning physical activity (Evaluation of Physical Activity Perception), pain (Numeric Rating Scale), and physical capacity and qualitative adherence (video).Statistical analyses will be performed according to intention to treat. A linear mixed model will be used to compare the primary endpoint between groups at 6 months post-randomisation.The study could demonstrate the impact of using a smartphone application on adherence to exercise programme in people with CLBP. We hypothesise that the application's use will improve outcomes through improved exercise adherence. ETHICS AND DISSEMINATION The study was approved by the medical ethics committee of Ile de France 3. The results of this study will be disseminated in peer-reviewed publications and presentations at international scientific meetings and will also be disseminated to the participants. TRIAL REGISTRATION NUMBER NCT04264949.
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Affiliation(s)
- Jean-Baptiste Lechauve
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lech Dobija
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, Unité de Biostatistiques CHU Clermont-Ferrand, University Hospital CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maxime Grolier
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Goldstein
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlotte Lanhers
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Home-based respiratory muscle training on quality of life and exercise tolerance in long-term post-COVID-19: Randomized controlled trial. Ann Phys Rehabil Med 2023; 66:101709. [PMID: 36191860 PMCID: PMC9708524 DOI: 10.1016/j.rehab.2022.101709] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/04/2022] [Accepted: 09/10/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effects of a home-based respiratory muscle training programme (inspiratory [IMT] or inspiratory/expiratory muscles [RMT]) supervised by telerehabilitation on quality of life and exercise tolerance in individuals with long-term post-COVID-19 symptoms. The secondary objective was to evaluate the effects of these programmes on respiratory muscle function, physical and lung function, and psychological state. METHODS 88 individuals with long-term symptoms of fatigue and dyspnoea after COVID-19 diagnosis were randomly (1:1 ratio) assigned to IMT, IMTsham, RMT or RMTsham groups for an 8-week intervention (40min/day, 6 times/week). Primary outcomes were quality of life (EuroQol-5D questionnaire) and exercise tolerance (Ruffier test). Secondary outcomes were respiratory muscle function (inspiratory/expiratory muscle strength; inspiratory muscle endurance), physical function (lower and upper limb strength [1-min Sit-to-Stand and handgrip force]), lung function (forced spirometry), and psychological status (anxiety/depression levels and post-traumatic stress disorder). All outcomes were measured pre-, intermediate- (4th week), and post-intervention. RESULTS At post-intervention, there was a statistically significant and large (d>0.90) improvement in quality of life, but not in exercise tolerance, in the RMT group compared with the RMTsham group. Both of the real training groups produced a statistically significant and large increase in inspiratory muscle strength and endurance (d≥0.80) and in lower limb muscle strength (d≥0.77) compared with the 2 sham groups. Expiratory muscle strength and peak expiratory flow showed a statistically significant and large (d≥0.87) increase in the RMT group compared with the other 3 groups. CONCLUSION Only an 8-week supervised home-based RMT programme was effective in improving quality of life, but not exercise tolerance, in individuals with long-term post-COVID-19 symptoms. In addition, IMT and RMT programmes were effective in improving respiratory muscle function and lower limb muscle strength, but had no impact on lung function and psychological status.
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Rören A, Yagappa DM, Théry C, Lefèvre-Colau MM, Rannou F, Nguyen C. Remote telerehabilitation to maintain adherence to home-based exercise therapy in people with musculoskeletal disorders: A pilot study. Ann Phys Rehabil Med 2023; 66:101723. [PMID: 36652784 DOI: 10.1016/j.rehab.2022.101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 09/17/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Alexandra Rören
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014 Paris, France; Université Paris Cité, INSERM UMR 1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris-Cité, 75004 Paris, France; Fédération pour la Recherche sur le Handicap et l'Autonomie, 75013 Paris, France.
