Ability in everyday activities and morale among older women with chronic musculoskeletal pain living alone : a behavioural medicine approach in physiotherapy

The overall purpose of this thesis was to utilise a behavioural medicine approach in physiotherapy to study how older women with chronic musculoskeletal pain, who live alone and are dependent on formal care, perceive their everyday lives and to explore how their ability to perform everyday activities and morale could be promoted. Method: This thesis used a descriptive, correlative design (Study I), a randomised two-group design (Study III) and a qualitative inductive explorative design (Study II and IV). Participants in Studies I-III: Older women (≥65 years) with chronic musculoskeletal pain, who live alone, are able to walk with or without walking aids indoors and are dependent on formal care to manage their everyday lives. Study IV: Home help service staff who were involved in study III. Results: The results showed that many different factors appeared to have impact on the women’s health, everyday activities and morale. The target group of older women seemed to report the same pain-related problems, the same degree of pain-related disability and the same beliefs as those found in previous research on older individuals with chronic pain conditions. Despite their chronic musculoskeletal pain and other health complaints as well as their dependencies on others to manage their everyday lives, the results show how important it was for the women to live at home for as long as possible. A key factor in promoting the ability to perform everyday activities among the women was having a daily rhythm in a supportive environment. Another key factor in this context was the home help service staff, who had a strong will and desire to promote their care recipients’ independence and quality of life. Nonetheless, the resource that the staff represent could most likely be utilised in a better way. The behavioural medicine in physiotherapy intervention showed that more support from physiotherapists and home help services staff is needed to enhance the effect of this type of intervention among the target group. Nevertheless, the results imply that this type of intervention may improve levels of physical activity, self- efficacy in relation to exercise and management of everyday life, but further research is needed in larger samples. Conclusions: This thesis demonstrates that there are many different factors that seem to affect the women’s health, ability in everyday activities and morale. The women describe how their ability in everyday activities can be promoted by performing their everyday activities in a daily rhythm, and home help service staff are a key resource in this context. Moreover, physical activity, self-efficacy in relation to exercise and management of everyday life can be improved by a behavioural medicine-based physiotherapy intervention in the target group. To promote the women’s abilities in everyday activities, to improve their morale and, in the end, to enable the target group of women to be “ageing in place” in the best possible way, society and health care professionals may have to pay them special attention

Impact of the fall prevention Otago Exercise Programme on pain among community-dwelling older adults : a short- and long-term follow-up study

Background: Pain is a major public health issue among community-dwelling older adults, with a prevalence of 45-80%. In addition to being strongly associated with reduced physical function, loss of independence, psychological distress, lower quality of life, and risk of earlier death. Recent research has also found that pain in older adults is associated with a higher risk of falls, which itself is another major health concern. Long-term and high-intensity pain are predictors of chronic pain and pain-related disability. Therefore, establishing an evidence-based intervention that can reduce both pain and falls in older adults is of high importance. Purpose: This study aimed to investigate whether a home-based fall-preventive exercise-program can reduce pain in the target population over both the short and long term. Patients and methods: This was a quasi-experimental study with a 1-group pretest-posttest design. We included 119 participants who had participated in a recent 2-year fall prevention intervention in a randomized controlled trial. The intervention included exercises based on the Otago Exercise Programme (OEP), an individually tailored and prescribed program that involves home-based exercises supervised by a physiotherapist. Pain was measured using an item from the EuroQol-5D questionnaire. Results: Pain was significantly reduced from baseline (n=119) at 3 (n=105, p=0.003), 12 (n=96, p=0.041), and 24 (n=80, p=0.028) months following the commencement of OEP-based exercises. Conclusions: These results indicate that the OEP could be a suitable evidence-based program for both pain management and fall prevention among community-dwelling older people who live with pain and are at a higher risk of falling. Our study highlights an effective technique for better pain management and fall prevention in older adults

The perceptions of older adults living with chronic musculoskeletal pain about participating in an intervention based on a behavioral medicine approach to physical therapy

Background: There is evidence that interventions based on a behavioral medicine approach to physical therapy (BMPI) are beneficial for older adults living with chronic pain; however, knowledge of the perceptions of older people regarding their participation in BMPI is lacking. Aim: The aim of this study was to describe the perceptions of older people about being participants in a home-based BMPI. Methods: Semi-structured interviews were conducted with 12 older adults living with chronic pain and participating in a BMPI. Data were analyzed using qualitative content analysis. Results: The respondents highlighted the importance of the home-based and individualized nature of the intervention. They perceived the support from the physical therapist (PT) as significant for their motivation and goal attainment. The benefits of the intervention were described in physical, psychological, social, and functional terms and as enabling participants to live at home for longer. Conclusion: The results show that participation in a BMPI was perceived as a positive and meaningful experience. Support from a PT is crucial to encouraging behavioral changes. Finally, participation in a BMPI may contribute to the ability of participants to “age in place” for longer

