Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study

Nicolson, P.J.; Williamson, Esther; Lee, Hopin; Morris, Alana; Garrett, Angela; Sanchez‐Santos, Maria T; Lamb, Sarah E

doi:10.1177/2235042x20974529

Cited by 3 publications

(7 citation statements)

References 58 publications

(94 reference statements)

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“…Lack of physical activity affects self-care strategies by increasing inflammation and mild impairment ( 22 ). People who are more physically active show more independence in performing moderate to intense physical activity ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…There is limited evidence to demonstrate the effectiveness of weight loss in symptom control. In interventions for with the aim of better effectively of the weight loss in controlling symptoms, it is combined with exercise interventions ( 23 ). Exercise is the foundation of non-surgical management of osteoarthritis and is recommended for all clinical cases.…”

Section: Discussionmentioning

confidence: 99%

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Explaining the Concept of Self-Care Competence and Its Dimensions in Elderly Women with Knee Osteoarthritis in Iran: A Qualitative Study

Kooranian

Parsa-Yekta

Rassouli

2023

Ethiop J Health Sci

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BACKGROUND: Chronic diseases, especially knee osteoarthritis, are more likely to occur among women with the increase in age. Self-care is an effective strategy for the management of disease in patients with knee osteoarthritis. Therefore, recognizing the dimensions of self-care competence in elderly women with knee osteoarthritis is particularly important for long-term management of the disease. The current study aimed to explain the concept and dimensions of self-care competence in elderly women with knee osteoarthritis. METHODS: This qualitative study was conducted using a conventional content analysis method proposed by Graneheim and Landman, from March to November 2020 in Mashhad (one of the largest cities in Iran). A total of 19 participants including 11 elderly women with knee osteoarthritis, 4 first-degree relatives and 4 medical staff were selected by the purposive sampling. Data were collected through in-depth and semi-structured interviews which continued until data saturation was reached. The MAXQDA (Version 10) was used to organize, code, and manage the data. FINDINGS: Three main themes including "symptom management", "personal growth" and "social cohesion" were emerged as the dimensions of self-care competence in elderly women with knee osteoarthritis. CONCLUSION: Understanding the dimensions of self-care competence as one of the basic needs of the elderly women with knee osteoarthritis who live alone, is very important. Symptoms management, personal growth, and social cohesion as dimensions of self-care competence among this group of the elderly help to develop self-care competence interventions based on their needs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Explaining the Concept of Self-Care Competence and Its Dimensions in Elderly Women with Knee Osteoarthritis in Iran: A Qualitative Study

Kooranian

Parsa-Yekta

Rassouli

2023

Ethiop J Health Sci

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“…Hence, identifying these synergistic effects is important to clinical practice. The most prevalent comorbidities among people with hip/knee OA include cardiovascular diseases, depression, type 2 diabetes, hypertension, and other types of musculoskeletal pain ( 7 ). It seems that management of these diseases besides knee OA is the main challenge for self-care.…”

Section: Discussionmentioning

confidence: 99%

“…In Iran, the rate of affliction and damages of KOA prevalence is 15.3% in the urban society and 19.3% in rural society, which is much higher than in other Asian countries ( 6 ). KOA has a strong association with aging( 7 ), and it is estimated that 18% of women worldwide and 9.6% of men over 60 years of age suffer from KOA ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…According to Orem's definition, selfcare behavior is a key concept in health promotion, which refers to the decisions made and activities done by a person to adapt to a health problem by improving his/her health ( 12 ). Limitations in mobility or self-care among older adults who suffer from KOA are associated with poor quality of life, future dysfunction, increased health and social care costs, and increased risk of mortality ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Barriers and Challenges to Self-Care among Older Adults with Knee Osteoarthritis: A Qualitative Study

Kooranian

Parsa-Yekta

Rassouli

2022

Ethiop J Health Sci

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Background: Knee osteoarthritis (KOA) is a chronic disease causing disability in older adults. Self-care is an effective strategy for KOA management in older adults and clinicians have shown increased interest regarding the challenges of self-care activities in these patients.The present study aimed to explore the perception of older adults' patients with KOA regarding barriers and challenges faced in their self-care management. Methods: In this qualitative study, data were collected using purposeful sampling and in-depth semi-structured interviews with 22 older adults with KOA, their first-degree caregivers, and medical team members in Mashhad, northeast Iran, from April to December 2020. All the interviews were transcribed verbatim. Interviews continued until reaching data saturation. All interviews were recorded. Data analysis was done using conventional content analysis according to the technique described by Graneheim and Lundman. The MAXQDA (Version 10) was used to organize, code, and manage the data. Findings: Three main themes (confusion, confrontation with increasing stresses, and social rupture) were emerged as the barriers and challenges to self-care among older adults with KOA. Conclusion: The results of this study provide a broad range of context-specific of barriers and challenges to selfcare among older adults with KOA, which can be used for designing and implementing appropriate interventions to improve self-care in these patients.