| | - Didier Marie Yagappa
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014 Paris, France
| | - Camille Théry
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014 Paris, France
| | - Marie-Martine Lefèvre-Colau
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014 Paris, France; Université Paris Cité, INSERM UMR 1153, Centre de Recherche en Épidémiologie et Statistique Sorbonne Paris-Cité, 75004 Paris, France; Fédération pour la Recherche sur le Handicap et l'Autonomie, 75013 Paris, France; Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France
| | - François Rannou
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014 Paris, France; Fédération pour la Recherche sur le Handicap et l'Autonomie, 75013 Paris, France; Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France; Université Paris Cité, INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs, Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - Christelle Nguyen
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, 75014 Paris, France; Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France; Université Paris Cité, INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs, Campus Saint-Germain-des-Prés, 75006 Paris, France
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Johansson MM, Nätt M, Peolsson A, Öhman A. Frail community-dwelling older persons' everyday lives and their experiences of rehabilitation - a qualitative study. Scand J Occup Ther 2023; 30:65-75. [PMID: 35786360 DOI: 10.1080/11038128.2022.2093269] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The number of older persons with frailty is increasing, and rehabilitation to improve the consequences of frailty are important for both the individual and society. However, the perspective of older persons themselves in research and planning of interventions is scarce. AIM The aim of this study was to describe frail older persons' everyday lives and their experiences and views of rehabilitation. MATERIAL AND METHODS Twenty older persons were interviewed, and analyses were performed using a qualitative content analysis method. RESULTS The two main categories were 'Frailty impacts everyday lifé and 'Experiences and perceptions of rehabilitation'. The participants described that they had to adapt their everyday lives in line with their health conditions. They all used strategies and were dependent on support in their activities of daily living. Their social network had decreased. All participants strived to stay active and independent, and wanted rehabilitation and support from professionals, experiencing decreased access to rehabilitation. CONCLUSIONS AND SIGNIFICANCE Frail older persons are a vulnerable group who often need support in everyday life. There is room for improvement when it comes to helping frail older persons to stay active and facilitate participation in both individual and group interventions.
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Affiliation(s)
- Maria M Johansson
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Malin Nätt
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Rehabilitation Medicine in Linköping, and Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical medicine, Linköping University, Linköping, Sweden
| | - Annika Öhman
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy, Linköping University, Norrköping, Sweden
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Chang MC, Park D, Choo YJ. Use of QR Codes for Promoting a Home-Based Therapeutic Exercise in Patients with Lumbar Disc Herniation and Lumbar Spinal Stenosis: A Prospective Randomized Study. J Pain Res 2022; 15:4065-4073. [PMID: 36582658 PMCID: PMC9793788 DOI: 10.2147/jpr.s391735] [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: 10/05/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose In the current study, we investigated the usefulness of the quick response (QR) code linked to the source of a video of home-based therapeutic exercise to promote home-based therapeutic exercise in patients with LDH and LSS. Patients and Methods Forty patients with LDH and LSS were included in this study. The patients were randomly assigned to one of two groups: QR codes or control groups (20 patients per group). The QR code group received QR code stickers linked with a video that includes a demonstration on how to exercise for the back muscles. We instructed the patients to perform home-based therapeutic exercises three or more days a week. Patients in the control group were asked to perform the therapeutic exercise without providing a QR code to them. The primary outcome was the number of exercises per week. The scores of the numeric rating scale (NRS) and Oswestry disability index (ODI) were investigated as secondary outcomes. Results The patients in the QR code group exercised for the lower back muscles on average about two times a week, and 40% of the patients in the QR code group performed the exercise three or more days a week. However, almost no patients in the control group performed therapeutic exercises. Patients in the QR code group showed significantly lower ODI scores at the 1-month and 2-month follow-ups compared with the control group. In addition, the patients who exercised ≥3 times per week showed more improvement in the disability than those who exercised <3 times per week. The NRS scores for lower back pain and radicular leg pain were not significantly different between the QR code and control groups. Conclusion We found that QR codes can be useful for encouraging patients with LDH or LSS to perform home-based therapeutic exercises.
