135 research outputs found
Psychosocial work stress, leisure time physical exercise and the risk of chronic pain in the neck/shoulders: Longitudinal data from the Norwegian HUNT Study
Objectives: To prospectively investigate if the risk of chronic neck/shoulder pain is associated with work stress and job control, and to assess if physical exercise modifies these associations. Material and Methods: The study population comprised 29 496 vocationally active women and men in the Norwegian Nord-Trøndelag Health Study (HUNT Study) without chronic pain at baseline in 1984–1986. Chronic neck/shoulder pain was assessed during a follow-up in 1995–1997. A generalized linear model (Poisson regression) was used to calculate adjusted relative risks (RRs). Results: Work stress was dosedependently associated with the risk of neck/shoulder pain (ptrend < 0.001 in both sexes). The women and men who perceived their work as stressful “almost all the time” had multi-adjusted RRs = 1.27 (95% confidence interval (CI): 1.1–1.47) and 1.71 (95% CI: 1.46–2), respectively, referencing those with no stressful work. Work stress interacted with sex (p < 0.001). Poor job control was not associated with the risk of neck/shoulder pain among the women (RR = 1.04, 95% CI: 0.92–1.19) nor the men (RR = 1.09, 95% CI: 0.95–1.26). Combined analyses showed an inverse dose-dependent association between hours of physical exercise/week and the risk of neck/shoulder pain in the men with no stressful work (ptrend = 0.05) and among the men who perceived their work as “rarely stressful” (ptrend < 0.02). This effect was not statistically significant among the women or among men with more frequent exposure to work stress. Conclusions: Work stress is an independent predictor of chronic neck/shoulder pain and the effect is stronger in men than in women. Physical exercise does not substantially reduce the risk among the persons with frequent exposure to work stress
Design of a clinician dashboard to facilitate co-decision making in the management of non-specific low back pain
This paper presents the design of a Clinician Dashboard to promote co-decision making between patients and clinicians. Targeted patients are those with non-specific low back pain, a leading cause of discomfort, disability and absence from work throughout the world. Targeted clinicians are those in primary care, including general practitioners, physiotherapists, and chiropractors. Here, the functional specifications for the Clinical Dashboard are delineated, and wireframes illustrating the system interface and flow of control are shown. Representative scenarios are presented to exemplify how the system could be used for co-decision making by a patient and clinician. Also included are a discussion of potential barriers to implementation and use in clinical practice and a look ahead to future work. This work has been conducted as part of the Horizon 2020 selfBACK project, which is funded by the European Commission
Usability and acceptability of an app (SELFBACK) to support self-management of low back pain: mixed methods study.
Self-management is the key recommendation for managing non-specific low back pain (LBP). However, there are well-documented barriers to self-management, therefore methods of facilitating adherence are required. Smartphone apps are increasingly being used to provide feedback and reinforcement to support self-management of long-term conditions such as LBP. The aim of this study was to assess the usability and acceptability of the selfBACK smartphone app, designed to support and facilitate self-management of non-specific LBP. The app provides weekly self-management plans, comprising physical activity, strength/flexibility exercises, and patient education. The plans are tailored to the patient's characteristics and symptom progress by using case-based reasoning methodology. The study was carried out in two stages, using a mixed-methods