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Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Williamson,

Sanchez-Santos,

Marian

et al. 2023

Programme Grants Appl Res

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Background Back pain frequently affects older people. Knowledge about back pain in older people and evidence to inform clinical care was lacking, particularly for older people with neurogenic claudication due to spinal stenosis, which is a debilitating condition. Objectives To understand and reduce the burden of back pain on older people by increasing knowledge about back pain in older people and developing evidence-based treatment strategies. Design We completed six work packages. These were not undertaken chronologically as there was overlap between work packages. Work package 1: Refine a physiotherapy intervention for neurogenic claudication. Work package 2: Feasibility of the Oxford Pain Activity and Lifestyle cohort study and Better Outcomes for Older people with Spinal Trouble randomised controlled trial. Work package 3: Development of a prognostic tool to identify when older people are at risk of mobility decline using data from the Oxford Pain Activity and Lifestyle cohort study. Work package 4: A randomised controlled trial of physiotherapy for neurogenic claudication and nested longitudinal qualitative study (Better Outcomes for Older people with Spinal Trouble randomised controlled trial). Work package 5: Predictors of participants’ response to treatment – prespecified subgroup analyses. Work package 6: Implementation planning. Setting Primary care and National Health Service Community and Secondary Care Trusts. Participants Community-dwelling adults over the age of 65 years and registered with primary care practices. Better Outcomes for Older people with Spinal Trouble trial participants reported back and/or leg pain consistent with neurogenic claudication. Interventions The Better Outcomes for Older people with Spinal Trouble programme was a physiotherapy-delivered combined physical and psychological group intervention for older people with neurogenic claudication. The comparator was a physiotherapy assessment and tailored advice (best practice advice). Main outcome measures The primary outcome for the Oxford Pain Activity and Lifestyle prognostic tool was mobility decline based on the EQ-5D-5L Mobility Question. The primary outcome for the Better Outcomes for Older people with Spinal Trouble trial was the Oswestry Disability Index at 12 months. Other outcomes included the Oswestry Disability Index walking item, 6-minute walk test and falls. The economic analyses used the EuroQol EQ-5D-5L to measure quality of life. Results Among Oxford Pain Activity and Lifestyle participants, 34% (1786/5304) reported back pain. A further 19.5% (1035/5304) reported back pain and associated leg pain, with 11.2% (n = 594/5304) reporting symptoms consistent with neurogenic claudication. Participants with back pain had worse quality of life compared to those without back pain and reported more adverse health states such as falls, frailty, low walking confidence and mobility decline. Those with neurogenic claudication were worst affected. At 2 years’ follow-up, among those reporting back pain at baseline, only 23% (489/2100) no longer reported symptoms. Recovery was lowest among participants reporting neurogenic claudication at baseline, with 90% still reporting symptoms. At 2 years’ follow-up, 18.6% of Oxford Pain Activity and Lifestyle participants reported mobility decline. Back pain with/without leg pain was not an independent predictor of mobility decline, but lower limb pain and the report of severe pain were independent predictors. Other predictors included slow walking pace, balance difficulties, low walking confidence, walking ability worse than last year, self-reported general health and comorbidity. In the Better Outcomes for Older people with Spinal Trouble trial, there was no significant difference in Oswestry Disability Index scores between treatment groups at 12 months (adjusted mean difference −1.4, 95% confidence interval −4.03 to 1.17), but at 6 months, scores favoured the Better Outcomes for Older people with Spinal Trouble programme (adjusted mean difference −3.7, 95% confidence interval −6.27 to −1.06). The Better Outcomes for Older people with Spinal Trouble programme resulted in greater improvements in the 6-minute walk test (mean difference 21.7 m, 95% confidence interval 5.96 to 37.38 m) and walking item (mean difference −0.2, 95% confidence interval −0.45 to −0.01) and reduced falls risk (odds ratio 0.6, 95% confidence interval 0.40 to 0.98) compared to best practice advice at 12 months. The probability that the Better Outcomes for Older people with Spinal Trouble programme is cost-effective ranged between 67% and 83% (National Health Service and Personal Social Services perspective) and between 79% and 89% (societal perspective) across cost-effectiveness thresholds between £15,000 and £30,000 per quality-adjusted life-year. From the embedded qualitative study, the Better Outcomes for Older people with Spinal Trouble programme was acceptable to participants, and enjoyable. Limitations Many of the data collected were self-reported and thus may be subject to recall bias or may have resulted in misclassification of participants. Conclusions Back pain is a substantial problem for older people, with the majority reporting persistent symptoms. We have developed an effective intervention to improve mobility and reduce falls in older people with neurogenic claudication; however, more effective interventions are needed for back pain generally. We have identified a set of self-reported questions that predict mobility decline in older people, so clinicians and their patients and families know when intervention is needed. Future work Develop and evaluate treatments for older people with back pain. Optimisation of the Better Outcomes for Older people with Spinal Trouble programme to better target pain-related disability. External validation of the Oxford Pain Activity and Lifestyle prognostic tool. Study registration This trial is registered as BOOST trial ISRCTN12698674. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: PTC-RP-PG-0213-20002) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 9. See the NIHR Funding and Awards website for further award information.

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Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study

Cited by 3 publications

References 58 publications

Explaining the Concept of Self-Care Competence and Its Dimensions in Elderly Women with Knee Osteoarthritis in Iran: A Qualitative Study

Explaining the Concept of Self-Care Competence and Its Dimensions in Elderly Women with Knee Osteoarthritis in Iran: A Qualitative Study

Barriers and Challenges to Self-Care among Older Adults with Knee Osteoarthritis: A Qualitative Study

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

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