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Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yoo Jin Choo
- Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, 41061, Republic of Korea,Correspondence: Yoo Jin Choo, Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, 80, Cheombok-ro, Dong-gu, Daegu, 41061, Republic of Korea, Tel +82 10 7344 7841, Email
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Li G, Wu M, Sun R. Will China's audit of natural environmental resource promote green sustainable development? Evidence from PSM-DID analysis based on substantial and strategic pollution reduction. PLoS One 2022; 17:e0278985. [PMID: 36512617 PMCID: PMC9747048 DOI: 10.1371/journal.pone.0278985] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Countries around the world have become concerned about their responsibility to protect the environment and resources. In this paper, we established a model of multi-period PSW-DID (weighted propensity score matching- differences-in-differences) to test the effect of China's audit of natural resource. We found that: (1) local governments had a strategic incentive to reduce pollution, they paid more attention to environmental performance linked to individual promotion than to green innovation and development. (2) Compared with the long-term and complexity of water pollution control, they paid more attention to air pollution treatment. (3) In the long run, the environmental audit was indeed beneficial to the improvement of environmental quality, but the time of taking effect was the second year (one-year lag). (4) In addition, because of the contradiction between the neglect of human capital and the timeliness of environmental supervision, the local government did not show substantial pollution reduction. Therefore, local officials should foster the long-term responsibility consciousness of green innovation and pay more attention to the integration of human capital. The audit of natural resources should establish a long-term mechanism, which could establish a complete accountability system or change off-office audit to interim audit. The construction of audit big data platforms should pay more attention to substantive characteristic data, such as data on population inflow, which is not only a paper score of air pollution. This study can reveal the dilemma of pollution prevention and control in China, urge local governments to promote the rational flow of human resources, improve the innovation level, and achieve substantive pollution control and efficiency enhancement of green development.
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Affiliation(s)
- Guofeng Li
- School of Statistics and Mathematics, Shandong University of Finance and Economics, Jinan, China
| | - Meng Wu
- School of Economics, Shandong University of Finance and Economics, Jinan, China
- * E-mail:
| | - Ruoyuan Sun
- School of Public Finance & Taxation, Shandong University of Finance and Economics, Jinan, China
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Effects of a single exercise session on pain intensity in adults with chronic pain: a systematic review and meta-analysis. Musculoskelet Sci Pract 2022; 62:102679. [PMID: 36332334 DOI: 10.1016/j.msksp.2022.102679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic pain is prevalent amongst society, making it necessary to find strategies to manage chronic pain. Regular exercise is efficacious; however, pain is a barrier to initiating exercise. A single exercise session is also believed to acutely reduce pain, however, the evidence for this is less robust. OBJECTIVES This systematic review and meta-analysis aimed to identify the effect of a single exercise session on pain intensity in adults with chronic pain. METHODS We searched eight databases and trial registries to identify randomised controlled trials evaluating the effect of a single exercise session on pain intensity in adults with chronic pain compared to a non-exercise control. Literature screening, data extraction, risk of bias (Cochrane 2.0) and quality assessment (GRADE) were conducted independently and in duplicate. Random-effects meta-analyses were performed using the metafor package in R. RESULTS We included 17 trials (46 study arms with 664 adults [44% female]). There were no significant differences in pain intensity (mean difference on a 0-10 scale) immediately post-exercise -0.02 (95% CI = -0.06, 0.62; I2 = 77.1%) or up to 45-min post-exercise -0.17 (95% CI = -0.49, 0.16; I2 = 34.2%). All trials were at high risk of bias and the overall confidence in these findings was very low. CONCLUSION A single exercise session did not reduce pain intensity up to 1-h post-exercise. Notably, increases in pain were not observed either, suggesting that while pain can be a barrier to initiating exercise, clinicians can educate patients on the unlikelihood of exercise acutely increasing pain intensity.
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Fanning J, Brooks AK, Ford S, Robison JT, Irby MB, Rejeski WJ. A remote group-mediated daylong physical activity intervention for older adults with chronic pain: Results of the MORPH-II randomized pilot trial. Front Digit Health 2022; 4:1040867. [PMID: 36405417 PMCID: PMC9666366 DOI: 10.3389/fdgth.2022.1040867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023] Open
Abstract
