- Title
- Physical activity and education for musculoskeletal pain across the lifespan
- Creator
- Viana Da Silva, Priscilla
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Musculoskeletal pain is highly prevalent and burdensome among children, adolescents, and adults. While considerable research has been conducted to investigate its diagnosis and treatment for adults, most recommendations for children and adolescents are inferred from research conducted in adults. This thesis has informed the development of an instrument to assess musculoskeletal pain impact in children, the use of physical activity in school-hours to improve musculoskeletal pain outcomes in children, and the adherence rates of children and adolescents under treatment for chronic pain, to assist in the optimisation of treatments. This research also highlights the importance of developing better strategies to improve patient education about low back pain for adults. Although the prevalence and burden of musculoskeletal pain are high, there is a lack of instruments to measure the impact of musculoskeletal pain in children. Chapter Two reports on the development and validation of a new instrument to measure musculoskeletal pain impact in school-aged children. A sample of 615 school-aged children was used to evaluate reliability (internal consistency) and construct validity (structural, convergent and discriminative validity) of a new instrument to measure musculoskeletal pain impact, based on a reflexive framework. The results indicated limited internal consistency (Cronbach’s alpha of 0.63) and moderate construct validity of the instrument, with most indices meeting the recommended thresholds of structural validity (SRMR = 0.030; GFI = 0.993, CFI = 0.955, RMSEA 0.073). While the instrument showed appropriate correlation (construct validity) with quality of life (r = -0.33), care-seeking (r = 0.45) and medication intake (r = 0.37), it did not correlate well with physical activity levels. Discriminative validity scores showed that the Paediatric Musculoskeletal Pain Impact summary score can discriminate well between children with frequent (high-pain-impact) and infrequent (low-pain-impact) pain. Despite the average results of the Paediatric Musculoskeletal Pain Impact summary score, it is a sound instrument for assessing musculoskeletal pain impact in school-aged children. Patient education is the first-line treatment recommended for the management of patients with low back pain. Chapters Three and Four investigate the effectiveness of a ‘Myths and Facts’ strategy to deliver patient education about low back pain compared with a ‘Facts only’ strategy for the correct recall of low back pain information at three weeks’ follow-up. Verbal and written education about low back pain was provided in the format of ‘Myths and Facts’ and ‘Facts only’ to 152 patients with chronic low back pain. The ‘Myths and Facts’ group received an information sheet containing six myths about low back pain treatment, refuted by six respective facts, with additional explanation of the facts. The ‘Facts only’ group received only the information sheet with the same six facts presented to the ‘Myths and Facts’ group. Both groups received further verbal explanation about the information sheet. The results showed no difference between groups at follow-up, with both groups having low rates of recall of back pain information (32%, OR 0.98; 95% CI: 0.48, 1.9). However, the results showed a degree of uncertainty due to the wide confidence intervals. Conversely, providing patient education using ‘Myths and Facts’ seemed to improve fear-avoidance and beliefs about physical activity for patients with low back pain (mean difference −1.58; 95% CI: −3.77, 0.61). This suggests that neither strategy was effective in improving correct recall of patients with low back pain. However, providing ‘Myths and Facts’ to change fear avoidance and beliefs seems to be more effective than the ‘Facts only’ strategy. Further research is recommended to evaluate the effectiveness of several different strategies used to deliver patient education about low back pain. Physical activity is recommended to prevent and improve several non-communicable diseases, including chronic musculoskeletal pain. Despite this, little is known about whether physical activity can improve the musculoskeletal pain outcomes of school-aged children. Chapters Six and Seven investigated the effectiveness of a strategy supporting school- teachers to increase children’s physical activity levels during school-time to improve musculoskeletal pain outcomes (frequency, severity, and impact), quality of life, physical activity, and sedentary time in 633 children with previous or current musculoskeletal pain. The results showed no difference between intervention and control schools for musculoskeletal pain frequency (OR 1.0, 95% CI: 0.6 to 1.6). However, children in the intervention schools were slightly more physically active (mean difference: 3.1 min/day, 95% CI: -0.02 to 6.2) and had lower pain impact in usual activities (OR 0.7, 95% CI: 0.4 to 1.0) than children in the control schools. This suggests that although increasing physical activity levels did not improve musculoskeletal pain outcomes, children with musculoskeletal pain can be encouraged to be physically active despite their pain. Future research could investigate whether educating school-teachers about self-management of musculoskeletal pain can improve the physical activity levels and even the musculoskeletal pain outcomes of schoolchildren. Adherence to treatment is important to ensure treatment effectiveness. Understanding how well children and adolescents adhere to non-pharmacological treatment for chronic pain is fundamental for developing a more appropriate treatment regimen for this population. The systematic review conducted in Chapter Seven found that children and adolescents in general adhered well to non-pharmacological treatments for chronic pain. However, the results showed that no studies investigated the determinants of adherence or nonadherence in children and adolescents. In addition, the results showed great discrepancy in how adherence was measured and reported in the studies, thus hindering interpretation and generalisation of the data. This suggests that further guidance on reporting adherence rates in research is needed. Overall, the studies presented in this thesis have important implications for the evidence- based management of musculoskeletal pain across the lifespan. Three studies highlighted the importance of having valid and reliable instruments to measure important outcomes in chronic pain treatment, such as musculoskeletal pain impact in children, correct recall and knowledge of low back pain education, and adherence rates in children and adolescents. One of the randomised controlled trials conducted for this thesis showed uncertainty on the effectiveness of providing Myths and Facts as a strategy for patient education, despite the wide use of this strategy in clinical and research practice. Future research should investigate the effectiveness of educational strategies to ensure correct recall and consequent learning of low back pain information. The second randomised controlled trial in this thesis showed that increasing physical activity levels in school-aged children can be helpful in keeping children with musculoskeletal pain physically active, although this activity does not seem to change musculoskeletal pain outcomes. Finally, the systematic review found that children and adolescents adhere well to treatments for chronic pain, with general adherence rates of ≥ 70%. However, no study statistically measured the determinants of adherence. This suggests that further research should be conducted to investigate the determinants of adherence (and nonadherence) in this population.
- Subject
- musculoskeletal pain; chronic pain; lifestyle interventions; patient education; educational strategies; low back pain; physical activity; children; adolescents
- Identifier
- http://hdl.handle.net/1959.13/1507252
- Identifier
- uon:55993
- Rights
- Copyright 2023 Priscilla Viana Da Silva
- Language
- eng
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