Multimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials

Abstract

Background and Purpose: Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. Methods: A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. Results: Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some con-

Pain neuroscience education, blended exercises and booster sessions as an effective therapy for pain, functional and psychological factors in patients with knee osteoarthritis: a study protocol for a single-blind randomised controlled trial with 22factorial design during 6-month follow-up

“…The first line of treatment for OA will generally be based on modifiable risk factors; such as weight control, nutritional choices, exercise therapy and being active, controlling comorbidities, healthy lifestyle over time and self-management education 3 4. What is certain is that changing the patient’s lifestyle in the long term and sticking to it can reduce the risk factors for the progression of the disease and its effects 18 19 28 50. However, due to the characteristics of chronic pain, there are still uncertainties in the effectiveness and durability of the effects of these interventions 5 6.…”

“…According to the mentioned cases, it seems that we need multimodal interventions for the treatment of KOA 50. Currently, the effect of exercise in the development and treatment of OA is not unknown (based on level I evidence),17 25–40 and also there is high-quality evidence (systematic studies and meta-analyses) regarding PNE in patients with chronic pain 12 13.…”

“…A study that clearly measures the effect of each intervention alone and in combination on patients. Also, in patients with OA, it is important to adhere to a healthy and active lifestyle for the long-term effect of interventions 4 28 50. In fact, it may be possible to rewrite the first-line non-surgical treatments for KOA and create a 'gold standard' consisting of PNE, blended exercises, nutritional education and EBSs.…”

Addressing Physical, Functional, and Physiological Outcomes in Older Adults using an Integrated mHealth Intervention “Active for Life”: A Pilot Randomized Controlled Trial

“…Non-pharmacological interventions that counter age-related physical and psychological deterioration may be effective for alleviating symptoms of pain and fatigue and enhancing function in older adults. Multi-modal interventions incorporating exercise rehabilitation components were found to be more effective than usual care for decreasing pain and disability among older adults suffering from chronic musculoskeletal disorders [16]. Similarly, moderate intensity exercise programs focusing on daily mobility (i.e., functional walking) and balance produced positive outcomes for preventing falls and improving physical performance in older persons not exhibiting frailty [17,18].…”

Feasibility Trial of an Integrated Treatment "Activate for Life" for Physical and Mental Well-being in Older Adults

“…About 28% of older adults suffer from chronic pain [8] while ~ 31% report experiencing signi cant fatigue [9].Chronic pain and fatigue can result in reduced physical activity, leading to decreased muscle tone and increased risk of injury from accidental falls; intensi ed arthritisrelated impairment; and other conditions that reduce capacity to participate in activities of daily living or in recreational activities that sustain mental and physical well-being [10,11,12,13]. Interventions to address pain and fatigue can be effective with older adults, particularly those targeting mobility and psychosocial [14,15]. However, these programs are not always available or accessible to older adults.…”