A qualitative study exploring physical therapists’ views on the Otago Exercise Programme for fall prevention: a stepping stone to “age in place” and to give faith in the future

Background: One of the most effective interventions to prevent falls is exercise. A commonly used program that prevents falls is the Otago Exercise Programme (OEP). Despite this, user-based knowledge of its applicability in real-world settings for older adults who are dependent on formal care in their homes is lacking. Purposes: To explore how physical therapists (PTs) experience the applicability of the OEP in clinical practice for home-dwelling older adults who are dependent on formal home care and to determine their beliefs regarding the benefits of the OEP for living longer at home. Methods: Semi-structured interviews were conducted with 17 physical therapists. Data were analyzed using qualitative thematic analysis. Results: The OEP was described by PTs to be applicable in clinical practice. Their experience was that the OEP seemed to be meaningful and to have a strong relationship with everyday activities. The OEP improved physical function, mood, self-efficacy, and participation in social activities in older adults, as well as provided faith in the future. Conclusion: The OEP is suitable for use in a primary care setting, and according to the perceptions of physical therapists, the OEP contributes to older adults’ capability to live longer at home

The tensions between micro-, meso- and macro-levels: physiotherapists’ views of their role towards fall prevention in the community – a qualitative study

Background: Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists’ (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting. Methods: Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis. Results: The analysis resulted in a core theme and three subthemes. The core theme was ‘capability to cope with the tensions between the micro-, meso- and macro-levels in fall, prevention’, which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician’s multifaceted role; 2) multiprofessional – but in the end alone; 3) reaching out – from the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians. Conclusion: Our findings indicate that the PTs’ role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso- and macro-levels to succeed in the work of fall prevention

Everyday life in older men living alone – a complexview needing a biopsychosocial perspective

Purpose: To explore how older men living alone, describe their everyday activities and their abilities as well as how they could be helped in everyday life. Materials and methods: Qualitative semi-structured interviews were analysed with inductive content analysis. Eight men aged 65+ years were included. They were all living alone, albeit with home help services. They were able to walk and had sufficient cognitive ability. Results: The analysis resulted in one theme “A driving force of managing activities and overcome hindering factors requires a broad spectrum of prerequisites for participating in everyday life” with the following four categories: Importance of everyday activities; individual prerequisites enabling everyday activities; body and mind inhibit, and react to the decreased, abilities; and importance of the environment. Conclusions: The results generate a complex view of older men’s everyday life. It is important for older men’s independence that health care and rehabilitation staff adopt a comprehensive view and work from a biopsychosocial (BPS) perspective. Implications for rehabilitation To be an older man living alone might mean a decreased health and good health is a strong predictor for increased abilities in everyday activities. The living situation of older men living alone is not well studied and needs to be explored to a greater extend, especially from their own perspective. An interaction of biological, psychological, and social factors was expressed as important for older men’s everyday life, in accordance with the biopsychosocial (BPS) model. The expressed importance of participation as well as performing both physical and social activities reflects the need of individualised goals in rehabilitation according to the behavioural medicine approach. It is of outmost importance that health care and rehabilitation staff in contact with this group has a comprehensive view and works from a biopsychosocial (BPS) perspective, for maintenance of the older men’s independence in everyday life

Older adults’ experiences with mHealth for fall prevention exercise : usability and promotion of behavior change strategies

Background: With the rapidly growing aging population, older adults need to stay healthy andactive for a longer time. Mobile health (mHealth) solutions could help support, prevent, or delayfunctional decline and falls in old age. Purpose: The aim was to explore older persons’ experiences of a mobile application for fallprevention exercise, and to identify what possible behavior change techniques to include in thefurther development of the application. Methods: Two focus groups were conducted with 12 older adults (seven women and five men) 70to 83 years of age. A qualitative content analysis was performed. Results: Two main results emerged: 1) external facilitators for using the application; and 2)internal facilitators for using the application and perceived gains, in addition 10 behavior changetechniques were identified. Conclusion: With support, an application could be adapted for older adults to manage, motivate,and adhere to fall prevention exercise. To achieve long-term adherence to health behaviorchanges, behavior change strategies and techniques are recommended to be included in furtherdevelopment of the fallprevention application