approach. All participants undertook surveys and semi-structured telephone interviews were conducted with a subgroup of participants. Stage 1 assessed an app version with only the physical activity component and a web-questionnaire that collects information necessary for tailoring the self-management plans. The physical activity component included monitoring of steps recorded by a wristband, goal-setting, and a scheme for sending personalised, timely and motivational notifications to the user's smartphone. Findings from stage 1 were used to refine the app and inform further development. Stage 2 investigated an app version that incorporated three self-management components (physical activity, exercises and education). A total of sixteen participants (age range 23-71 years) with ongoing or chronic non-specific LBP were included in stage 1, and eleven participants (age range 32-56) were included in stage 2. In stage 1, 94% of participants reported that the baseline questionnaire was easy to answer and 84% found completion time to be acceptable. Overall, participants were positive about the usability of the physical activity component but only 31% found the app functions to be well integrated. 90% of the participants were satisfied with the notifications and 80% perceived the notifications to be personalised. In stage 2, all participants reported that the web-questionnaire was easy to answer and the completion time acceptable. The physical activity and exercise components were rated useful by 80%, while 60% rated the educational component useful. Overall, participants were satisfied with the usability of the app; however, only 50% found the functions to be well integrated and 20% found them to be inconsistent. Overall, 80% of participants reported it to be useful for self-management. The interviews largely reinforced the survey findings in both stages. This study has demonstrated that participants considered the selfBACK app to be acceptable and usable, and that they thought it would be useful for supporting self-management of LBP. However, we identified some limitations and suggestions, which will be useful in guiding further development of the selfBACK app and other mHealth interventions
Interplay between chronic widespread pain and lifestyle factors on the risk of type 2 diabetes: longitudinal data from the Norwegian HUNT Study
Introduction Chronic widespread pain (CWP) and diabetes
commonly co-occur; however, it is unclear whether CWP
infers an additional risk for diabetes among those with
known risk factors for type 2 diabetes. We aimed to
examine if CWP magnifies the effect of adverse lifestyle
factors on the risk of diabetes.
Research design and methods The study comprised
data on 25 528 adults in the Norwegian HUNT Study
without diabetes at baseline (2006–2008). We calculated
adjusted risk ratios (RRs) with 95% CIs for diabetes
at follow-up (2017–2019), associated with CWP and
body mass index (BMI), physical activity, and insomnia
symptoms. The relative excess risk due to interaction
(RERI) was calculated to investigate the synergistic effect
between CWP and adverse lifestyle factors.
Results Compared with the reference group without
chronic pain and no adverse lifestyle factors, those with
BMI ≥30 kg/m2
with and without CWP had RRs for diabetes
of 10.85 (95% CI 7.83 to 15.05) and 8.87 (95% CI 6.49 to
12.12), respectively; those with physical activity <2 hours/
week with and without CWP had RRs for diabetes of 2.26
(95% CI 1.78 to 2.88) and 1.54 (95% CI 1.24 to 1.93),
respectively; and those with insomnia symptoms with and
without CWP had RRs for diabetes of 1.31 (95% CI 1.07 to
1.60) and 1.27 (95% CI 1.04 to 1.56), respectively. There
was little evidence of synergistic effect between CWP and
BMI ≥30 kg/m2
(RERI=1.66, 95%CI −0.44 to 3.76), low
physical activity (RERI=0.37, 95%CI −0.29 to 1.03) or
insomnia symptoms (RERI=−0.09, 95%CI −0.51 to 0.34)
on the risk of diabetes.
