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Cheng ST, Chan KL, Lam RWL, Mok MHT, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. A multicomponent intervention for the management of chronic pain in older adults: study protocol for a randomized controlled trial. Trials 2017; 18:528. [PMID: 29121961 PMCID: PMC5680817 DOI: 10.1186/s13063-017-2270-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that physical interventions and psychological methods based on the cognitive behavioral approach are efficacious in alleviating pain and that combining both tends to yield more benefits than either intervention alone. In view of the aging population with chronic pain and the lack of evidence-based pain management programs locally, we developed a multicomponent intervention incorporating physical exercise and cognitive behavioral techniques and examined its long-term effects against treatment as usual (i.e., pain education) in older adults with chronic musculoskeletal pain in Hong Kong. METHODS/DESIGN We are conducting a double-blind, cluster-randomized controlled trial. A sample of 160 participants aged ≥ 60 years will be recruited from social centers or outpatient clinics and will be randomized on the basis of center/clinic to either the multicomponent intervention or the pain education program. Both interventions consist of ten weekly sessions of 90 minutes each. The primary outcome is pain intensity, and the secondary outcomes include pain interference, pain persistence, pain self-efficacy, pain coping, pain catastrophizing cognitions, health-related quality of life, depressive symptoms, and hip and knee muscle strength. All outcome measures will be collected at baseline, postintervention, and at 3 and 6 months follow-up. Intention-to-treat analysis will be performed using mixed-effects regression to see whether the multicomponent intervention alleviates pain intensity and associated outcomes over and above the effects of pain education (i.e., a treatment × time intervention effect). DISCUSSION Because the activities included in the multicomponent intervention were carefully selected for ready implementation by allied health professionals in general, the results of this study, if positive, will make available an efficacious, nonpharmacological pain management program that can be widely adopted in clinical and social service settings and will hence improve older people's access to pain management services. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IIR-16008387. Registered on 28 April 2016.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK.
| | - Ka Long Chan
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Rosanna W L Lam
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
| | - Monique H T Mok
- Department of Rehabilitation and Extended Care, Kowloon Hospital, 147A Argyle Street, Kowloon, Hong Kong
| | - Phoon Ping Chen
- Department of Anesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Yu Fat Chow
- Department of Anesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong
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Opondo D, Visscher S, Eslami S, Verheij RA, Korevaar JC, Abu-Hanna A. Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record. PLoS One 2015; 10:e0129515. [PMID: 26110650 PMCID: PMC4482496 DOI: 10.1371/journal.pone.0129515] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 05/08/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. METHODS We included patients 65 years and older who received NSAIDs between 2005 and 2010. Prescription data were extracted from EMR systems of GP practices participating in the Dutch NIVEL Primary Care Database. We calculated the proportion of NSAID prescriptions with co-prescription of gastroprotective medication for each GP practice at intervals of three months. Association between proportion of gastroprotection, brand of electronic medical record (EMR), and type of GP practice were explored. Temporal trends in proportion of gastroprotection between electronic medical records systems were analyzed using a random effects linear regression model. RESULTS We included 91,521 patient visits with NSAID prescriptions from 77 general practices between 2005 and 2010. Overall proportion of NSAID prescriptions to the elderly with co-prescription of gastroprotective medication was 43%. Mean proportion of gastroprotection increased from 27% (CI 25-29%) in the first quarter of 2005 with a rate of 1.2% every 3 months to 55%(CI 52-58%) at the end of 2010. Brand of EMR and type of GP practice were independently associated with co-prescription of gastroprotection. CONCLUSION Although prescription of gastroprotective medications to elderly patients who receive NSAIDs increased in The Netherlands, they are not co-prescribed in about half of the indicated cases. Brand of EMR system is associated with differences in prescription of gastroprotective medication. Optimal design and utilization of EMRs is a potential area of intervention to improve quality of prescription.
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Affiliation(s)
- Dedan Opondo
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Stefan Visscher
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert A. Verheij
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joke C. Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
Arthritic pain is a common and disabling problem for many older adults. There is widespread evidence that despite its prevalance and debilitating effects on the physical, emotional and cognitive status of older adults, arthritic pain remains under-treated in those age 65 and older. This condition significantly and negatively impacts older adults' quality of life and is a critical problem that requires the attention of gerontological social work. This chapter provides a brief summary of arthritic pain in older adults. It also discusses the treatment efficacy of cognitive-behavioral therapy and psycho-educational programs for older adults with this type of pain.
