Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

OBJECTIVE:

to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.

METHOD:

cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.

RESULTS:

The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001).

CONCLUSION:

the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.     

Low back pain characterized by muscle resistance and occupational factors associated with nursing

Objective

to identify the occupational factors associated with low back pain using a surveillance tool and to characterize the low back pain by the resistance of the extensor muscles of the vertebral column among nursing professionals at an Intensive Care Unit.

Methods

Cross-sectional study. The workers answered a questionnaire about occupational factors and participated in a resistance test of the extensor muscles of the vertebral column. Associations were established through Student''s T-test or Mann-Whitney''s U-test and correlations using Pearson''s test.

Results

Out of 48 participants, 32 (67%) suffered from low pain. For the resistance test, the subjects suffering from low back pain endured less time in comparison with asymptomatic subjects, but without significant differences (p=0.147). The duration of the pain episode showed a significant negative correlation (p=0.016) with the results of the resistance test though. The main factors identified as causes of low back pain were biomechanical and postural elements, conditions of the muscle structure and physical and organizational conditions.

Conclusions

the main occupational factors associated with the low back pain were the posture and the characteristics of the physical and organizational conditions. In addition, the extensor muscles of the column showed a trend towards lesser resistance for workers in pain. This evidence is important when considering prevention and treatment strategies.     

Pain intensity is associated with both performance-based disability and self-reported disability in a sample of older adults attending primary health care centers

BackgroundOlder adults' function level can be used as a predictor of future detrimental events, such as disability, reliance on others, risk of institutionalization and likelihood of death. The assessment of function at the primary health care centers using self-reported and/or performance based measures is of prime importance.ObjectiveTo determine whether personal factors, pain, depression and physical activity are associated with self-reported and performance based disability for older adults aged ≥60 years attending primary health care centers, as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and Short Physical Performance Battery (SPPB), respectively.MethodsParticipants (196 females and 55 males; mean age ± SD = 70.87 ± 7.76) had their pain, self-reported disability, performance, physical activity levels and depressive symptoms assessed. Regression analyses were performed with self-reported and performance-based disability as the dependent variable and age, sex, education, chronic conditions, depression, physical activity and pain characteristics as dependent variables.ResultsMean (SD) results for SPPB were 8.45 (2.86) and 20.06 (8.21) for WHODAS. Pain intensity, depression, pain frequency, number of chronic conditions and level of physical activity explained 44% of the self-reported disability variance. Pain intensity, age, level of physical activity, years of formal education and chronic conditions explained 37% of the performance variance. Pain intensity alone explained 27% and 18% of the self-reported and performance based disability, respectively.ConclusionFindings indicate that primary health care interventions should target pain intensity, depressive symptoms and physical activity as a means to preventing or decreasing both self-reported and performance based disability.     

老年人抑郁症状与慢性病及日常生活活动能力的关联性研究

目的 分析老年人慢性病、抑郁症状及日常生活活动能力三者之间的相互关系,探讨老年人抑郁症状和老年人日常生活活动能力受限的危险因素.方法 采用多阶段整群抽样方法,应用老年抑郁短量表、Katz日常生活活动量表（Katz-ADL）和Lawton工具性日常生活活动量表（Lawton-IADL）,对济宁市部分县区≥65岁的504例老年人进行问卷调查.结果 济宁市部分县区老年人总患病率为74.01％,抑郁症状阳性率为7.14％,ADL、IADL功能受限率分别为19.05％和66.67％,男性老年人抑郁症状阳性率及ADL、IADL功能受限率低于女性（x2分别为18.15、12.31、30.18,P均＜0.05）;老年人现患有慢性病的种类数是抑郁症状和ADL受限的危险因素（OR分别为1.71、1.53）,ADL和IADL受限也是老年人抑郁症状的危险因素（OR分别为3.15、9.36）;控制性别、年龄因素后,患有慢性病种类数对老年人抑郁症状、ADL、IADL的影响以及ADL和IADL受限对老年人抑郁症状的影响均无统计学意义.结论 性别、年龄是老年人抑郁症状、ADL和IADL受限的最根本的危险因素,家庭和社会在对老年人照护时,应积极锻炼提高老年人的日常生活活动能力,提升老年人的正性情绪,减少抑郁症状的发生.     