Chronic pain is a debilitating condition that affects many older adults who often have limited access to non-pharmacological pain management strategies. One potentially effective and novel lifestyle medicine for chronic pain involves increasing physical activity through frequent movement across the day, thereby also decreasing the presence of extended sedentary bouts. The MORPH-II pilot randomized controlled refinement trial iterated on the MORPH trial, which was a first-of-its-kind group-mediated daylong physical activity (DPA) intervention for older adults with chronic pain rooted in social cognitive and self-determination theories and supported by an mHealth toolset designed to foster social connection and awareness of physical activity patterns. MORPH-II was delivered fully remotely via videoconference software and supported by a technology kit comprising an iPad, activity monitor, and wireless weight scale. It was also implemented a refined coaching model designed to help participants better understand their own patterns of activity. A total of 44 participants were randomized to receive the 12-week group-mediated DPA intervention or to a low-contact control. Qualitative interviews suggest the program was well-received by participants and that participants developed an understanding of how patterns of physical activity related to their pain symptoms. Participants also highlighted several additional areas for refinement related to the coaching model and feedback provided within the mHealth app. Analyses of covariance, controlling for baseline values, revealed a small effect (η 2 = 0.01) on pain intensity favoring the intervention condition, though both groups improved during the study period. There was a large effect favoring the intervention condition on ActivPAL-assessed average daily steps (η 2 = 0.23) and postural shifts (η 2 = 0.24). Control participants spent less time in short sedentary bouts (η 2 = 0.09), and there was a small effect (η 2 = 0.02) indicating intervention participants spent less time in extended sedentary bouts. Finally, relative to control, intervention participants demonstrated a moderate improvement in autonomy satisfaction (η 2 = 0.05), relatedness frustration (η 2 = 0.05), and competence frustration (η 2 = 0.06), and a large magnitude improvement in competence satisfaction (η 2 = 0.22). These findings indicate that the MORPH-II intervention was feasible and acceptable, and may positively impact steps, postural breaks, and several key domains of basic psychological needs detailed in self-determination theory.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Justin T. Robison
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - Megan B. Irby
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, United States
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Factors impacting adherence to an exercise-based physical therapy program for individuals with low back pain. PLoS One 2022; 17:e0276326. [PMID: 36264988 PMCID: PMC9584523 DOI: 10.1371/journal.pone.0276326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background/Objective Exercise-based rehabilitation is a conservative management approach for individuals with low back pain. However, adherence rates for conservative management are often low and the reasons for this are not well described. The objective of this study was to evaluate predictors of adherence and patient-reported reasons for non-adherence after ceasing a supervised exercise-based rehabilitation program in individuals with low back pain. Design Retrospective observational study. Methods Data was retrospectively analyzed from 5 rehabilitation clinics utilizing a standardized exercise-based rehabilitation program. Baseline demographics, diagnosis and symptom specific features, visit number, and discontinuation profiles were quantified for 2,243 patients who underwent the program. Results Forty-three percent (43%) of participants were adherent to the program, with the majority (31.7%) discontinuing treatment prior to completion due to logistic and accessibility issues. Another 13.2% discontinued prior to the prescribed duration due to clinically significant improvements in pain and/or disability without formal discharge evaluation, whereas 8.3% did not continue due to lack of improvement. Finally, 6.0% were discharged for related and unrelated medical reasons including surgery. Individuals diagnosed with disc pathology were most likely to be adherent to the program. Limitations This study was a retrospective chart review with missing data for some variables. Future studies with a prospective design would increase quality of evidence. Conclusions The majority of individuals prescribed an in-clinic exercise-based rehabilitation program are non-adherent. Patient diagnosis was the most important predictor of adherence. For those who were not adherent, important barriers include personal issues, insufficient insurance authorization and lack of geographic accessibility.
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Cuenca-Martínez F, Sempere-Rubio N, Varangot-Reille C, Fernández-Carnero J, Suso-Martí L, Alba-Quesada P, Touche RL. Effects of High-Intensity Interval Training (HIIT) on Patients with Musculoskeletal Disorders: A Systematic Review and Meta-Analysis with a Meta-Regression and Mapping Report. Diagnostics (Basel) 2022; 12:2532. [PMID: 36292221 PMCID: PMC9601160 DOI: 10.3390/diagnostics12102532] [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: 09/26/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
The aim was to assess the impact of high-intensity interval training (HIIT) on patients with musculoskeletal disorders. We conducted a search of Medline, Embase, PEDro, and Google Scholar. We conducted a meta-analysis to determine the effectiveness of HIIT on pain intensity, maximal oxygen consumption (VO2 max), disability, and quality of life (QoL). We employed the GRADE and PEDro scales to rate the quality, certainty, and applicability of the evidence. Results showed significant differences in pain intensity, with a moderate clinical-effect (SMD = -0.73; 95% CI: -1.40--0.06), and in VO2 max, with a moderate clinical-effect (SMD = 0.69; 95% CI: 0.42-0.97). However, the meta-analysis showed no statistically significant results for disability (SMD = -0.34; 95% CI: -0.92-0.24) and QoL (SMD = 0.40; 95% CI: -0.80-1.60). We compared HIIT against other exercise models for reducing pain intensity and increasing VO2 max. The meta-analysis showed no significant differences in favour of HIIT. Meta-regression analysis revealed that pain intensity scores were negatively associated with VO2 max (R2 = 82.99%, p = 0.003). There is low-moderate evidence that the HIIT intervention for patients with musculoskeletal disorders can reduce pain intensity and increase VO2 max but has no effect on disability and QoL. Results also showed that HIIT was not superior to other exercise models in reducing pain intensity and increasing VO2 max.