Conclusions These findings show no clear interaction
between CWP and adverse lifestyle factors on the risk of
diabetes
Health-related quality of life in young adults born small for gestational age : a prospective cohort study
Background Individuals born small for gestational age (SGA) have an increased risk of several adverse health outcomes, but their health-related quality of life (HRQoL) across young adulthood has yet to be studied. The main aim of this study was to investigate if being born SGA at term is associated with poor HRQoL at 32 years of age. A second aim was to explore longitudinal changes in HRQoL from age 20 to 32 years. Methods In the prospective NTNU Low Birth Weight in a Lifetime Perspective study, 56 participants born SGA and 68 non-SGA control participants completed the Short Form 36 Health Survey (SF-36) at age 32 years to assess HRQoL. The SF-36 was also administrated at age 20 and 28 years. Longitudinal changes in the eight SF-36 domains and the two component summaries from 20 to 32 years were analyzed by linear mixed models. In total, 82 adults born SGA and 98 controls participated at least once and were included in the longitudinal analyses. Results At age 32 years the participants born SGA scored 14.8 (95% CI 4.7 to 25.3) points lower in the SF-36 role-physical domain compared with the control group, i.e. more problems with work or other daily activities due to physical health problems. The longitudinal analyses showed significant group differences from 20 to 32 years in the role-emotional domain, and in the physical and mental component summaries. Among participants born SGA, the physical component summary decreased from age 20 to 28 years (-3.2, 95% CI -5.0 to -1.8), while the mental component summary (6.0, 95% CI 2.9 to 8.6) and role-emotional domain score (19.3, 95% CI 9.9 to 30.3) increased, but there were no further changes from 28 to 32 years. There were no longitudinal changes in the control group from 20 to 32 years. Conclusion Overall, individuals born SGA at term reported similar HRQoL at age 32 years compared with non-SGA controls. Self-perceived mental health improved during young adulthood among individuals born SGA, while self-perceived physical health deteriorated. The latter findings warrant further investigation.Peer reviewe
Modified prolonged exposure therapy as Early Intervention after Rape (The EIR-study): study protocol for a multicenter randomized add-on superiority trial
Background Sexual assault and rape are the traumatic life events with the highest probability for posttraumatic
stress disorder (PTSD), which can have devastating consequences for those aficted by the condition. Studies indicate
that modifed prolonged exposure (mPE) therapy may be efective in preventing the development of PTSD in recently
traumatized individuals, and especially for people who have experienced sexual assault. If a brief, manualized early
intervention can prevent or reduce post-traumatic symptoms in women who have recently experienced rape, healthcare services targeted for these populations (i.e., sexual assault centers, SACs) should consider implementing such
interventions as part of routine care.
Methods/design This is a multicenter randomized controlled add-on superiority trial that enrolls patients attending
sexual assault centers within 72 h after rape or attempted rape. The objective is to assess whether mPE shortly after
rape can prevent the development of post-traumatic stress symptoms. Patients will be randomized to either mPE plus
treatment as usual (TAU) or TAU alone. The primary outcome is the development of post-traumatic stress symptoms
3 months after trauma. Secondary outcomes will be symptoms of depression, sleep difculties, pelvic foor hyperactivity, and sexual dysfunction. The frst 22 subjects will constitute an internal pilot trial to test acceptance of the
intervention and feasibility of the assessment battery.
Discussion This study will guide further research and clinical initiatives for implementing strategies for preventing
post-traumatic stress symptoms after rape and provide new knowledge about which women may beneft the most
from such initiatives and for revising existing treatment guidelines within this area
App-delivered self-management intervention trial selfBACK for people with low back pain: protocol for implementation and process evaluation
Background: Implementation and process evaluation is vital for understanding how interventions function in different settings, including if and why interventions have different effects or do not work at all.
Objective: This paper presents the protocol for an implementation and process evaluation embedded in a multicenter randomized controlled trial conducted in Denmark and Norway (the selfBACK project). selfBACK is a data-driven decision support system that provides participants with weekly self-management plans for low back pain. These plans are delivered through a smartphone app and tailored to individual participants by using case-based reasoning methodology. In the trial, we compare selfBACK in addition to usual care with usual care alone.
Methods: The aim of this study is to conduct a convergent mixed-methods implementation and process evaluation of the selfBACK app by following the reach, effectiveness, adoption, implementation, and maintenance framework. We will evaluate the process of implementing selfBACK and investigate how participants use the intervention in daily life. The evaluation will also cover the reach of the intervention, health care provider willingness to adopt it, and participant satisfaction with the intervention. We will gather quantitative measures by questionnaires and measures of data analytics on app use and perform a qualitative exploration of the implementation using semistructured interviews theoretically informed by normalization process theory. Data collection will be conducted between March 2019 and October 2020.
Results: The trial opened for recruitment in February 2019. This mixed-methods implementation and evaluation study is embedded in the randomized controlled trial and will be collecting data from March 2019 to October 2020; dissemination of trial results is planned thereafter. The results from the process evaluation are expected 2021-2022.