脑出血患者实施临床护理路径护理的效果分析

目的 探讨在脑出血患者中实施临床护理路径护理的效果.方法 选取沈阳市中医院2018年6月—2020年6月收治的74例脑出血患者为研究对象,随机分为观察组和对照组各37例,所有患者均给予保守治疗,在治疗过程中对照组实施常规护理、观察组实施临床护理路径护理.比较两组入院时和出院前的生活质量和日常生活能力,以及患者对护理的满...     

Description of self-care training in occupational therapy: Case studies of five Kenyan children with cerebral palsy

The purpose of this prospective case study design was to describe the changes in dressing skills for five Kenyan children with cerebral palsy who participated in a 10-week occupational therapy intervention programme. The training sessions were individually designed to meet the needs of the child. The children's performances on undressing and dressing and the time these tasks took was used as a baseline and outcome measure. These measurements were documented by video films and then analysed using visual inspection and converted into the scores of the Klein-Bell Activities of Daily Living (ADL) Scale. The results for each child were analysed using a simplified version of the Reliability Change Index. The results showed that four of the five children improved their ability to dress and that the children increased their time to undress significantly (p<0.05). Three children needed more time and two children needed less time for dressing (p<0.05). The results were influenced by the activity limitations among these children and the environmental, social backgrounds, cultural and economic situation unique to Kenya. It is recommended that case study research be used to validate clinical practice in paediatric occupational therapy and to understand cultural differences and its impact on health care.     

Functional restoration for chronic low back pain: Changes in depression,cognitive distortion,and disability

In the present study, 107 patients (72 males and 35 females) completed self-report measures of depression, distortion, disability, and pain intensity at three points during their rehabilitation: (1) admission to a 3-week comprehensive functional restoration program, (2) discharge from the comprehensive phase, and (3) 4–6 weeks later at their first post-program evaluation. Various range-of-motion measures were also collected at these same times using inclinometry. Results demonstrated significant improvements on all measures which were maintained into follow-up. Patients were also subsequently grouped into depressed and non-depressed at admission, and both groups demonstrated significant improvement across time. Additionally, patients were divided into high and low distortion groups. High general cognitive distortion patients did not show improvement on 3 of the 5 range of motion, or pain intensity scores, although they did improve on their depression, distortion, and disability scores. Findings also suggested thatlow back pain-related cognitive distortion may be considered a state or situational factor, whereasgeneral cognitive distortion appears to be more of a trait characteristic.     

中国农村老年女性腰痛与抑郁症状的相关性

目的  探讨中国农村老年女性腰痛与抑郁症状的相关性。 方法  使用2015年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study,CHARLS）数据,纳入60岁及以上农村女性作为研究对象,计算简版流调中心抑郁量表（10-item center for epidemiological studies depression Scale,CESD-10）得分,将研究对象分为抑郁组和非抑郁组。采用倾向评分匹配（propensity score matching,PSM）平衡与抑郁症状有关的协变量,利用单因素非条件Logistic回归分析腰痛与抑郁症状的相关性。 结果  共纳入1 668名研究对象,平均年龄（67.51±5.90）岁,腰痛患病率为30.22%（95% CI：28.02% ~ 32.48%）,抑郁症状患病率为46.04%（95% CI：43.63% ~ 48.47%）,抑郁症状平均得分为（10.13±7.00）。PSM 1:1匹配协变量后,单因素非条件Logistic回归分析显示农村老年女性腰痛与抑郁症状有关（OR=2.901,95% CI：2.002 ~ 4.203,P < 0.001）。 结论  中国农村老年女性腰痛与抑郁症状风险增加有关。     

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.     

Adaptation and Ability in Daily Occupations in People with Poliomyelitis Sequelae

