Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up

Abstract Background Chronic musculoskeletal pain is common in adolescents, and it has been shown that adolescents with pain may become young adults with pain. Pain often coincides with psychosomatic symptoms in adults, but little is known about longitudinal associations and predictors of pain in adolescents. The aim was to investigate chronic musculoskeletal pain and its associations with health status, sleeping problems, stress, anxiety, depression, and physical activity in 16-year-old students at baseline, and to identify risk factors using a three-year follow-up. Methods This was a longitudinal study of 256 students attending a Swedish upper secondary school. Questionnaires regarding chronic musculoskeletal pain and distribution of pain (mannequin), health status (EQ-5D-3 L), sleeping problems (Uppsala Sleep Inventory), stress symptoms (single-item question), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) were issued at baseline and follow-up. Student’s t-test and chi2 test were used for descriptive statistics and logistic regression analyses were used to study associations between chronic pain and independent variables. Results Fifty-two out of 221 students at baseline (23.5%) and 39 out of 154 students at follow-up (25.3%) were categorized as having chronic musculoskeletal pain. Chronic musculoskeletal pain at follow-up was separately associated with reporting of an EQ-5D value below median (OR 4.06, 95% CI 1.83–9.01), severe sleeping problems (OR 3.63, 95% CI 1.69–7.82), and possible anxiety (OR 4.19, 95% CI 1.74–10.11) or probable anxiety (OR 3.82, 95% CI 1.17–12.48) at baseline. Similar results were found for associations between chronic musculoskeletal pain and independent variables at baseline. In multiple logistic regression analysis, chronic musculoskeletal pain at baseline was a predictor of chronic musculoskeletal pain at follow-up (OR 2.99, 95% CI 1.09–8.24, R2 = 0.240). Conclusion Chronic musculoskeletal pain at baseline was the most important predictor for reporting chronic musculoskeletal pain at the three-year follow-up, but a worse health status, severe sleeping problems, and anxiety also predicted persistence or development of chronic musculoskeletal pain over time. Interventions should be introduced early on by the school health services to promote student health.

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Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3-year follow up study in the general population

Pain ◽

10.1016/j.pain.2003.12.013 ◽

2004 ◽

Vol 108 (1) ◽

pp. 115-123 ◽

Cited By ~ 93

Author(s):

Stefan Bergman ◽

Lennart T.H Jacobsson ◽

Per Herrström ◽

Ingemar F Petersson

Keyword(s):

Health Status ◽

General Population ◽

Musculoskeletal Pain ◽

Chronic Musculoskeletal Pain ◽

Follow Up Study ◽

Sf 36

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Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain: interventions and promising long-term outcomes

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04780-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Anna Trulsson Schouenborg ◽

Marcelo Rivano Fischer ◽

Elisabeth Bondesson ◽

Anna Jöud

Keyword(s):

Physical Activity ◽

Musculoskeletal Pain ◽

Clinical Results ◽

Rehabilitation Program ◽

Chronic Musculoskeletal Pain ◽

Sensorimotor Training ◽

Rehabilitation Programs ◽

Pain Disability ◽

Physical Activity Advice

Abstract Background There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed. Aim To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period. Methods All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014–2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured ‘clinical reasoning’ using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients’ medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge. Results In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up. Conclusions A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.

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POS1234 IMPACT OF THE CHANGE IN ADMINISTRATION ROUTE OF TOCILIZUMAB AND ABATACEPT, DUE TO THE COVID-19 LOCKDOWN ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3126 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 900.1-900

Author(s):