Conclusions: This study will provide a detailed understanding of how self-management of low back pain can be improved and how a digital health intervention can be used as an add-on to usual care to support patients to self-manage their low back pain. We will provide knowledge that can be used to explore the possibilities of extending the generic components of the selfBACK system and key drivers that could be of use in other conditions and diseases where self-management is an essential prevention or treatment strategy.
Trial Registration: ClinicalTrials.gov NCT03798288; https://www.clinicaltrials.gov/ct2/show/NCT03798288
International Registered Report Identifier (IRRID): DERR1-10.2196/20308
Using intervention mapping to develop a decision support system–based smartphone app (selfBACK) to support self-management of nonspecific low back pain: development and usability study
Background:
International guidelines consistently endorse the promotion of self-management for people with low back pain (LBP); however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode of supporting self-management in people with chronic conditions, including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak, and detailed descriptions and documentation of the interventions are lacking. Structured intervention mapping (IM) constitutes a 6-step process that can be used to guide the development of complex interventions.
Objective:
The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of nonspecific LBP to reduce pain-related disability.
Methods:
The first 5 steps of the IM process were systematically applied. The core processes included literature reviews, brainstorming and group discussions, and the inclusion of stakeholders and representatives from the target population. Over a period of >2 years, the intervention content and the technical features of delivery were created, tested, and revised through user tests, feasibility studies, and a pilot study.
Results:
A behavioral outcome was identified as a proxy for reaching the overall program goal, that is, increased use of evidence-based self-management strategies. Physical exercises, education, and physical activity were the main components of the self-management intervention and were designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by the behavior change theory and the normalization process theory.
Conclusions:
We describe a detailed example of the application of the IM approach for the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency in the developmental process of the intervention and can be a possible blueprint for designing and creating future digital health interventions for self-management
An app-delivered self-management program for people with low back pain: protocol for the selfBACK randomized controlled trial.
Background: Low back pain (LBP) is prevalent across all social classes, in all age groups, and across industrialized and developing countries. From a global perspective, LBP is considered the leading cause of disability and negatively impacts everyday life and well-being. Self-management is a recommended first-line treatment, and mobile apps are a promising platform to support self-management of conditions like LBP. In the selfBACK project, we have developed a digital decision support system made available for the user via an app intended to support tailored self-management of nonspecific LBP. Objective: The trial aims to evaluate the effectiveness of using the selfBACK app to support self-management in addition to usual care (intervention group) versus usual care only (control group) in people with nonspecific LBP. Methods: This is a single-blinded, randomized controlled trial (RCT) with two parallel arms. The selfBACK app provides tailored self-management plans consisting of advice on physical activity, physical exercises, and educational content. Tailoring of plans is achieved by using case-based reasoning (CBR) methodology, which is a branch of artificial intelligence. The core of the CBR methodology is to use data about the current case (participant) along with knowledge about previous and similar cases to tailor the self-management plan to the current case. This enables a person-centered intervention based on what has and has not been successful in previous cases. Participants in the RCT are people with LBP who consulted a health care professional in primary care within the preceding 8 weeks. Participants are randomized to using the selfBACK app in addition to usual care versus usual care only. We aim to include a total of 350 participants (175 participants in each arm). Outcomes are collected at baseline, 6 weeks, and 3, 6, and 9 months. The primary end point is difference in pain-related disability between the intervention group and the control group assessed by the Roland-Morris Disability Questionnaire at 3 months. Results: The trial opened for recruitment in February 2019. Data collection is expected to be complete by fall 2020, and the results for the primary outcome are expected to be published in fall 2020. Conclusions: This RCT will provide insights regarding the benefits of supporting tailored self-management of LBP through an app available at times convenient for the user. If successful, the intervention has the potential to become a model for the provision of tailored self-management support to people with nonspecific LBP and inform future interventions for other painful musculoskeletal conditions
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