The aims of these studies were to explore the adaptive process from an occupational perspective by revealing strategies used to manage daily occupations, to examine factors influencing the development of strategies, to investigate ability and perceived difficulty in ADL, use of assistive devices and to investigate the prevalence of distress in aspects of perceived health. Methods. Both qualitative and quantitative analyses were used. The adaptive process was explored by tape-recorded interviews, observations in the subjects' own homes and analysis according to grounded theory. Structured interviews regarding demographic data, use of assistive devices and housing adaptations were also included. Assessments used in the studies were: the NRH postpolio limb classification for the progress and degree of polio; the staircase of ADL (an extension of Katz' index) supplemented with self-ratings of perceived difficulty; walking speed for 30 m indoors and the Nottingham Health Profile (NHP). Subjects. In the qualitative analysis, 22 persons were selected according to theoretical sampling from a longitudinal study of volunteers with poliomyelitis sequelae. In the quantitative analysis, 133 participants with polio were obtained from a consecutive clinical group. Results. Six broad groups of strategies were used to keep some kind of balance among goals, abilities and environmental demands in daily occupations. One group of strategies was emotion-focused, while five groups were problem-focused: utilising physical capability, promoting concrete problem-solving, altering the pattern of occupations, influencing relations and facilitating future activities. The examination of factors influencing the development and choice of everyday life strategies resulted in identification of the concept conception of occupational self, which comprised the participant's body image, sense of competence, values and goals in interaction with the environment. Coming to a new approach towards the shift in one's capabilities revealed two integrated processes: one dealing with the process of realisation and reorganisation, the other six patterns of behaviour in daily occupations. The participants had a high degree of independence in personal ADL, whereas more than 50% were dependent in cleaning, shopping and transportation. However, a great number of independent persons reported difficulties in some activities. Most distress was found in the dimensions of physical mobility, pain and energy according to NHP and most health-related problems were reported in housework, employment and leisure. Fifty-nine percent of the participants were in gainful employment. Conclusions. The results showed that the persons with poliomyelitis sequelae tried to maintain their independence despite perceived difficulties in ADL and might be reluctant to use assistive devices. Signs of overload indicate that balance among goals, abilities and environmental demands might be difficult to achieve. Flexibility in the use of strategies facilitated participation in daily occupations. Requirements for this adaptive pattern seemed to be time to realise and modify behaviour; energy and ability to solve problems; access to information and support and being ready to compensate with assistive devices. The results suggest that late effects of polio interfere with many areas of daily activities and that there is a need for multidisciplinary support.     

Social support,depression, and physical disability: Age and diagnostic group effects

BackgroundSocial support is an important resource that may benefit individuals aging with physical disabilities, although its effects may vary depending on age, sex, and type of disability.ObjectivesTo (1) examine differences in social support – and how support might vary as a function of age and sex – in samples of individuals with multiple sclerosis (MS), spinal cord injury (SCI), and muscular dystrophy (MD) and (2) understand the extent that associations between different support domains and depression might be moderated by disability diagnosis, sex and age.MethodsA convenience sample (N = 1416) of individuals with MS, SCI, and MD completed surveys that included measures of perceived social support and depressive symptoms.ResultsNo significant support differences were found between diagnostic groups. There was a gradual decrease in social support with chronological age, and women reported more support than men, particularly friend support. Levels of perceived friend support were negatively associated with depression, and the associations between social support and depression did not differ as a function of age, sex, or diagnosis.ConclusionsSocial support is similarly associated with lower levels of depression for men and women, across disability diagnoses and all ages. Being a man and being older may be associated with lower levels of perceived support. Research is needed to determine if interventions that improve support will decrease depression and improve quality of life in persons with disabilities, particularly for men and individuals who are aging.     

Reliability and validity of milliken activities of daily living scale (MAS) in measuring activity limitations of a turkish population

Abstract

Aim: The Milliken Activities of Daily Living Scale (MAS) is a self-report scale to address limitation of ability to perform daily tasks in upper extremity injuries. It can address the necessity of each task, which makes MAS useful while planning individual treatment. The objective of this study was to perform cross-cultural adaptation of the MAS TURKISH and to evaluate its reliability and validity for Turkish-speaking patients with upper extremity conditions. Method: A total of 99 patients were asked to complete the adapted MAS and DASH at baseline and one week after the initial assessment. Also grip strength was evaluated with an interval of one week. Results: The reliability of the adapted version was good, with high internal consistency (Cronbach's alpha = 0.964) and test–retest reliability (interclass correlation coefficient (ICC) = 0.772) for the total score. A statistically significant correlation between MAS and DASH scores and grip strength scores of the injured side was obtained. Conclusion: The results of the study have shown that the Turkish version of MAS has excellent test–retest reliability and validity. It is a suitable assessment for evaluating function and giving an overview of activity limitations in many performance areas in a Turkish population.     

