107 research outputs found
Kreftpasienters barrierer mot smertebehandling
Bakgrunn: Ulike faktorer hos helsepersonell, pasienten selv eller i rammefaktorene kan forklare mangelfull smertelindring hos kreftpasienter. Hos pasientene kan barrierer for optimal smertebehandling være tilbakeholdenhet med å rapportere smerte og å følge anbefalte smerteregimer. Dette kan forklares med feiloppfatninger, misforståelser eller manglende kunnskap om smerte og smertebehandling. For eksempel redsel for avhengighet, toleranse og bivirkninger eller at smerte er en uunngåelig del av sykdommen.
Hensikt: Å beskrive pasientrelaterte barrierer i forhold til smerte og smertebehandling i et utvalg av norske kreftpasienter. Og undersøke om barrierer for smertebehandling påvirker pasientenes smerteintensitet og smertens påvirkning på funksjon.
Metode: Studien er en beskrivende tverrsnittsundersøkelse med 217 polikliniske kreftpasienter som har smerter og/eller bruker smertestillende medikamenter hvor barriere mot smerte og smertebehandling undersøkes ved hjelp av barriereskjema (NBQ–II).
Hovedresultat: De spørsmål som reflekterer de høyeste barrierene for smertebehandling er spørsmål om avhengighet, toleranse, monitorere symptomer i forhold til egen helsetilstand, nye smerter og redsel for enkelte bivirkninger som døsighet.
Konklusjon: Polikliniske kreftpasienter rapporterer en del barrierer for smertebehandling og må kanskje få en mer individualisert informasjon om smerte og smertebehandling for å bedre smertebehandlingen.Background: Numerous professional, patient, and system barriers contribute to the under-treatment of pain in cancer patients. Patients may, for example, be reluctant to report pain and to use available analgesics. This reluctance is often based on erroneous beliefs or misconceptions about pain and pain medication and includes factors such as fears of addiction and tolerance, fear of side-effects, and a belief that pain is an inevitable component of the disease.
Objectives: To investigate patient-related barriers to pain management in a sample of outpatients with cancer and investigate whether barriers influence patients pain intensity and pain interference with function.
Method: The study is a cross-sectional descriptive study with a convenient sample of 217 cancer patients self-reporting pain and/or using analgesics assessing barriers to pain and pain management using the Norwegian version of the Barriers Questionnaire (NBQ–II).
Results: Questions reflecting the highest barriers were concerns about addiction, tolerance and about the pain-medications’ ability to prevent knowledge about new pain and changes in their health. With regard to side-effects of pain medication, the highest reported level on NBQ–II was on the items concerning drowsiness.
Conclusion: Out-patients with cancer still have barriers to pain management and may need more individualized information and follow-up by health personnel in order to enhance pain management.
Keyword: cancer pain, patients’ barriers, pain management, outpatient
Delirium is associated with low levels of upright activity in geriatric inpatients—results from a prospective observational study
Delirium; Geriatrics; Physical activityDeliri; Geriatria; Activitat físicaDelirio; Geriatría; Actividad físicaBackground
Delirium is common in geriatric inpatients and associated with poor outcomes. Hospitalization is associated with low levels of physical activity. Motor symptoms are common in delirium, but how delirium affects physical activity remains unknown.
Aims
To investigate differences in physical activity between geriatric inpatients with and without delirium.
Methods
We included acutely admitted patients ≥ 75 years in a prospective observational study at a medical geriatric ward at a Norwegian University Hospital. Delirium was diagnosed according to the DSM-5 criteria. Physical activity was measured by an accelerometer-based device worn on the right thigh. The main outcome was time in upright position (upright time) per 24 h (00.00 to 23.59) on the first day of hospitalization with verified delirium status. Group differences were analysed using t test.
Results
We included 237 patients, mean age 86.1 years (Standard Deviation (SD) 5.1), and 73 patients (30.8%) had delirium. Mean upright time day 1 for the entire group was 92.2 min (SD 84.3), with 50.9 min (SD 50.7) in the delirium group and 110.6 min (SD 89.7) in the no-delirium group, mean difference 59.7 minutes, 95% Confidence Interval 41.6 to 77.8, p value < 0.001.
