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

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

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

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)

Mobility and associations with levels of cerebrospinal fluid amyloid β and tau in a memory clinic cohort

BackgroundMobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer’s disease (AD).MethodsIn this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-β 42 (Aβ42), total-tau (t-tau), and phospho tau (p-tau181). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia.ResultsAβ42 was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aβ42 was significantly associated with Mini-BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau181 was not associated with any of the mobility outcomes in any of the analyses.ConclusionBetter performance on mobility outcomes were associated with higher levels of CSF Aβ42. The association was strongest between Aβ42 and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology

The long-term effect of being treated in a geriatric ward compared to an orthopaedic ward on six measures of free-living physical behavior 4 and 12 months after a hip fracture - a randomised controlled trial

Background This study is part of the Trondheim Hip Fracture Trial, where we compared free-living physical behavior in daily life 4 and 12 months following hip surgery for patients managed with comprehensive geriatric care (CGC) in a geriatric ward with those managed with orthopedic care (OC) in an orthopedic ward. Methods This is a single centre, prospective, randomized controlled trial. 397 hip fracture patients were randomized to CGC (n = 199) or OC (n = 198) in the Emergency Department with follow-up assessments performed four and 12 months post-surgery. Outcomes were mean upright time, number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor. Missing data were handled by multiple imputation and group differences assessed by linear regression with adjustments for gender, age and fracture type. Results There were no group differences in participants’ pre-fracture characteristics. Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min (17.4 %, CI 9.6 to 59.6, p = .007) and at 12 months, 27.7 min (13.9 %, CI 3.5 to 51.8, p = .025). Average and maximum length of upright events was longer in the CGC (p’s < .042). No group difference was found for number of upright events (p’s > .452). Conclusion Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery, with more time and longer periods spent in upright. Results support findings from the same study for functional outcomes, and demonstrate that CGC impacts daily life as long as one year after surgery

Protocol for the PreventIT feasibility randomised controlled trial of a lifestyle-integrated exercise intervention in young older adults

Introduction The European population is rapidly ageing. In order to handle substantial future challenges in the healthcare system, we need to shift focus from treatment towards health promotion. The PreventIT project has adapted the Lifestyle-integrated Exercise (LiFE) programme and developed an intervention for healthy young older adults at risk of accelerated functional decline. The intervention targets balance, muscle strength and physical activity, and is delivered either via a smartphone application (enhanced LiFE, eLiFE) or by use of paper manuals (adapted LiFE, aLiFE). Methods and analysis The PreventIT study is a multicentre, three-armed feasibility randomised controlled trial, comparing eLiFE and aLiFE against a control group that receives international guidelines of physical activity. It is performed in three European cities in Norway, Germany, and The Netherlands. The primary objective is to assess the feasibility and usability of the interventions, and to assess changes in daily life function as measured by the Late-Life Function and Disability Instrument scale and a physical behaviour complexity metric. Participants are assessed at baseline, after the 6 months intervention period and at 1 year after randomisation. Men and women between 61 and 70 years of age are randomly drawn from regional registries and respondents screened for risk of functional decline to recruit and randomise 180 participants (60 participants per study arm). Ethics and dissemination Ethical approval was received at all three trial sites. Baseline results are intended to be published by late 2018, with final study findings expected in early 2019. Subgroup and further in-depth analyses will subsequently be published. Trial registration number NCT03065088; Pre-results

Technical validation of real-world monitoring of gait: a multicentric observational study

Introduction: Existing mobility endpoints based on functional performance, physical assessments and patient self-reporting are often affected by lack of sensitivity, limiting their utility in clinical practice. Wearable devices including inertial measurement units (IMUs) can overcome these limitations by quantifying digital mobility outcomes (DMOs) both during supervised structured assessments and in real-world conditions. The validity of IMU-based methods in the real- world, however, is still limited in patient populations. Rigorous validation procedures should cover the device metrological verification, the validation of the algorithms for the DMOs computation specifically for the population of interest and in daily life situations, and the users’ perspective on the device. Methods and analysis: This protocol was designed to establish the technical validity and patient acceptability of the approach used to quantify digital mobility in the real world by Mobilise-D, a consortium funded by the European Union (EU) as part of the Innovative Medicine Initiative, aiming at fostering regulatory approval and clinical adoption of DMOs. After defining the procedures for the metrological verification of an IMU-based device, the experimental procedures for the validation of algorithms used to calculate the DMOs are presented. These include laboratory and real-world assessment in 120 participants from five groups: healthy older adults; chronic obstructive pulmonary disease, Parkinson’s disease, multiple sclerosis, proximal femoral fracture and congestive heart failure. DMOs extracted from the monitoring device will be compared with those from different reference systems, chosen according to the contexts of observation. Questionnaires and interviews will evaluate the users’ perspective on the deployed technology and relevance of the mobility assessment. Ethics and dissemination: The study has been granted ethics approval by the centre’s committees (London—Bloomsbury Research Ethics committee; Helsinki Committee, Tel Aviv Sourasky Medical Centre; Medical Faculties of The University of Tübingen and of the University of Kiel). Data and algorithms will be made publicly available