The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes.

Pain is common in the aging population, particularly among older residents of nursing homes. It has been found that 50% of older people living in the community have been experiencing chronic pain, and the number increased to 80% for older residents of nursing homes. Exercise is an effective non-pharmacological intervention that can reduce pain and improve physical and psychological functions. A quasi-experimental study with a pretest-posttest control group designed was conducted to evaluate the effects of a physical exercise program (PEP) on older residents of nursing homes who have chronic pain. Three-hundred-ninety-six older residents with chronic pain were recruited from 10 nursing homes run by non-governmental organizations in Hong Kong. The average age of the older residents was 85.44 ± 6.29. Five nursing homes were randomized to the experimental group with PEP (n = 225, age = 85.45 ± 6.25); the other five nursing homes were randomized to the control group without the PEP (n = 171, age = 85.44 ± 6.35). PEP was an eight-week training program given by a physiotherapist and nurses once a week. It consisted of warm-up exercises, muscle strengthening, stretching, balancing, and self-administered massage to acupressure points. At the end of each PEP session, pamphlets with pictures illustrating the "exercise of the day" were given to the older residents of nursing homes as a tool to enhance their self-management skills. The control group received no training during the eight weeks. Upon completion of the PEP, the experimental group experienced a significantly greater reduction in pain intensity from 4.19 ± 2.25 (on an 11 point scale) to 2.67 ± 2.08, as compared to the control group (p < .05). In addition, the psychological well-being (happiness, loneliness, life satisfaction, and depression) of the experimental group was significantly improved (p < .05).

Health-related profile and quality of life among nursing home residents: does pain matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.

Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain: a randomised controlled study.

AIMS AND OBJECTIVES: To examine the effectiveness of an integrated motivational interviewing and physical exercise programme on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise for community-dwelling older persons with chronic pain. BACKGROUND: Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain. DESIGN: Single-blinded randomised control study. METHODS: Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and physical exercise programme, while the control group received regular activities in the centre. Motivational interviewing used open-ended questions to encourage participants to express and recognise their pain and behaviours and professional feedback was given accordingly. Pain intensity, pain self-efficacy, anxiety, happiness, depression, mobility and quality of life were measured before and after the motivational interviewing and physical exercise programme. Attendance and compliance rate of the programme was calculated in the experimental group. RESULTS: Significant improvements in pain intensity, pain self-efficacy, anxiety, happiness and mobility after the motivational interviewing and physical exercise programme (all p < 0.05) for experimental group, while no significant improvement in control group except on the happiness scale. Regarding group differences in the outcome measures, the change scores on pain intensity, state anxiety and depression were significantly better in the experimental group. CONCLUSION: Motivational interviewing and physical exercise programme is effective in improving pain, physical mobility, psychological well-being and self-efficacy for community-dwelling older persons with chronic pain. RELEVANCE TO CLINICAL PRACTICE: Motivational interviewing is a feasible counselling technique whose content can be modified based on target group to change maladaptive behaviours, elicit ambivalences and enhance self-efficacy for making changes. Thus, promoting motivational interviewing and physical exercise programme to older persons with pain is effective and important.

Electrophysical therapy for managing diabetic foot ulcers: a systematic review.

To systematically assess published reports on the efficacy of electrophysical therapy in the treatment of diabetic foot ulcers, including electrical stimulation, low-level laser therapy, therapeutic ultrasound and electromagnetic therapy. Databases searched included MEDLINE, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from 1966 to 2011. Studies reviewed included only randomised controlled trials (RCTs) on treatment with electrophysical modalities compared with sham, conventional treatment or other electrophysical modalities. Information extracted were objective measures of healing and data useful for the calculation of effect size. Eight RCTs were eventually included in the critical appraisal, with a combined total of 325 participants. Five studies were conducted on electrical stimulation, two on phototherapy and one on ultrasound. All studies reported that the experimental group was significantly more favourable than the control or sham group. The pooled estimate of the number of healed ulcers of the three studies on electrical stimulation compared to the control or sham electrical stimulation showed statistical significance [mean difference of 2·8 (95% CI = 1·5-5·5, P = 0·002] in favour of electrical stimulation. The results indicated potential benefit of using electrophysical therapy for managing diabetic foot ulcers. However, due to the small number of trials ever conducted, the possibility of any harmful effects cannot be ruled out, and high-quality trials with larger sample sizes are warranted.

Factorial structure of the Pain Rehabilitation Expectations Scale: a preliminary study.

The aim of this study was to report the preliminary validation results for the Pain Rehabilitation Expectations Scale (PRES). The PRES is a clinical tool developed to measure the expectations about rehabilitation treatment and outcome for people with back pain. Fifty people with chronic back pain were recruited from 11 physiotherapy outpatient clinics in Hong Kong for this study. Multitrait scaling analysis indicated that the three subscales of the PRES (working alliance, proxy efficacy, and motivation/expectation) were internally consistent, with Cronbach's alpha reliability coefficients ranging from 0.93 to 0.96. Proxy efficacy was found to be related to working alliance, and working alliance was positively related to client motivation and expectations. The preliminary psychometric analysis results suggested that the PRES could potentially be used to measure chronic pain patients' expectations about pain rehabilitation treatments. However, this study is based on a very small sample size; psychometric validation of the PRES with a larger sample of chronic pain patients to confirm the measurement structure of the PRES using confirmatory factor analysis is warranted.

Measurement structure of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronic pain.

OBJECTIVE: To examine the factorial structure of the Chinese translation of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronic pain. SETTING: Outpatient physiotherapy department in a local hospital and a local rehabilitation clinic. PARTICIPANTS: One hundred and twenty patients with chronic pain in physiotherapy treatment. METHODS: Each participant was asked to complete the Chinese version of the Pain Self-Efficacy Questionnaire, visual analogue scale (VAS), modified Roland Morris Disability Questionnaire, and Short Form Health Survey (SF-36). The test structure of the Pain Self-Efficacy Questionnaire was evaluated by confirmatory factor analysis. Highly correlated paths were added onto the initial structure for improving the final construct for the Pain Self-Efficacy Questionnaire. The correlations between the Chinese Pain Self-Efficacy Questionnaire and related measurements were computed using Pearson product-moment correlation coefficients. RESULTS: Confirmatory factor analysis indicated that the one-factor model provided the best fit between the model and data, with the chi-square of the respecified model computed to be 36.79 (33, N = 120), the goodness-of-fit index 0.940, cumulative fit index 0.996, and the root mean square error of approximation 0.031. The item-total correlations ranged from 0.70 to 0.85. Cronbach's alpha of the Chinese version of the Pain Self-Efficacy Questionnaire was computed to be 0.94. The total scores also correlated significantly with the modified Roland Morris Disability Questionnaire and six subscales of SF-36. CONCLUSION: A single-factor model confirmed the unidimensionality of the Chinese version of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronic pain. It demonstrated good internal consistency reliability and construct-related validity.