Discussion
Low levels of physical activity in patients with delirium raise the question if immobilization may contribute to poor outcomes in delirium. Future studies should investigate if mobilization interventions could improve outcomes of delirium.
Conclusions
In this sample of geriatric inpatients, the group with delirium had lower levels of physical activity than the group without delirium.Open access funding provided by Diakonhjemmet Hospital. The Liaison Committee for education, research and innovation in Central Norway funded the project. The funder had no role in designing the study, in the collection and interpretation of data or in writing the manuscript
Impacts of COVID-19 restrictions on level of physical activity and health in home-dwelling older adults in Norway
Background - The spread of the coronavirus in spring 2020 led to a lockdown of physical activity (PA) offers. The aim of this study was to investigate how PA, as well as general and mental health, in community-dwelling older adults were affected by the COVID-19 restrictions in Norway.
Methods - Invitation to participate in the study was sent via Facebook and the Norwegian Pensioners’ Association. Inclusion criteria were being ≥ 65 years old and living at home. Participants completed a questionnaire either digitally or on paper in June–August 2020. The questionnaire included questions on PA, general health, and mental health both before (13th of March) and during lockdown.
Results - We included 565 participants (mean age 74 ± 5.3 years, 60.4% female); almost 60% had a university degree, 84% reported performing PA more than once per week, and 20% reported a fall in the previous 12 months. The Wilcoxon signed-rank test indicated that the corona lockdown significantly reduced activity level (Z = -4.918, p
Conclusions - In a relatively highly educated and active group of older participants, COVID-19 restrictions still negatively affected level of activity as well as general and mental health. These short-term decreases in activity level and health suggest that preventive actions and increased focus on measures to support older adults in maintaining an active lifestyle are needed
Impact of physiotherapy access on health-related quality of life following hip fracture: an observational study on 30 752 hip fractures from the Norwegian Hip Fracture Register 2014–2018
Objectives The main objective of this study was to investigate the characteristics of patients receiving private community physiotherapy (PT) the first year after a hip fracture. Second, to determine whether utilisation of PT could improve health-related quality of life (HRQoL).
Methods In an observational cohort study, 30 752 hip fractures from the Norwegian Hip Fracture Register were linked with data from Statistics Norway and the Norwegian Control and Payment of Health Reimbursements Database. Association between covariates and utilisation of PT in the first year after fracture, the association between covariates and EQ-5D index score and the probability of experiencing ‘no problems’ in the five dimensions of the EQ-5D were assessed with multiple logistic regression models.
Results Median age was 81 years, and 68.4% were females. Most patients with hip fracture (57.7%) were classified as American Society of Anesthesiologists classes 3–5, lived alone (52.4%), and had a low or medium level of education (85.7%). In the first year after injury, 10 838 of 30 752 patients with hip fracture (35.2%) received PT. Lower socioeconomic status (measured by income and level of education), male sex, increasing comorbidity, presence of cognitive impairment and increasing age led to a lower probability of receiving postoperative PT. Among those who used PT, EQ-5D index score was 0.061 points (p<0.001) higher than those who did not. Correspondingly, the probability of having ‘no problems’ in three of the five dimensions of EQ-5D was greater.
Conclusions A minority of the patients with hip fracture had access to private PT the first year after injury. This may indicate a shortcoming in the provision of beneficial post-surgery rehabilitative care reducing post-treatment HRQoL. The findings underscore the need for healthcare policies that address disparities in PT access, particularly for elderly patients, those with comorbidities and reduced health, and those with lower socioeconomic status.publishedVersio
Feasibility of an implementation strategy for preventing falls in homecare services
Background: Falls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial.Methods: This study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory.Results: Qualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was.Conclusions: Overall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge.<br/
Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture : the protocol of the Trondheim Hip Fracture Trial
Background: Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in
quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional
geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of
multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT) aims
to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special
orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual
in an orthopaedic unit.
Methods/design: The intervention of interest, a comprehensive geriatric assessment is compared with traditional
care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously
able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants
are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility
measured by the Short Physical Performance Battery (SPPB) at 4 months after surgery. Secondary outcomes
measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait,
falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival.
