Pain and Its Management: Strategies and Outcomes in Older Adults With or at Risk for Knee Osteoarthritis

Abstract Knee osteoarthritis (KOA) is a leading cause of mobility disability that is characterized by chronic pain among older adults. Non-Hispanic Blacks (NHBs) suffer disproportionately from non-Hispanic Whites (NHWs), reporting higher pain intensity and disability. It is unclear how these differences in symptomatology translate into different patterns of utilization for self-management (SM) of pain, and if such patterns are associated with underlying biological pain mechanisms. This multisite observational study examined (1) use of self-management strategies among older NHB and NHW adults with/at risk for KOA and (2) associations among self-management strategies, clinical and experimental pain. After approval from institutional IRBs, NHB and NHW older adults (N= 202) with knee pain completed the McGill Pain Questionnaire-Short Form, questions on treatment strategies (e.g., massage, ice, heat, medications), and quantitative sensory testing. Covariates included study site and education. On average, participants reported using 2 ± 1.65 SM strategies, with 79% endorsing at least one SM strategy. Analysis of covariance revealed that clinical pain differed by race/ethnicity and use of SM and/or medical treatments (p’s < 0.01). SM use did not differ by race/ethnicity, p = 0.15, but did differ significantly by gender, p < 0.05. Multiple linear regression demonstrated significant positive associations between SM and heat pain sensitivity for both NHBs and NHWs, (p < 0.05). SM is an important component of OA management for NHBs and NHWs. Our study is one of the first to show that SM use is significantly associated with pain mechanisms. Improved understanding will facilitate better mechanism-targeted pain management.

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Association between Loneliness and Diseases Self-Management in Older Adults: Systematic Review

Innovation in Aging ◽

10.1093/geroni/igab046.2374 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 626-627

Author(s):

Emma Cho ◽

Ya-Ching Huang ◽

Alexandra Garcia ◽

Hsuan-Ju Kuo

Keyword(s):

Systematic Review ◽

Older Adults ◽

At Risk ◽

Health Behaviors ◽

Chronic Diseases ◽

Negative Impact ◽

Self Management ◽

Physically Active ◽

Aging Populations ◽

Management Behaviors

Abstract Purpose Older adults with chronic diseases are more at risk for loneliness, and loneliness has a negative impact on health behaviors, which are key to managing chronic diseases. However, little is known about the association between loneliness and self-management behaviors in older adults with chronic diseases. As societies worldwide experience the growth of aging populations who are at higher risk of having chronic diseases as they age, clinicians and researchers should assess and address loneliness of older adults with chronic diseases. Methods This systematic review synthesizes research found in PubMed, MEDLINE, PsychINFO, CINAHL, and SocINDEX. Findings: fourteen studies were conducted in four countries and represented n= 128,610. Loneliness was measured by three different instruments. Reports of loneliness were frequent and ranged from 7.7% (in a report of severe loneliness) to 43.2% (moderate loneliness) of older adults. Older adults who experienced loneliness were less likely to be physically active, eat a healthy diet, or cope in positive ways and more likely to be female and seek healthcare. Conclusions This systematic review found that loneliness was moderately prevalent, and that loneliness was associated with negative disease self-management behaviors in older adults with chronic diseases. Gaps in the research include a need for studies guided by theoretical pathways, using a consistent, theoretically-based measure of loneliness, and conducted on among people with specific chronic diseases.

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A qualitative investigation of the impact of asthma and self-management strategies among older adults

Journal of Asthma ◽

10.1080/02770903.2016.1193602 ◽

2016 ◽

Vol 54 (1) ◽

pp. 39-45 ◽

Cited By ~ 17

Author(s):

Rachel O'Conor ◽

Melissa Martynenko ◽

Monica Gagnon ◽

Diane Hauser ◽

Edwin Young ◽

...