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Affiliation(s)
- Eunkyung Yoon
- Jackson State University, College of Public Services, 3825 Ridgewood Road, Jackson, MS 39211, USA
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Hawranik P, Johnston P, Deatrich J. Therapeutic Touch and Agitation in Individuals With Alzheimer's Disease. West J Nurs Res 2007; 30:417-34. [DOI: 10.1177/0193945907305126] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Limited effective strategies exist to alleviate or treat disruptive behaviors in people with Alzheimer's disease. Fifty-one residents of a long-term care facility with Alzheimer's disease were randomly assigned to one of three intervention groups. A multiple time series, blinded, experimental design was used to compare the effectiveness of therapeutic touch, simulated therapeutic touch, and usual care on disruptive behavior. Three forms of disruptive behavior comprised the dependent variables: physical aggression, physical nonaggression, and verbal agitation. Physical nonaggressive behaviors decreased significantly in those residents who received therapeutic touch compared with those who received the simulated version and the usual care. No significant differences in physically aggressive and verbally agitated behaviors were observed across the three study groups. The study provided preliminary evidence for the potential for therapeutic touch in dealing with agitated behaviors by people with dementia. Researchers and practitioners must consider a broad array of strategies to deal with these behaviors.
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Simpson MR, Stevens P, Kovach CR. Nurses' experience with the clinical application of a research-based nursing protocol in a long-term care setting. J Clin Nurs 2007; 16:1021-8. [PMID: 17518878 DOI: 10.1111/j.1365-2702.2007.01697.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe nurses' experience with the clinical application of a research-based nursing protocol (The Serial Trial Intervention) within a long-term care setting. DESIGN A descriptive, qualitative study was conducted with a convenience sample of eight nurses from three nursing homes, who assessed and treated residents with dementia according to the Serial Trial Intervention protocol. METHODS Each nurse participated in a semi-structured interview between September 2003 and May 2004. Interviews were audiotaped and transcribed verbatim. Qualitative content analysis of the data, including thematic analysis, was used to identify patterns of experience. RESULTS Three themes emerged that offer insight into the factors contributing to implementation of research-based practice in a clinical setting. These include determining to intervene, pertinent steps of the protocol and facilitators and barriers. CONCLUSIONS The interplay between the protocol, the residents receiving care, the nurses providing care and the setting in which the care is provided, are interacting to affect the outcomes expected. RELEVANCE TO CLINICAL PRACTICE Nurses who recognize the research process, the need for continual improvement in patient care and who possess competency in comprehensive physical assessment are needed to implement this evidence-based protocol successfully. The regulatory atmosphere, workload structure and interdisciplinary collaboration are additional factors contributing to the successful use of the Serial Trial Intervention.
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Affiliation(s)
- Michelle R Simpson
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53201-0413, USA.
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Ruecroft G. Development of a self-management tool in the chronic pain service. ACTA ACUST UNITED AC 2006. [DOI: 10.1002/pdh.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kovach CR, Taneli Y, Dohearty P, Schlidt AM, Cashin S, Silva-Smith AL. Effect of the BACE intervention on agitation of people with dementia. THE GERONTOLOGIST 2005; 44:797-806. [PMID: 15611216 DOI: 10.1093/geront/44.6.797] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. DESIGN AND METHODS A pretest-posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person's high-arousal and low-arousal states. The outcome measure was observed agitation. RESULTS When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group x Time interaction, F(1, 69) = 4.26, p =.043, with a partial eta(2) =.06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of.7. IMPLICATIONS The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.
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Affiliation(s)
- Christine R Kovach
- Cunningham Hall, 1921 East Hartford Avenue, University of Wisconsin-Milwaukee, Milwaukee, WI 53201-0413, USA.
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Blomqvist K. Older people in persistent pain: nursing and paramedical staff perceptions and pain management. J Adv Nurs 2003; 41:575-84. [PMID: 12622866 DOI: 10.1046/j.1365-2648.2003.02569.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Persistent pain is a common problem for older people. Knowledge about how nursing and paramedical staff perceive these people and what they do to relieve the pain seems scarce. AIM To explore nursing and paramedical staff perceptions of older people in persistent pain and their day-to-day management of pain. METHODS Interviews in Swedish with 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists were collected from February to May 2000. The analysis was based on their stories (n = 150) about older people in persistent pain who received help in their own homes or in special accommodation. A typology of staff perceptions of pain in older people was developed. Activities to manage pain were examined using content analysis. RESULTS Respondents perceived the pain as real, exaggerated, trivial, care-related, endured, concealed, self-caused or inarticulate. Older people perceived as exaggerating the pain, those with care-related and self-caused pain evoked frustration in the staff, while those perceived as enduring their pain evoked satisfaction. Various strategies to manage pain were used: no activity, medication, mediating contacts, distracting activities, physical therapies, mobility, work in a gentle way, rest or relieving pressure on body part, and communication concerning pain. The activities differed between the types, as well as between staff with different professional backgrounds. CONCLUSION Care and treatment provided by staff should be based on older people's needs rather than on staff attitudes and preferences. The typology revealed that staff perceived older people in pain as a heterogeneous group and that their perceptions affected the pain-relieving activities that were offered. It seems urgent to address how to handle pain in older people who never complain and those who complain a great deal, as well as how to handle pain in people with impaired communicative ability. Reflective discussions on feelings related to different individuals are needed.
