Physical activity in Sami and non-Sami populations in rural Northern Norway, the SAMINOR 2 Clinical Survey.

BACKGROUND: The Sami people is an indigenous minority population living in the northern parts of Norway and mainly in rural areas. We lack data of contemporary levels of physical activity (PA) in rural regions of Northern Norway and in the Sami population in particular. We aimed to describe the PA levels and investigate whether PA levels differs between Sami and non-Sami and between coastal and inland areas. METHODS: We used data from the second survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations - the SAMINOR 2 Clinical Survey (2012-2014) that includes the adult population in 10 municipalities in the counties Troms, Finnmark and Nordland. Participants self-reported on PA, ethnicity and modifiable lifestyle factors. Twelve thousand four hundred fifty-five individuals were invited with a response rate of 48.2% (n = 6004 participants). We tested differences using chi-square tests, two sample t-tests and linear regression models. RESULTS: Among 5628 participants, 41.1 and 40.9% of men and women, respectively, were defined as Sami. We found no ethnic differences in PA in men overall. However, Sami men living in Tana, and Nesseby reported higher PA compared to non-Sami men in the same area. For Sami women there was overall lower PA levels compared to non-Sami women, especially pronounced in Kautokeino/ Karasjok. CONCLUSION: This study showed small differences in PA levels between Sami and non-Sami men. Sami women had lower PA levels compared to their non-Sami counterparts. It is important to identify whether there are differences in various ethnic populations, together with other predictors for PA in future planning of public health interventions.

Family members' experience with in-hospital health care after severe traumatic brain injury: a national multicentre study.

BACKGROUND: Family member's experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members' experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients' function and rehabilitation pathways. METHODS: Prospective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases. RESULTS: Best family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p < 0.05). Worst family members` experience was related to information about consequences of the injury. Patient's dependency level (p < 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p < 0.01). CONCLUSIONS: This study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI.

Understanding Pain and Pain Management in Elderly Nursing Home Patients Applying an Interprofessional Learning Activity in Health Care Students: A Norwegian Pilot Study.

BACKGROUND: Pain is common among elderly patients in nursing homes. However, pain assessment and treatment are inadequate. Interprofessional treatment is recommended, and consequently interprofessional education in pain management is necessary. AIMS: This pilot project aimed to describe how two interprofessional groups of students approached pain management in two nursing home patients. DESIGN: We formed two teams comprising one student from the nursing, physical therapy, pharmacy, and medical educations. Each team spent one day examining a patient with chronic pain at a nursing home and they developed pain management plans. METHODS: We collected data through video recordings during teamwork before and after examining the patients and field notes during the patient examination. We analysed the video-recordings applying the seven-step model including 1) viewing the video data, 2) describing the video data, 3) identifying critical events, 4) transcribing, 5) coding, 6) constructing storyline and 7) composing a narrative. Field notes supplied the transcripts. RESULTS: Both teams succeeded in making a pain management plan for their patient. The common examination of the patient was crucial for the students' approaches to pain management and changed their pre-assumptions about the patients' pain. By sharing knowledge and reflecting together, the students reached a common consensus on suggestions for management of the patients' problems. Interprofessional collaboration fostered enthusiasm and a more holistic pain management approach. However, students' lack of knowledge limited their understanding of pain. CONCLUSION: Knowledge of pain management in nursing home patients and the practice of interprofessional cooperation should be included in pain curricula for health care professionals.

Factors Affecting Caregiver Burden 1 Year After Severe Traumatic Brain Injury: A Prospective Nationwide Multicenter Study.

OBJECTIVES: To assess burden in the caregivers of patients with severe traumatic brain injury (TBI) 1 year postinjury, related to caregiver's demographic data and social network, patient's demographic data, injury severity, and functional status. DESIGN: Prospective national multicenter study. Self-report from caregivers, patient data collected from the national cohort on patients with severe TBI. PARTICIPANTS: 92 caregivers. MAIN OUTCOME MEASURE: The Caregiver Burden Scale (CBS). RESULTS: Total caregiver burden was reported high in 16% of caregivers and moderate in 34%. The mean total burden index was 2.12, indicating a moderate burden. Caregivers reported highest scores on the General strain index, followed by the Disappointment index. Poor social network, feeling loneliness, and caring for patients with severe disability were significant predictors of higher burden in univariate analyses (P < .01). Multiple linear regression analyses showed that experiencing loneliness and caring for a patient with more severe disability were independent predictors for higher caregiver burden for all CBS indices. Marital status (married) and low frequency of meeting friends were significant results in some indices. CONCLUSIONS: Lack of a social network, feeling loneliness, and patient's functional status are predictors of caregiver burden. General strain, disappointment, and isolation were identified as areas in which caregiver burden is high.

