| 1. |
- Dragioti, Elena, Ph.D., et al.
(författare)
-
Association of insomnia severity with well-being, quality of life and health care costs: A cross-sectional study in older adults with chronic pain (PainS65+)
- 2018
-
Ingår i: European Journal of Pain. - : WILEY. - 1090-3801 .- 1532-2149. ; 22:2, s. 414-425
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundInsomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well-being, quality of life and health care costs. MethodsThe sample included 2790 older individuals (median age=76; interquartile range [IQR]=70-82) with chronic pain. The participants completed a postal survey assessing basic demographic data, pain intensity and frequency, height, weight, comorbidities, general well-being, quality of life and the insomnia severity index (ISI). Data on health care costs were calculated as costs per year (Euro prices) and measured in terms of outpatient and inpatient care, pain drugs, total drugs and total health care costs. ResultsThe overall fraction of clinical insomnia was 24.6% (moderate clinical insomnia: 21.9% [95% CI: 18.8-23.3]; severe clinical insomnia: 2.7% [95% CI: 1.6-3.2]). Persons who reported clinical insomnia were more likely to experience pain more frequently with higher pain intensity compared to those reported no clinically significant insomnia. Mean total health care costs were Euro 8469 (95% CI: Euro4029-Euro14,271) for persons with severe insomnia compared with Euro 4345 (95% CI: Euro4033-Euro4694) for persons with no clinically significant insomnia. An association between severe insomnia, well-being, quality of life, outpatient care, total drugs costs and total health care costs remained after controlling for age, sex, pain intensity, frequency, body mass index and comorbidities using linear regression models. ConclusionsOur results determine an independent association of insomnia with low health-related quality of life and increased health care costs in older adults with chronic pain. SignificanceThe concurrence and the severity of insomnia among older adults with chronic pain were associated with decreased well-being and quality of life, and increased health care costs to society.
|
|
| 2. |
- Dragioti, Elena, Ph.D., et al.
(författare)
-
EFFECTIVENESS OF MULTIDISCIPLINARY PROGRAMMES FOR CLINICAL PAIN CONDITIONS: AN UMBRELLA REVIEW
- 2018
-
Ingår i: Journal of Rehabilitation Medicine. - : FOUNDATION REHABILITATION INFORMATION. - 1650-1977 .- 1651-2081. ; 50:9, s. 779-791
-
Forskningsöversikt (refereegranskat)abstract
- Objective: To evaluate the strength of the evidence for multimodal/multidisciplinary rehabilitation programmes (MMRPs) for common pain outcomes. Data sources: PubMed, PsychInfo, PEDro and Co-chrane Library were searched from inception to August 2017. Study selection: Meta-analyses of randomized controlled trials or controlled clinical trials and qualitative systematic reviews of randomized controlled trials and non-randomized controlled trials were considered eligible. Data extraction: Two independent reviewers abstracted data and evaluated the methodological quality of the reviews. The strength of the evidence was graded using several criteria. Data synthesis: Twelve meta-analyses, including 134 associations, and 24 qualitative systematic reviews were selected. None of the associations in meta-analyses and qualitative systematic reviews were supported by either strong or highly suggestive evidence. In meta-analyses, only 8 (6%) associations that were significant at p-value amp;lt;= 0.05 were supported by suggestive evidence, whereas 44 (33%) associations were supported by weak evidence. Moderate evidence was found only in 4 (17%) qualitative systematic reviews, while 14 (58%) qualitative systematic reviews had limited evidence. Conclusion: There is no evidence that MMRPs are effective for prevalent clinical pain conditions. The majority of the evidence remains ambiguous and susceptible to biases due to the small sample size of participants and the limited number of studies included.
|
|
| 3. |
- Söderlund Schaller, Anne, 1967-
(författare)
-
Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is not unusual for patients with head and neck cancer (HNC) to suffer from both tumor and treatment-related pain that is difficult to alleviate despite individualized pharmacological treatment.The presence of concomitant various dimensions of pain in patients during the often difficult period following radiotherapy (RT) has not been elucidated. Several aspects concerning the importance of relatives for HNC patients have been addressed. However, little attention has been given to how relatives perceive patients with HNC pain and it is important to further elucidate this sparsely studied topic. Knowledge about health-related quality of life (HR-QoL) in this patient group during early RT is limited and needs to be assessed in relation to diagnosis and treatment. Self-care (SC) refers to what patients do on their own to achieve, maintain, and promote optimal health and may help reduce pain for several pain conditions. The impact of patient education and SC on pain and other common HNC symptoms need further clarification.The aims of this thesis were:to describe experiences and perceptions of pain in patients with HNC shortly after RTto describe how relatives perceived the patient’s situation, especially concerning pain, and how they experienced their own situationto identify factors that impact HR-QoL during early RTto develop effective pain management strategies, maintain activities of daily living, and promote HR-QoL in patients with HNC undergoing RT using patient education and SC instruction.In paper I patients with HNC described existential pain – expressed as fear of death, meaninglessness and guilt – already during and shortly after RT. Physical pain, psychological distress and social withdrawal played a significant role. Patients with HNC who were treated with RT should also proactively be offered treatment for the various dimensions of pain.In paper II relatives described their mental stress in response to a challenging situation that required their active support to help ease the patient's difficult condition. The interviews with relatives also revealed a lack of personal knowledge and frustration over the inability to participate in patient care, as well as inadequate support from the healthcare system. Early interventions from the healthcare system on behalf of the relatives may be necessary to meet these needs.In Paper III regression models revealed that pain intensity and symptoms of depression adversely affected HR-QoL in patients with HNC during early RT. Customized prehabilitation programs aimed at preventing pain and symptoms of depression could help preserve good HR-QoL.Paper IV assessed individual patient education and SC initiatives that resulted in a tendency for lower pain intensity during a portion of RT. One way to potentially enhance the benefits of education and SC could be to improve for example patient motivation and self-efficacy, as well as to optimize supportive efforts from caregivers.In conclusion, by identifying factors that can impact HR-QoL and evaluating the effect of patient education and SC, this thesis contributes to knowledge on perceived pain and the patient’s situation during and shortly after RT in patients with HNC and their relatives. This thesis points to the need for evaluation and further development of patient education and effective SC strategies for pain in patients with HNC undergoing RT, as well as for development and evaluation of support strategies for patients with pain and their families during and after RT.
|
|