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Affiliation(s)
- Ferran Cuenca-Martínez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, 46010 Valencia, Spain
| | - Clovis Varangot-Reille
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28933 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Patricio Alba-Quesada
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), 28003 Madrid, Spain
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Dillenhoefer S, Stehling F, Welsner M, Schlegtendal A, Sutharsan S, Olivier M, Taube C, Mellies U, Koerner-Rettberg C, Brinkmann F, Gruber W. Barriers for Sports and Exercise Participation and Corresponding Barrier Management in Cystic Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13150. [PMID: 36293733 PMCID: PMC9603748 DOI: 10.3390/ijerph192013150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nowadays physical activity (PA)/exercise is an important component of cystic fibrosis (CF) therapy. The aim of the study was to assess the barriers to PA and the barrier management and to explore the effect of supervision on the barriers and barrier management during an exercise program. METHODS In total, 88 people with CF (pwCF) of the ages 6 to 50 years old (mean 24.2 ± 7.9 yrs) participated in the partially supervised 12-month exercise program and filled in a structured and validated questionnaire about barriers to sports and barrier management at baseline. Additionally, 23 pwCF filled in the questionnaire after 6 months and 12 months. The items were clustered into physical and psychosocial barriers and into preventive counter strategies and situational counter strategies and analyzed at baseline and over time. RESULTS Physical barriers were more relevant than psychosocial barriers and no trend could be seen in the situational and preventive counter strategies. When divided in subgroups, the less active pwCF (<7500 steps/day), more active pwCF (>7500 steps/day), physical barriers, and psychosocial barriers showed no significant differences. However physical barriers showed a tendency to have a higher value in the less active group compared to the more active group (p > 0.05). Stratified by age or FEV1%pred between the subgroups, no differences could be seen regarding barriers and counter strategies. CONCLUSIONS Physical barriers seemed to have a higher priority when it comes to not participating in PA/exercise. Supervision over 6 months during an exercise program did not show a beneficial effect on barriers and barrier management. Besides the motivational aspect of sport counselling, the volitional aspect seemed to be more important to incorporate more PA into daily life. Individual barriers and their concrete counter strategies should be discussed with the patient with CF. Sport counselling is needed permanently and should be part of the CF routine care.
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Affiliation(s)
- Stefanie Dillenhoefer
- Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, 44791 Bochum, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany
| | - Anne Schlegtendal
- Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, 44791 Bochum, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, Adult Cystic Fibrosis Center, University Hospital Essen-Ruhrlandklinik, University of Duisburg-Essen, 45239 Essen, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
| | | | - Folke Brinkmann
- Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Children’s Hospital of Ruhr University Bochum at St. Josef-Hospital, 44791 Bochum, Germany
| | - Wolfgang Gruber
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, 45117 Essen, Germany
- Institute of Human Nutrition and Food Science, Christian Albrechts University Kiel, 24118 Kiel, Germany
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Martinez-Calderon J, de-la-Casa-Almeida M, Matias-Soto J. The Effects of Mind-Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912062. [PMID: 36231365 PMCID: PMC9564899 DOI: 10.3390/ijerph191912062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 05/12/2023]
Abstract
An umbrella review of systematic reviews with a meta-analysis was developed to summarize the evidence on the effectiveness of qigong, tai chi, and yoga in chronic spinal pain outcomes. The CINAHL, Cochrane Library, Embase, PsycINFO, PubMed and SPORTDiscus databases were searched. Pain, psychological factors, and quality of life (QOL) were the outcomes of interest. The methodological quality of the reviews was evaluated using the AMSTAR-2 tool. The overlap was calculated using the corrected covered area. A total of 72 meta-analyses drawn from 20 systematic reviews were included and often were rated at a critically low quality. The effects of qigong on chronic low back and neck pain (CLBP and CNP, respectively) were inconsistent, although it improved the physical component of QOL after 12 weeks for CNP. Tai chi was superior to the controls in reducing CLBP; no reviews of interest were found on CNP. Yoga was superior to multiple controls in reducing CLBP, but no relevant effects on depression or QOL were found. QOL, anxiety, depression, and general mood improved with yoga for CNP. Inconsistencies arose related to yoga and CNP. Our findings mainly supported the potential effects of yoga and tai chi on pain-related outcomes, psychological factors, and QOL in populations with CLBP and NP. Clinical and methodological considerations were discussed.