Neighbourhood characteristics and 10-year risk of depression in Canadian adults with and without a chronic illness

The neighbourhood environment could play a role in the risk of depression in adults and those with a chronic illness. We investigated the effects of a range of neighbourhood characteristics on the 10-year risk of depression in a representative sample of 9026 Canadian adults and subsamples with a chronic condition. Characteristics of neighbourhoods were not significantly related to the risk of depression in the general sample and subsamples with a chronic condition. However, residing near a park was significantly associated with a lower risk of depression for people living in crowded households, and having a local health service nearby was protective for those living in materially deprived neighbourhoods. Living in a neighbourhood that was both socially advantaged and offered cultural services was also associated with lower risk of depression. Additional research is needed for smaller effect size detection. Future intervention research is warranted for health policy recommendations.     

The association between disease severity,functional status,depression and daily quality of life in congestive heart failure patients

Congestive heart failure significantly compromises quality of life by contributing to severe physical, role, and social functioning impairment as well as increased psychological distress. Previous research examining quality of life in CHF patients has typically been conducted using global self-report instruments that may exceed a patient's ability to accurately recall their experiences. This investigation examines the impact of disease severity, functional status, and level of depression on daily quality of life (i.e., mean level and variability) in CHF patients during a 2-week monitoring period. Indices of quality of life included emotional and physical quality of life, social support and conflict, positive and negative mood, and coping responses. Fifty-eight patients with CHF participated in the investigation. Depressive symptoms were positively associated with a number of quality of life indices (i.e., physical and emotional quality of life, social support and conflict, mood, and coping behaviours). Left ventricular ejection fraction and functional impairment had a much weaker association with quality of life. These findings suggest that depressive symptoms may have a greater impact on quality of life in CHF patients than severity of cardiac dysfunction or functional impairment.     

我国60岁及以上老年人日常生活活动能力对抑郁状况的影响

目的探究日常生活活动能力(ADL)对老年人抑郁的影响, 并关注社会网络及子女支持在其中的作用。方法使用2018年"中国老年社会追踪调查"资料中年龄≥60岁者作为研究对象。估计样本量10 215人。ADL、社会网络、抑郁状况均使用量表测量, 采用有调节的中介模型对社会网络及子女支持的作用进行分析。采用SPSS 25.0软件进行统计学分析, 使用PROCESS 3.3宏程序进行有调节的中介效应检验。结果共纳入年龄≥60岁老年人10 760人作为研究对象, ADL对老年人抑郁状况存在直接影响(β=-0.090, P<0.01);社会网络在ADL与抑郁关系中发挥了中介作用(β=0.035, P<0.01;β=-0.064, P<0.05), 子女支持发挥调节作用(β=-0.029, P<0.05)。结论社会网络是缓冲老年人ADL下降对抑郁状况影响的重要资源, 子女支持是增强社会网络积极作用、减轻老年人抑郁风险的有力补充, 应充分发挥社会网络和子女支持的协同作用, 减缓老年人ADL下降对其心理健康的影响。     

Relationship between psychosocial factors and objective physical function in special needs school staff members suffering from low back pain

Physical function impairment in patients with low back pain (LBP) occurs due to the influence of psychosocial factors. Only a few studies have objectively evaluated physical function. We aimed to objectively assess the physical functions of individuals subjects with LBP, and clarify the association between physical function and psychosocial factors. We enrolled 411 individuals with LBP working in special needs schools. We examined their degree of pain, and the psychosocial factors strength through the STarT Back Tool, which categorized them into the low-risk, medium-risk, and high-risk groups. We assessed their abdominal muscle endurance, lower limb muscle strength, and hip joint flexibility. The relationships between these physical functions and psychosocial factors were analyzed by logistic regression models. Those in the high-risk group had significantly lower abdominal muscle and lower limb muscle strength (p<0.001). After adjusting for confounding factors, the odds ratios of the high-risk compared to the low-risk group for low abdominal muscle endurance, lower limb muscle strength, and restricted right and left Straight Leg Raising were 5.47, 3.14, 2.65, and 3.12, respectively (95% CIs: 2.35–12.74, 1.43–6.89, 1.08–6.55, and 1.20–8.11, respectively). Therefore, the low physical function observed in the high-risk group was associated with their psychosocial factors.