Keyword(s):

Older Adults ◽

Management Strategies ◽

Self Management ◽

Qualitative Investigation ◽

The Impact

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Pain experiences and self-management strategies among middle-aged and older adults with arthritis

Journal of Clinical Nursing ◽

10.1111/jocn.12134 ◽

2013 ◽

Vol 22 (13-14) ◽

pp. 1857-1869 ◽

Cited By ~ 11

Author(s):

Guilan Gong ◽

Jie Li ◽

Xiuyun Li ◽

Jing Mao

Keyword(s):

Older Adults ◽

Management Strategies ◽

Self Management ◽

Middle Aged ◽

Pain Experiences

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Prospective change in daily walking over 2 years in older adults with or at risk of knee osteoarthritis: the MOST study

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2015.08.004 ◽

2016 ◽

Vol 24 (2) ◽

pp. 246-253 ◽

Cited By ~ 6

Author(s):

D.K. White ◽

C. Tudor-Locke ◽

Y. Zhang ◽

J. Niu ◽

D.T. Felson ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Knee Osteoarthritis

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The Influence of Dysphagia on Nutritional and Frailty Status among Community-Dwelling Older Adults

Nutrients ◽

10.3390/nu13020512 ◽

2021 ◽

Vol 13 (2) ◽

pp. 512

Author(s):

Takahiro Nishida ◽

Kazumi Yamabe ◽

Sumihisa Honda

Keyword(s):

Older Adults ◽

At Risk ◽

Short Form ◽

Multiple Logistic Regression Analysis ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Swallowing Function ◽

Frailty Status ◽

Community Dwelling Older Adults

Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9–8.2) and frailty status (OR: 2.3; 95% CI: 1.0–5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs.

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Effectiveness of Tuina manipulation in patients with knee osteoarthritis: study protocol for a randomized controlled trial

10.21203/rs.3.rs-20550/v3 ◽

2020 ◽

Author(s):

Zhizhen Lv ◽

Qingguang Zhu ◽

Guangxin Guo ◽

Wuquan Sun ◽

Yanbin Cheng ◽

...

Keyword(s):

Health Care ◽

Randomized Controlled Trial ◽

Knee Osteoarthritis ◽

Short Form ◽

Controlled Trial ◽

Mcgill Pain Questionnaire ◽

Health Care Education ◽

Care Education ◽

Randomized Controlled ◽

Education Group

Abstract Background: Knee osteoarthritis (KOA) is a common musculoskeletal disorder. Previous studies reported that Tuina manipulation showed benificial effects in management of musculoskeletal disorders . However, there was no enough evidence to support the effectiveness of Tuina manipulation for KOA. The purpose of this study is to evaluate the effectiveness of Tuina manipulation on pain and dysfunction of patients with KOA compared with health care education.Methods/Design: This study is a single-centre, two-arm, open-label randomized controlled trial (RCT). A total of 170 eligible KOA patients will be randomly assigned to the Tuina manipulation group or the health care education group in a 1:1 ratio. In the Tuina manipulation group, patients will receive a 30 min treatment including pain point assessment and manual therapy. The health care education group will receive 45 min of lecture and discussion. All treatments will be conducted three times a week for four weeks. The primary outcome is the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the McGill Pain Questionnaire (MPQ) and 36-item Short-Form Health Survey (SF-36). The results will show the evidence of the effect of Tuina manipulation for KOA compared with health care education.Discussion: The design and methodology of the trial is rigorous and allows the collection of valuable data to assess the effect of a specific Tuina regimen for the treatment of KOA. Therefore, the trial will provide a solid foundation for future clinical research on KOA and Tuina therapy.Trial registration: This trial was registered with the Chinese Clinical Trial Registry on 24 February 2020 (ChiCTR2000030154), http://www.chictr.org.cn/index.aspx

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Association between psychological factors related to pain and instrumental activities of daily living disability in older adults with knee osteoarthritis

10.1101/2021.09.10.21262871 ◽

2021 ◽

Author(s):