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Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena s/n, 41009 Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, University of Seville, 41004 Seville, Spain
| | - Maria de-la-Casa-Almeida
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena s/n, 41009 Sevilla, Spain
- Correspondence: ; Tel.: +34-954-486-520
| | - Javier Matias-Soto
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, University of Seville, 41004 Seville, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa, 3, 29071 Malaga, Spain
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McLeod G, Morgan E, McMillan S, McCahon S, Sanna N. Why Are Patients Not Doing Their Prescribed Home-Based Exercises? An Updated Review of the Factors Affecting Adherence to Prescribed Home-Based Exercise in Patients With Chronic Low Back Pain. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221116143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prescribed home-based exercise programs have been found to be an effective non-pharmacological treatment for the management of chronic low back pain. However, such programs rely on continued patient adherence to performing the exercises. The purpose of this integrative review is to present the key factors that influence adherence to prescribed home-based exercise for individuals with chronic low back pain. Searches of AMED, SPORTDiscus, CINAHL, MEDLINE, ScienceDirect, and Cochrane Library databases were performed for the period 2015 to 2021, using the following key search terms: exercise adherence, exercise compliance, exercise therapy, home-based exercise, chronic low back pain, and enabler, barrier or factor. Eight studies met the inclusion criteria and included Qualitative, Prospective Observation, Feasibility, Case Series and Randomised Controlled Trial studies. All participants were adults ranging from 18 to 85 years old with chronic low back pain and there was an overall female representation of 53.4%. Studies were assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. The findings highlighted 2 key factors influencing adherence to home-based exercise programs for individuals with chronic low back pain: (1) the need for practitioners to develop effective communication skills that focus on the individual’s needs, including personalisation of exercise programs aimed at an individual’s symptoms, lifestyle and treatment goals; and (2) follow-up feedback and support strategies via electronic (virtual) or face to face in-clinic and home visits. Adherence to home-based exercise programs requires effective practitioner communication and targeted follow-up support and feedback.
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Affiliation(s)
- Gopi McLeod
- Southern Cross University, Lismore, NSW, Australia
| | - Eva Morgan
- Southern Cross University, Lismore, NSW, Australia
| | | | | | - Niribi Sanna
- Southern Cross University, Lismore, NSW, Australia
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Wang H, Hu F, Lyu X, Jia H, Wang B, Liu F, Yang Y. Kinesiophobia could affect shoulder function after repair of rotator cuff tears. BMC Musculoskelet Disord 2022; 23:714. [PMID: 35883122 PMCID: PMC9316366 DOI: 10.1186/s12891-022-05679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.
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Affiliation(s)
- Huihui Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiaolong Lyu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Bourke MJ, Ferguson D, Cooke M. Patient Experiences of Self-Management for Chronic Low Back Pain: A Qualitative Study. Phys Ther 2022; 102:6556165. [PMID: 35358311 DOI: 10.1093/ptj/pzac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 11/08/2021] [Accepted: 02/02/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is a lifelong condition causing disability and distress. One aim of treatment is to enhance self-management. To date, self-management interventions have had limited effectiveness. A greater understanding of self-management for CLBP has the potential to improve future interventional trials. The purpose of this study was to identify the experience of CLBP self-management for patients attending outpatient physical therapy and assess how the experience of CLBP self-management changes over time. METHODS This qualitative study used constructivist grounded theory. Patients with CLBP who were attending an outpatient physical therapy department were recruited using convenience sampling. Each participant attended a semistructured interview. These were audio recorded and transcribed verbatim. The data were coded and thematically analyzed by the lead researcher. Recruitment continued until data saturation. Participants reviewed preliminary themes for validation. RESULTS Six subthemes emerged from 9 interviews: (1) self-doubt, (2) coping day to day, (3) independent discovery, (4) developing resilience, (5) health care: opportunity and threat, and (6) living with pain differently. Two themes took on greatest significance. Self-doubt appeared most strongly and was prevalent in all experiences. However, living with pain differently appeared in those who had developed a level of pain acceptance. These themes formed a conceptual model, "Fluctuating Uncertainty." CONCLUSION The experience of CLBP self-management is one of fluctuating self-doubt. Self-doubt is the predominant experience and is characterized by the perception of pain as a threat and low pain self-efficacy. During times of greater clarity, individuals develop strategies that increase pain self-efficacy and reinforce the perception of pain without threat. These are features of learning to live well with pain. IMPACT CLBP is a lifelong condition requiring self-management. The current study characterizes the self-management strategies used by patients attending physical therapy. The fluctuating nature of these strategies is dependent upon perception of pain and pain self-efficacy. LAY SUMMARY People with CLBP who self-manage their pain fluctuate between attempting to control pain and learning to live with pain. People who understand their condition develop wider-ranging self-management strategies.