Psychometric properties of the pain stages of change questionnaire as evaluated by Rasch analysis in patients with chronic musculoskeletal pain.

BACKGROUND: Our objective was to evaluate the measurement properties of the Pain Stages of Change Questionnaire (PSOCQ) and its four subscales Precontemplation, Contemplation, Action and Maintenance. METHODS: A total of 231 patients, median age 42 years, with chronic musculoskeletal pain responded to the 30 items in PSOCQ. Thresholds for item scores, and unidimensionality and invariance of the PSOCQ and its four subscales were evaluated by Rasch analysis, partial credit model. RESULTS: The items had disordered threshold and needed to be rescored. The 30 items in the PSOCQ did not fit the Rasch model Chi- square item trait statistics. All subscales fitted the Rasch models. The associations to pain (11 point numeric rating scale), emotional distress (Hopkins symptom check list v 25) and self-efficacy (Arthritis Self-Efficacy Scale) were highest for the Precontemplation subscale. CONCLUSION: The present analysis revealed that all four subscales in PSOCQ fitted the Rasch model. No common construct for all subscales were identified, but the Action and Maintenance subscales were closely related.

Vertebral fractures and self-perceived health in elderly women and men in a population-based cross-sectional study: the Tromsø Study 2007-08.

BACKGROUND: Health-related quality of life (HRQL) may be associated with increased mortality in the elderly. The effect of prevalent vertebral fractures on HRQL in elderly women and men is not well described. The purpose of this study was to examine the association between prevalent vertebral fractures and back pain, neck pain, and HRQL in elderly women and men, and to study possible gender differences in the reported pain and HRQL. METHODS: Information on prevalent vertebral fractures was ascertained by a vertebral fracture assessment (VFA) method (dual-energy X-ray absorptiometry (DXA), GE Lunar Prodigy) in 2887 women and men, mean age 65.4 (SD 9.4) who participated in the population-based Tromsø Study which was conducted in 2007-08. Bone mineral density (BMD; g/cm2) was measured by DXA at the femoral sites. Self-reported HRQL was assessed using the standardized measures EQ-5D-3 L and EQ VAS from the EuroQol Group. Lifestyle information was collected by questionnaires. The association between vertebral fractures and pain was analyzed using logistic regression, between vertebral fractures and EQ-5D-3 L and EQ VAS scores by multiple regression analyses. RESULTS: In women, presence of vertebral fractures was associated with an increased risk of back pain with an OR of 1.76 (95% CI: 1.24 - 2.50) after adjustments for age, height, weight, and BMD. Women with vertebral fractures had lower EQ-5D-3 L scores (p < 0.001) than women without vertebral fractures, also after adjustments. These associations were not present in men. Type of fracture was not associated with EQ-5D-3 L scores, but increasing numbers (p < 0.001) and severity of fractures (p < 0.002) were associated with decreasing EQ-5D-3 L score in women. CONCLUSION: Prevalent vertebral fractures are associated with increased risk of back pain and reduced HRQL in postmenopausal women, but not in men.

Staying active despite pain: pain beliefs and experiences with activity-related pain in patients with chronic musculoskeletal pain.

OBJECTIVE: Maintain a level of activity and exercise is advice often given to patients with chronic musculoskeletal pain, but many patients find physical activity painful and consequently hesitate to move. Disability seems to be associated with fear of pain and there is a need to enhance our understanding of patients' beliefs and attitudes about how fear of pain affects physical activity and why some people are active despite their pain. The aim of this research was to understand thoughts and experiences about pain related to activity in patients with musculoskeletal disorders; the situations that promoted pain and if and how fear was expressed. METHODS: Five women and five men, recruited from a larger survey on fear, pain and physical activity were interviewed. The interviews were analysed by qualitative methods for themes about participants' pain and beliefs about pain. RESULTS: By interpreting signals from the body, patients calculated and planned their daily life to stay active despite pain and participate in their social lives. Pain was a signal with diverse meanings which, with the influence of time, seemed to change from a sign of danger to a reminder to moderate their level of activity. By experimenting with different activities, patients learned how to gradually remain or become physically active. CONCLUSION: Patients strived to stay active despite pain. The interpretation of pain changed over time, from a threatening signal to a signal with diverse meanings. PRACTICE IMPLICATIONS: The findings provide insights that may improve the educational rehabilitation of patients with musculoskeletal pain.