Keigo Nanjo ◽

Takashi Ikeda ◽

Naoko Nagashio ◽

Tomoko Sakai ◽

Tetsuya Jinno

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Knee Osteoarthritis ◽

Activities Of Daily Living ◽

Psychological Factors ◽

Daily Living ◽

Short Form ◽

Independent Variables ◽

Knee Oa ◽

Iadl Disability

Objective To investigate the association between psychological factors related to pain and instrumental activities of daily living (IADL) disability in older adults with knee osteoarthritis (OA). Design A cross-sectional study. Setting Outpatients at a general hospital in Japan. Participants: One hundred seventy-nine (N=179) patients with knee OA and aged => 65years. Interventions Not applicable. Main Outcome Measure: Six-item short form of the pain catastrophizing scale (PCS-6) and four-item short form of the pain self-efficacy questionnaire (PSEQ-4) were used to assess the psychological status related to pain. IADL status was assessed using eight activity items. Participants selected able, need help, or unable depending on their abilities to perform these IADL activities. If they chose need help or unable to perform, for at least one item, we defined them as disabled. Results Of all participants, 88 (49.1%) showed disability in conducting IADL. Binary logistic regression analysis with the dependent variable as IADL disabled or not and PCS-6 and PSEQ-4 as independent variables were performed. Age, sex, pain intensity, depressive symptoms, usual gait speed (UGS), and isometric knee extension strength were included as covariates in the logistic regression model. Only PSEQ-4 (odds ratio (OR)=0.90, 95% confidence interval (95%CI)=0.82-0.99, p=0.02) was a significant independent variable for psychological factors related to pain. PCS-6 was not a significant variable (OR=1.06, 95%CI=0.94-1.19, p=0.13). Sex (OR=0.38, 95%CI=0.15-0.96, p=0.04) and UGS (OR=0.13, 95%CI=0.02-0.72, p=0.02) were significantly independent variables. Conclusion Our study showed the importance of assessing self-efficacy related to pain using the PSEQ-4 to determine the presence of IADL disability in older adults with knee OA.

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Co-Design in the Development of a Mobile Health App for the Management of Knee Osteoarthritis by Patients and Physicians: Qualitative Study (Preprint)

10.2196/preprints.17893 ◽

2020 ◽

Author(s):

Kelly J Mrklas ◽

Tanya Barber ◽

Denise Campbell-Scherer ◽

Lee A Green ◽

Linda C Li ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Mobile Health ◽

Management Strategies ◽

Family Physicians ◽

Research Process ◽

User Preferences ◽

Self Management ◽

Functional Requirements ◽

User Integration ◽

Study Participants

BACKGROUND Despite a doubling of osteoarthritis-targeted mobile health (mHealth) apps and high user interest and demand for health apps, their impact on patients, patient outcomes, and providers has not met expectations. Most health and medical apps fail to retain users longer than 90 days, and their potential for facilitating disease management, data sharing, and patient-provider communication is untapped. An important, recurrent criticism of app technology development is low user integration design. User integration ensures user needs, desires, functional requirements, and app aesthetics are responsive and reflect target user preferences. OBJECTIVE This study aims to describe the co-design process for developing a knee osteoarthritis minimum viable product (MVP) mHealth app with patients, family physicians, and researchers that facilitates guided, evidence-based self-management and patient-physician communication. METHODS Our qualitative co-design approach involved focus groups, prioritization activities, and a pre-post quality and satisfaction Kano survey. Study participants included family physicians, patient researchers and patients with knee osteoarthritis (including previous participants of related collaborative research), researchers, key stakeholders, and industry partners. The study setting was an academic health center in Southern Alberta. RESULTS Distinct differences exist between what patients, physicians, and researchers perceive are the most important, convenient, desirable, and actionable app functional requirements. Despite differences, study participants agreed that the MVP should be electronic, should track patient symptoms and activities, and include features customized for patient- and physician-identified factors and international guideline-based self-management strategies. Through the research process, participants negotiated consensus on their respective priority functional requirements. The highest priorities were a visual symptom graph, setting goals, exercise planning and daily tracking, and self-management strategies. The structured co-design with patients, physicians, and researchers established multiple collaborative processes, grounded in shared concepts, language, power, rationale, mutual learning, and respect for diversity and differing opinions. These shared team principles fostered an open and inclusive environment that allowed for effective conceptualization, negotiation, and group reflection, aided by the provision of tangible and ongoing support throughout the research process, which encouraged team members to question conventional thinking. Group-, subgroup-, and individual-level data helped the team reveal how and for whom perspectives about individual functional requirements changed or remained stable over the course of the study. This provided valuable insight into how and why consensus emerged, despite the presence of multiple and differing underlying rationales for functional requirement prioritization. CONCLUSIONS It is feasible to preserve the diversity of perspectives while negotiating a consensus on the core functional requirements of an mHealth prototype app for knee osteoarthritis management. Our study sample was purposely constructed to facilitate high co-design interactivity. This study revealed important differences between the patient, physician, and researcher preferences for functional requirements of an mHealth app that did not preclude the development of consensus.

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