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Affiliation(s)
- Maurice John Bourke
- Department of Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Diarmaid Ferguson
- Department of Physiotherapy, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Rehabilitation to improve outcomes of lumbar fusion surgery: a systematic review with meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1525-1545. [PMID: 35258644 DOI: 10.1007/s00586-022-07158-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of rehabilitation strategies on disability, pain, pain-related fear, and return-to-work in patients undergoing lumbar fusion surgery for degenerative conditions or adult isthmic spondylolisthesis. METHODS Six electronic databases were systematically searched for randomized controlled trials (RCTs) evaluating the effect of rehabilitation (unimodal or multimodal). The estimated effect size was calculated for interventions with homogeneous content using a random-effects model. Certainty of evidence was assessed by GRADE. RESULTS In total, 18 RCTs, including 1402 unique patients, compared specific rehabilitation to other rehabilitation strategies or usual care. Most described indications were degenerative disc disease and spondylolisthesis. All rehabilitation interventions were delivered in the postoperative period, and six of them also included a preoperative component. Intervention dose and intensity varied between studies (ranging from one session to daily sessions for one month). Usual care consisted mostly of information and postoperative mobilization. At short term, low quality of evidence shows that exercise therapy was more effective for reducing disability and pain than usual care (standardized mean difference [95% CI]: -0.41 [-0.71; -0.10] and -0.36 [-0.65; -0.08], four and five studies, respectively). Multimodal rehabilitation consisted mostly of exercise therapy combined with cognitive behavioral training, and was more effective in reducing disability and pain-related fear than exercise therapy alone (-0.31 [-0.49; -0.13] and -0.64 [-1.11; -0.17], six and four studies, respectively). Effects disappeared beyond one year. Rehabilitation showed a positive tendency towards a higher return-to-work rate (pooled relative risk [95% CI]: 1.30 [0.99; 1.69], four studies). CONCLUSION There is low-quality evidence showing that both exercise therapy and multimodal rehabilitation are effective for improving outcomes up to six months after lumbar fusion, with multimodal rehabilitation providing additional benefits over exercise alone in reducing disability and pain-related fear. Additional high-quality studies are needed to demonstrate the effectiveness of rehabilitation strategies in the long term and for work-related outcomes.
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Chao HT, Chang PC, Lin YK, Huang WC, Wu CC, Chang LI, Liao YM. Longitudinal Effects of a Combined Program of Pelvic Floor Muscle Training and Yoga on Genitourinary Symptoms in Asian Women of Older Age: A Randomized Experimental Study. Geriatr Nurs 2022; 46:27-38. [PMID: 35597057 DOI: 10.1016/j.gerinurse.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.
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Affiliation(s)
- Hsiang-Tai Chao
- Obstetrics and Gynecology Department, Taipei Veterans General Hospital, 201 Shi-Pai Road, Section 2, Taipei City 11217, Taiwan, Republic of China (R.O.C.); College of Medicine, National Yang Ming Chiao Tung University, 155 Li-Nong Street, Section 2, Taipei City 112, Taiwan, Republic of China (R.O.C.)
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, 250 Wenhua 1st Road, Guishan, Taoyuan 333, Taiwan, Republic of China (R.O.C.)
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, Cathy General Hospital, 280 Ren-Ai Road, Section 4, Taipei City 106, Taiwan, Republic of China (R.O.C.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, 252 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.); Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Lu-I Chang
- Department of Nursing, College of Medicine, Tzu Chi University, 701 Zhong-Yang Road, Section 3, Hualien City 97004, Taiwan, Republic of China (R.O.C.)
| | - Yuan-Mei Liao
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Li-Nong Street, Section 2, Taipei City 112, Taiwan, Republic of China (R.O.C.).
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