Persistent pain associated with socioeconomic and personal factors in a Sami and Non-Sami population in Norway: an analysis of SAMINOR 2 survey data.

In international studies, higher prevalence of persistent pain has been reported in indigenous populations compared to majority populations. The present study aimed to determine the prevalence of persistent pain within a Sami and a non-Sami population in northern Norway, with adjustment for the confounding factors of age, sex, marital status, education, income, mental health, smoking status and ethnic background. Using SAMINOR 2 survey data including Sami and non-Sami populations, we analysed 5,546 responses, from individuals aged 40-79 years, to questions concerning persistent pain (≥ 3 months). In total, 2,426 (43.7%) participants reported persistent pain with differences between Sami women and non-Sami women (44.1% versus 51.1%, respectively), but none between Sami men and non-Sami men (38.7% versus 38.2%, respectively). Elderly Sami women were less likely to report persistent pain than were elderly non-Sami women. In men, no ethnic differences in pain were observed according to age-group. Marital status, education levels, household income, psychological distress, and smoking status did not influence the association between ethnicity and pain. Pain severity and location did not differ between Sami and non-Sami participants. In this study, we found only minor ethnic differences in persistent pain. Similar living conditions and cultural features may explain these findings.

The Tampa Scale of Kinesiophobia: A Rasch analysis of its properties in subjects with low back and more widespread pain.

OBJECTIVE: The aim of this study was to investigate the psychometric properties of the Norwegian version of the Tampa Scale of Kinesiophobia in patients with low back pain and in patients with more widespread pain distribution including low back pain. SUBJECTS: A total of 120 subjects, 48 with isolated low back pain and 72 with more widespread pain distribution were included. DESIGN AND METHODS: The Norwegian translation of the Tampa Scale of Kinesiophobia, Hopkins Symptom Check List 25 question version and Fear Avoidance Behaviour Questionnaire were completed. The properties of the Norwegian translation of the Tampa Scale of Kinesiophobia were explored by a Rasch analysis. RESULTS: The Tampa Scale of Kinesiophobia fitted the Rasch model and passed the independent t-test for a unidimensional scale. The response categories for some of the items needed to be collapsed from 4 to 3 levels. Only the item "It's not really safe for a person with a condition like mine to be physically active" was significantly different in men and women. CONCLUSION: The Norwegian translation of Tampa Scale of Kinesiophobia seems to reflect a unidimensional construct of kinesiophobia. The scale seemed to be quite robust across age and gender, and the response patterns to the items were similar in patients with low back pain and widespread pain distribution including low back pain.

Patterns of change and stability in caregiver burden and life satisfaction from 1 to 2 years after severe traumatic brain injury: A Norwegian longitudinal study.

OBJECTIVE: To assess burden and life satisfaction in family members of patients with severe traumatic brain injury (sTBI) at 1 and 2 years post-injury, examine if change in burden can be predicted by family member and patient demographics, patient's functional status, family members social network or level of burden at 1 year. METHODS: Prospective national multicenter study. Self-report from family members, patient data collected from a national cohort study on patients with sTBI. 80 family members participated. MAIN OUTCOME MEASURE: The Caregiver Burden Scale (CBS), life satisfaction. RESULTS: Total burden increased between years 1 and 2 post-injury (P = 0.04). Thirty percent of the family members reported an increased burden, 55% were stable, and 15% had a decrease in burden between the two follow-up times. Logistic regression analyses revealed that experiencing loneliness was an independent predictor of increased burden from 1 to 2 years post-injury (OR = 4.35, P < 0.05). Life Satisfaction was lower at the 2 year follow-up than at 1 year (p = 0.03). CONCLUSIONS: The results demonstrate a need for long-term follow-up of patients and family members that focuses on professional support to relieve burden and risk of loneliness or social isolation. This group may benefit from additional follow-up interventions tailored to their needs.

Life satisfaction in subjects with long-term musculoskeletal pain in relation to pain intensity, pain distribution and coping.