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Cowan DT, Fitzpatrick JM, Roberts JD, While AE, Baldwin J. The assessment and management of pain among older people in care homes: current status and future directions. Int J Nurs Stud 2003; 40:291-8. [PMID: 12605951 DOI: 10.1016/s0020-7489(02)00087-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pain is highlighted as a significant, yet neglected problem among older people, particularly in long-term care settings. The effects of inadequate assessment and treatment of pain among older people may lead to multiple problems. Problems arise due to cognitive impairment of clients and inadequate assessment by healthcare professionals. Analgesics are under-used and there is a need for improved education of both healthcare professionals and older people regarding attitudes to pain and ageing. Research is needed into the prevalence of pain among older people in United Kingdom (UK) care homes, how best to further educate healthcare professionals regarding pain management and how to enable older people to be facilitative partners in this process.
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Affiliation(s)
- David T Cowan
- Ageing and Health Section, Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
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Abstract
The consequences of poor planning for pain management during surgery of geriatric patients not only affect the immediate well-being of the patient but also have terrible socioeconomic implications. Delays in rehabilitation, increases in hospital lengths of stay, and increased comorbidity can be expected if interventions for pain management are either inadequate or excessive without appropriate monitoring. During surgery, seniors are likely to suffer from acute and chronic pain that must be addressed aggressively in the postoperative period to ensure a rapid functional recovery. New pain scales have been developed with seniors in mind, and greater testing of older scales in elderly populations have helped to identify measures of pain more suited to frail seniors. This article is designed to help clinicians to strategically implement optimal pain management principles and techniques and, thus, help to fulfill the obligation to relieve pain and suffering in patients in the perioperative period, which will ensure the greatest chance of recovery to optimal independence for patients.
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Affiliation(s)
- F M Gloth
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
The release of guidelines in 1998 by the American Geriatrics Society on "The Management of Chronic Pain in Older Persons" was a breakthrough in helping to manage pain in this population. Already advances have fostered a need to update recommendations. This article focuses on the treatment strategies available for seniors that are likely to help to fulfill the obligation to relieve pain and suffering in patients. A review was done of the literature using Medline and other search techniques. New pain scales have been developed with seniors in mind and greater testing of older scales in elderly populations have helped to identify measures of pain more suited to frail seniors. Advances in cyclooxygenase inhibition selectivity, alternative medicine, and progress in the identification of nonopioid pain receptors and the development of products to target them are just a few of changes that have altered the way clinicians think about treating pain. The use of hospice in end-of-life palliative care is a valuable resource for clinicians managing pain at that phase in care as well. Tools are available to prevent and treat pain successfully in seniors. Educating clinicians about available assessment tools, techniques and interventions may be the biggest challenge to comforting the older adult in pain.
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Affiliation(s)
- F M Gloth
- Union Memorial Hospital, Johns Hopkins University School of Medicine, Hospice Network of Maryland, Baltimore, USA
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Wynne CF, Ling SM, Remsburg R. Comparison of pain assessment instruments in cognitively intact and cognitively impaired nursing home residents. Geriatr Nurs 2000; 21:20-3. [PMID: 10679604 DOI: 10.1067/mgn.2000.105793] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study was conducted to determine which pain severity and location instruments were most useful in the nursing home setting. Pain severity and location were assessed monthly for 1 year in 37 participants enrolled in a restorative rehabilitation program. Pain location was determined by the residents' indications on a diagram, a doll, and their body. Pain severity was determined by resident response to verbal, visual analog, faces, and word scales. Cognitively impaired residents had greater difficulty using all instruments. The McGill Word Scale was used most to determine pain severity. Pointing to themselves most frequently determined pain location among residents. New strategies are needed for pain assessment in the elderly, especially the cognitively impaired elderly, and a combination of instruments to assess pain in the latter group may be necessary.
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Affiliation(s)
- C F Wynne
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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