Discussion: We believe that the design of the study, the randomisation procedure and outcome measurements
will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility
and other relevant outcomes in hip fracture patients
Funksjonsvedlikehold og gruppetrening for eldre - gjennomføring og evaluering av praksis
Fagartikkelen beskriver et kvalitetsutviklingsprosjekt hvor hensikten var å beskrive hvordan gruppetrening for hjemmeboende eldre kan arrangeres i praksis og samtidig belyse deltakere, gjennomførbarhet og resultater.Hensikten er å beskrive hvordan gruppetrening for hjemmeboende eldre kan arrangeres i praksis og samtidig belyse deltakere, gjennomførbarhet og resultater. Design: studien er et kvalitetsutviklingsprosjekt i praksisfeltet, og beskriver utvikling av gruppetilbudet, karakteristika ved deltakerne og endring i funksjon fra før til rett etter trening. Materiale: femti deltakere rekruttert gjennom lokalaviser og oppslag i nærmiljøet ble testet før oppstart av gruppetrening, hvorav 28 også ble testet etter en treningsperiode på sju måneder. Metode: vi benyttet Falls Efficacy Scale-International (FES-I), Den fysiske funksjonsskalaen fra Short Formular 36 (SF-36) og Senior Fitness Test som mål på funksjon. Treningstilbudet var styrke, balanse- og bevegelighetsøvelser én time én gang per uke over sju måneder. Resultat: 80 prosent var kvinner og gjennomsnittsalderen var 78.2 år (SD 6.2). 38 prosent hadde falt i løpet av det siste året. 90 prosent av deltakerne rapporterte god helse, mens 84 prosent var generelt bekymret for å falle. Treningsoppmøte var på 82.9 prosent. Det var ingen signifikant bedring i funksjon gjennom treningsperioden bortsett fra bekymring for å falle som var redusert fra 23.3 til 21.6 på en skala fra 16 til 64 poeng (p=0.023). Konkusjon: vi har beskrevet hvordan et lavterskeltilbud kan opprettes og gjennomføres som et tiltak for å vedlikeholde funksjon hos hjemmeboende eldre. Resultatene viser at gruppetrening 0.7 gang per uke alene er for lite til å bedre fysisk funksjon og bør derfor kombineres med hjemmetrening eller andre fysiske aktivitetstiltak
Performance-based clinical tests of balance and muscle strength used in young seniors: a systematic literature review
Background: Many balance and strength tests exist that have been designed for older seniors, often aged ≥70 years. To guide strategies for preventing functional decline, valid and reliable tests are needed to detect early signs of functional decline in young seniors. Currently, little is known about which tests are being used in young seniors and their methodological quality. This two-step review aims to 1) identify commonly used tests of balance and strength, and 2) evaluate their measurement properties in young seniors.
Methods: First, a systematic literature search was conducted in MEDLINE to identify primary studies that employed performance-based tests of balance and muscle strength, and which aspects of balance and strength these tests assess in young seniors aged 60–70. Subsequently, for tests used in ≥3 studies, a second search was performed to identify method studies evaluating their measurement properties. The quality of included method studies was evaluated using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) checklist.
Results: Of 3454 articles identified, 295 met the inclusion criteria. For the first objective, 69 balance and 51 muscle strength tests were identified, with variations in administration mode and outcome reporting. Twenty-six balance tests and 15 muscle strength tests were used in ≥3 studies, with proactive balance tests and functional muscle power tests used most often. For the second objective, the search revealed 1880 method studies, of which nine studies (using 5 balance tests and 1 strength test) were included for quality assessment. The Timed Up and Go test was evaluated the most (4 studies), while the Community Balance and Mobility (CBM) scale was the second most assessed test (3 studies). For strength, one study assessed the reliability of the Five times sit-to-stand.
Conclusion: Commonly used balance and muscle strength tests in young seniors vary greatly with regards to administration mode and outcome reporting. Few studies have evaluated measurement properties of these tests when used in young seniors. There is a need for standardisation of existing tests to improve their informative value and comparability. For measuring balance, the CBM is a new and promising tool to detect even small balance deficits in balance in young seniors
Change of physical activity parameters of hip and pelvic fracture patients during inpatient rehabilitation and after discharge: analysis of global and in-depth parameters
Background
A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps. These traditional parameters mix different domains of PA, such as physical capacity (PC), behaviour and living environment. We examined the change of global cumulative PA measures during rehabilitation and after discharge in patients with hip or pelvic fracture and whether more ‘in-depth’ PA parameters, such as walking interval length, variability of interval length and sit-to-stand transitions and their changes during rehabilitation and 3 months after discharge might better reflect the above mentioned three clinically relevant domains of PA.