OBJECTIVE: To investigate levels of life satisfaction in subjects with long-term musculoskeletal pain in relation to pain characteristics and coping. DESIGN: Cross-sectional study. METHODS: A total of 232 (42%) respondents answered self--report questionnaires regarding life satisfaction, self-efficacy, sense of coherence, pain distribution and pain intensity at rest and during activity. RESULTS: Levels of life satisfaction and scores for sense of coherence were low. Pain intensity at rest was negatively correlated with global life satisfaction. This result was also obtained in multiple regression analyses together with the coping factors. The life satisfaction domains activities of daily living/contacts were negatively correlated with pain intensity during activity, and the domains work/economy were negatively correlated with pain distribution. Pain was not associated with satisfaction with family life, partner relationship or sexual life. Younger age, being married/cohabitant and being female were protective for some domains. Clinically meaningful subgroups with regard to adaptation were identified by cluster analysis, and the highest level of coping was found in the adaptive cluster with high life satisfaction/low pain intensity at rest. CONCLUSION: Long-term pain is related to low levels of life satisfaction, and pain intensity and distribution influence satisfaction in different domains. Pain intensity is negatively associated with coping. The results support efforts to reduce pain, together with strengthening active coping processes and addressing individual needs.

Readiness to adopt a self-management approach to pain--are profiles of subscale scores on the Pain Stages of Change Questionnaire useful?

The study evaluated the ability of the Pain Stages of Change Questionnaire (PSOCQ) to classify subjects into specific profiles of readiness to adopt a self-management approach to pain. An analysis was made of whether the five earlier described PSOCQ-profiles Precontemplation, Contemplation, Non-contemplative Action, Participation and Ambivalent could be reproduced by two different methods, cluster analysis and visual analysis. The 184 included subjects completed the PSOCQ, the Hopkins Symptom Checklist (HSCL-25), the Tampa scale of Kinesiophobia (TSK) and five self-efficacy questions from the arthritis self-efficacy questionnaire (ASES). Profiles were drawn based on the mean scores of the four subscales in PSOCQ. All the five predefined profiles were identified visually by two coders with an interrater agreement of Kappa 0.731. A 6-cluster solution generated the four profiles Precontemplation, Contemplation, Non-contemplative Action and Participation. Discriminant function analysis (DFA) on cluster analysis classified 83.5% of cases in the same group, and DFA on visual classification 72.1% of cases. Fifty-three percent were classified in the same profile by cluster and visual analysis. The two profiles Precontemplation and Participation seem to identify distinct subgroups that differ in educational level, pain during activity and psychometric measures. Non-contemplative Action share characteristics with Precontemplation, and the Contemplation group has scores in between. In conclusion, more research on the validity of the PSOCQ is needed. Outcome studies after pain treatment programmes could focus three main states that differ on measures for concurrent validity: Profiles that can be identified as Precontemplation or Non-contemplative action, Contemplators, and subjects with Participation profiles.

Activity-related pain in patients with chronic musculoskeletal disorders.

PURPOSE: Activity-related pain may be a barrier to rehabilitation in patients with chronic musculoskeletal disorders. This study investigated patients' reports of increased pain during activity, and the association between such pain and psychological factors and pain variables. METHOD: Questionnaires from 232 adults with chronic musculoskeletal pain measured pain intensity, spread of pain and pain duration. Pain during activity was assessed both on a 11-point Numeric Rating Scale (NRS), and operationalised as a dichotomous measure, where responders defined if they experienced pain during general activity and exercise. Psychological factors were measured by the Hopkins symptom check list 25, the Tampa Scale for Kinesiophobia and a subscale of the Arthritis Self-efficacy Scale. Multiple and logistic regression were used to analyse associations between increased pain during activity and associated variables. RESULTS: Increased pain during activity was reported by 69% of participants. Fear of movement was a significant factor for reporting increased pain during activity, both general activity and exercise also in a subsample with low psychological distress. Other significant factors were spread of pain and a low sense of self-efficacy. CONCLUSION: Patients with high fear of movement, large spread of pain and low self-efficacy were more likely to report increased pain during activity even in the absence of psychological distress.

Reliability of bloodflux measurements from the upper trapezius muscle during muscle contractions.

The aim of this study was to assess the blood flux responses to isometric contractions and recovery. We also wanted to assess the variations in Laser Doppler blood fluxes (LDF) within the upper trapezius muscles, the concordance between the left and right sides and the reliability of blood-flux measurements between contractions and over measurement days. Ten subjects, mean age 25 years (21-35 years), performed two isometric shoulder abduction contractions at 10% of maximal voluntary contraction torque (MVC), repeated on two separate days. LDF were measured in three sites in the upper trapezius muscles bilaterally. Mean arterial pressure, heart rate and electromyography from the upper trapezius muscles was also recorded. The reliability of blood flux measurements during rest and contractions are good; however, considerable variations between positions and between measurements in different muscles were observed. Laser-Doppler measurement of microcirculation is a promising method. Considerable variations between measurement sites, muscles, and variations over measurement days indicate caution with interpretation of blood flux responses between conditions and individuals.