L. Diebold ◽

T. Wirth ◽

V. Pradel ◽

N. Balandraud ◽

E. Fockens ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Physical Activity ◽

Disease Activity ◽

Univariate Analysis ◽

Route Of Administration ◽

Anxiety And Depression ◽

Administration Route ◽

Factors Associated ◽

The Impact

Background:Among therapeutics used to treat rheumatoid arthritis (RA), Tocilizumab (TCZ) and Abatacept (ABA) are both biologic agents that can be delivered subcutaneously (SC) or intravenously (IV). During the first COVID-19 lockdown in France, all patients treated with IV TCZ or IV ABA were offered the option to switch to SC administration.Objectives:The primary aim was to assess the impact of changing the route of administration on the disease activity. The second aim was to assess whether the return to IV route at the patient’s request was associated with disease activity variation, flares, anxiety, depression and low physical activity during the lockdown.Methods:We conducted a prospective monocentric observational study. Eligibility criteria: Adult ≥ 18 years old, RA treated with IV TCZ or IV ABA with a stable dose ≥3 months, change in administration route (from IV to SC) between March 16, 2020, and April 17, 2020. The following data were collected at baseline and 6 months later (M6): demographics, RA characteristics, treatment, history of previous SC treatment, disease activity (DAS28), self-administered questionnaires on flares, RA life repercussions, physical activity, anxiety and depression (FLARE, RAID, Ricci &Gagnon, HAD).The primary outcome was the proportion of patients with a DAS28 variation>1.2 at M6. Analyses: Chi2-test for quantitative variables and Mann-Whitney test for qualitative variables. Factors associated with return to IV route identification was performed with univariate and multivariate analysis.Results:Among the 84 patients who were offered to switch their treatment route of administration, 13 refused to change their treatment. Among the 71 who switched (48 TCZ, 23 ABA), 58 had a M6 follow-up visit (13 lost of follow-up) and DAS28 was available for 49 patients at M6. Main baseline characteristics: female 81%, mean age 62.7, mean disease duration: 16.0, ACPA positive: 72.4%, mean DAS28: 2.01, previously treated with SC TCZ or ABA: 17%.At M6, the mean DAS28 variation was 0.18 ± 0.15. Ten (12.2%) patients had a DAS28 worsening>1.2 (ABA: 5/17 [29.4%] and TCZ: 5/32 [15.6%], p= 0.152) and 19 patients (32.8%) had a DAS28 worsening>0.6 (ABA: 11/17 [64.7%] and TCZ: 8/32 [25.0%], p= 0.007).At M6, 41 patients (77.4%) were back to IV route (26 TCZ, 15 ABA) at their request. The proportion of patients with a DAS28 worsening>1.2 and>0.6 in the groups return to IV versus SC maintenance were 22.5%, 42.5% versus 11.1% and 22.2% (p=0.4), respectively. The univariate analysis identified the following factors associated with the return to IV route: HAD depression score (12 vs 41, p=0.009), HAS anxiety score (12 vs 41, p=0.047) and corticosteroid use (70% vs 100%, p=0.021), in the SC maintenance vs return to IV, respectively.Conclusion:The change of administration route of TCZ and ABA during the first COVID-19 lockdown was infrequently associated with a worsening of RA disease. However, the great majority of the patients (77.4%) request to return to IV route, even without disease activity worsening. This nocebo effect was associated with higher anxiety and depression scores.Disclosure of Interests:None declared

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Pain interference with physical functioning is associated with physical activity level in patients with chronic musculoskeletal pain

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.05.042 ◽

2018 ◽

Vol 61 ◽

pp. e19 ◽

Cited By ~ 1

Author(s):

P. Terrier ◽

C. Praz ◽

J. Le Carré ◽

P. Vuistiner ◽

B. Léger ◽

...

Keyword(s):

Physical Activity ◽

Musculoskeletal Pain ◽

Physical Functioning ◽

Physical Activity Level ◽

Activity Level ◽

Chronic Musculoskeletal Pain ◽

Pain Interference

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Evaluating a Self-Determination Model of Physical Activity and Exercise in People With Chronic Musculoskeletal Pain

Rehabilitation Research Policy and Education ◽

10.1891/re-21-05 ◽

2021 ◽

Vol 35 (3) ◽

pp. 248-262

Author(s):

Jia Rung Wu ◽

Jessica Brooks ◽

Fong Chan ◽

Kanako Iwanaga ◽

Nicole Ditchman ◽

...

Keyword(s):

Physical Activity ◽

Health Promotion ◽

Musculoskeletal Pain ◽

Structural Equation ◽

Autonomous Motivation ◽

Chronic Musculoskeletal Pain ◽

Self Determination ◽

Equation Modeling ◽

Physical Activity And Exercise ◽

Health Promotion Interventions

BackgroundResearch evidence supports the assertion that healthy employees are happier and more productive. Employers prefer to hire healthy workers to reduce absenteeism. Rehabilitation counselors have started to explore health promotion interventions to help individuals with chronic health conditions and disability improve their physical and mental health as a strategy to increase their employment opportunities.PurposeThe present study evaluated a self-determination theory (SDT) model of physical activity and exercise in a sample of 218 individuals with chronic musculoskeletal pain using structural equation modeling.ResultsThe SDT model fit the data well, accounting for 54% of the variance in physical activity and exercise. Relatedness was significantly associated with autonomous motivation for physical activity and exercise. Autonomous motivation was associated with competency. Competency was associated with physical activity and exercise. Autonomous motivation and competency mediated relatedness and physical activity and exercise.ImplicationsThis study contributes to an emerging body of theory-informed health promotion literature and identifies the specific pathways that will increase the motivation to engage in physical activity and exercise. Findings can be used to design and validate theory-driven health promotion interventions as an employment strategy for people with chronic musculoskeletal pain receiving vocational rehabilitation services.