Methods
This study is a secondary data analysis of a randomised controlled trial to improve PA and fall-related self-efficacy in hip or pelvic fracture patients (≥60 years) with concerns about falling. Changes of accelerometer-measured global cumulative and in-depth PA parameters (activPAL3) were analysed in an observational design before and after discharge combining both groups. For comparison, the same analyses were applied to the traditional PC measures gait speed and 5-chair-rise.
Results
Seventy-five percent of the 111 study participants were female (mean age: 82.5 (SD = 6.76) years. Daily walking duration, upright time and number of steps as aspects of global PA increased during inpatient rehabilitation as well as afterwards. The in-depth PA parameters showed differing patterns. While the total number of walking bouts increased similarly, the number of longer walking bouts decreased by 50% after discharge. This pattern was also seen for the average walking interval length, which increased by 2.34 s (95% confidence interval (CI): 0.68; 4.00) during inpatient rehabilitation and decreased afterwards below baseline level (− 4.19 s (95% CI: − 5.56; − 2.82)). The traditional PC measures showed similar patterns to the in-depth PA parameters with improvements during rehabilitation, but not at home.
Conclusion
Our findings suggest that the in-depth PA parameters add further information to the global cumulative PA parameters. Whereas global cumulative PA parameters improved significantly during inpatient rehabilitation and after discharge, in-depth PA parameters as well as PC did not continuously improve at home. In contrast to global cumulative PA parameters the in-depth parameters seem to reflect contextual factors such as the build environment and aspects of PC, which are traditionally assessed by clinical PC measures. These in combination with digital mobility measures can help clinicians to assess the health status of fragility fracture patients, individually tailor therapy measures and monitor the rehabilitation process
Concurrent validity and reliability of the Community Balance and Mobility scale in young-older adults
Background: With the growing number of young-older adults (baby-boomers), there is an increasing demand for assessment tools specific for this population, which are able to detect subtle balance and mobility deficits. Various balance and mobility tests already exist, but suffer from ceiling effects in higher functioning older adults. A reliable and valid challenging balance and mobility test is critical to determine a young-older adult’s balance and mobility performance and to timely initiate preventive interventions. The aim was to evaluate the concurrent validity, inter- and intrarater reliability, internal consistency, and ceiling effects of a challenging balance and mobility scale, the Community Balance and Mobility Scale (CBM), in young-older adults aged 60 to 70 years.
Methods: Fifty-one participants aged 66.4 ± 2.7 years (range, 60–70 years) were assessed with the CBM. The Fullerton Advanced Balance scale (FAB), 3-Meter Tandem Walk (3MTW), 8-level balance scale, Timed-Up-and-Go (TUG), and 7-m habitual gait speed were used to estimate concurrent validity, examined by Spearman correlation coefficient (ρ). Inter- and intrarater reliability were calculated as Intra-class-correlations (ICC), and internal consistency by Cronbach alpha and item-total correlations (ρ). Ceiling effects were determined by obtaining the percentage of participants reaching the highest possible score.
Results: The CBM significantly correlated with the FAB (ρ = 0.75; p < .001), 3MTW errors (ρ = − 0.61; p < .001), 3MTW time (ρ = − 0.35; p = .05), the 8-level balance scale (ρ = 0.35; p < .05), the TUG (ρ = − 0.42; p < .01), and 7-m habitual gait speed (ρ = 0.46, p < .001). Inter- (ICC2,k = 0.97), intrarater reliability (ICC3,k = 1.00) were excellent, and internal consistency (α = 0.88; ρ = 0.28–0.81) was good to satisfactory. The CBM did not show ceiling effects in contrast to other scales.
Conclusions: Concurrent validity of the CBM was good when compared to the FAB and moderate to good when compared to other measures of balance and mobility. Based on this study, the CBM can be recommended to measure balance and mobility performance in the specific population of young-older adults.
Trial registration Trial number: ISRCTN37750605 . (Registered on 21/04/2016)
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