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Prevalence of postural deviations and associated factors in children and adolescents: a cross-sectional study

Fisioterapia em Movimento ◽

10.1590/1980-5918.029.004.ao14 ◽

2016 ◽

Vol 29 (4) ◽

pp. 777-786 ◽

Cited By ~ 4

Author(s):

Mariana Vieira Batistão ◽

Roberta de Fátima Carreira Moreira ◽

Helenice Jane Cote Gil Coury ◽

Luis Ernesto Bueno Salasar ◽

Tatiana de Oliveira Sato

Keyword(s):

Physical Activity ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Associated Factors ◽

Multiple Logistic Regression Analysis ◽

Extrinsic Factors ◽

Cross Sectional ◽

Postural Changes ◽

Intrinsic And Extrinsic Factors

Abstract Introduction: Postural deviations are frequent in childhood and may cause pain and functional impairment. Previously, only a few studies have examined the association between body posture and intrinsic and extrinsic factors. Objective: To assess the prevalence of postural changes in school children, and to determine, using multiple logistic regression analysis, whether factors such as age, gender, BMI, handedness and physical activity might explain these deviations. Methods: The posture of 288 students was assessed by observation. Subjects were aged between 6 and 15 years, 59.4% (n = 171) of which were female. The mean age was 10.6 (± 2.4) years. Mean body weight was 38.6 (± 12.7) kg and mean height was 1.5 (± 0.1) m. A digital scale, a tapeline, a plumb line and standardized forms were used to collect data. The data were analyzed descriptively using the chi-square test and logistic regression analysis (significance level of 5%). Results: We found the following deviations to be prevalent among schoolchildren: forward head posture, 53.5%, shoulder elevation, 74.3%, asymmetry of the iliac crests, 51.7%, valgus knees, 43.1%, thoracic hyperkyphosis, 30.2%, lumbar hyperlordosis, 37.2% and winged shoulder blades, 66.3%. The associated factors were age, gender, BMI and physical activity. Discussion: There was a high prevalence of postural deviations and the intrinsic and extrinsic factors partially explain the postural deviations. Conclusion: These findings contribute to the understanding of how and why these deviations develop, and to the implementation of preventive and rehabilitation programs, given that some of the associated factors are modifiable.

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Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial

Pain Medicine ◽

10.1093/pm/pnaa145 ◽

2020 ◽

Vol 21 (11) ◽

pp. 2811-2822

Author(s):

Brandon C Yarns ◽

Mark A Lumley ◽

Justina T Cassidy ◽

W Neil Steers ◽

Sheryl Osato ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Musculoskeletal Pain ◽

Behavioral Therapy ◽

Emotional Awareness ◽

Pain Reduction ◽

Post Treatment ◽

Chronic Musculoskeletal Pain ◽

Comparison Trial ◽

Secondary Outcomes

Abstract Objective Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain. Design Randomized comparison trial. Setting Outpatient clinics at the West Los Angeles VA Medical Center. Subjects Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain. Methods Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up. Results EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance. Conclusions This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.

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Does Availability of Worksite Supports for Physical Activity Differ by Industry and Occupation?

American Journal of Health Promotion ◽

10.1177/0890117116668795 ◽

2016 ◽

Vol 32 (3) ◽

pp. 517-526 ◽

Cited By ~ 6

Author(s):

Elizabeth A. Dodson ◽

J. Aaron Hipp ◽

Jung Ae Lee ◽

Lin Yang ◽

Christine M. Marx ◽

...

Keyword(s):

Physical Activity ◽

Logistic Regression ◽

Odds Ratio ◽

International Physical Activity Questionnaire ◽

Response Rate ◽

Metropolitan Areas ◽

Employee Health ◽

Cross Sectional ◽

Independent Variables ◽

Activity Questionnaire

Purpose: To explore combinations of worksite supports (WSS) for physical activity (PA) that may assist employees in meeting PA recommendations and to investigate how availability of WSS differs across industries and occupations. Design: Cross-sectional. Setting: Several Missouri metropolitan areas. Participants: Adults employed >20 h/wk outside the home. Measures: Survey utilized existing self-reported measures (eg, presence of WSS for PA) and the International Physical Activity Questionnaire. Analysis: Logistic regression was conducted for 2 outcome variables: leisure and transportation PA. Independent variables included 16 WSS. Of particular interest were interaction effects between WSS variables. Analyses were stratified by 5 occupation and 7 industry types. Results: Overall, 2013 people completed the survey (46% response rate). Often, availability of 1 WSS did not increase the likelihood of meeting PA recommendations, but several pairs of WSS did. For example, in business occupations, the odds of meeting PA recommendations through transportation PA increased when employees had access to showers and incentives to bike/walk (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.16-2.22); showers and maps (OR = 1.25; 1.02-1.55); maps and incentives to bike/walk (OR = 1.48; 1.04-2.12). Conclusion: Various combinations of WSS may increase the likelihood that employees will meet PA recommendations. Many are of low or no cost, including flexible time for exercise and maps of worksite-adjacent walk/bike routes. Findings may be instructive for employers seeking to improve employee health through worksite PA.

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