Behavioural medicine intervention in older adults

...Is there any effect on pain, global health and behaviour?

Chronic pain is a common condition around the world and represents a public health issue. Described as pain lasting three or more months despite treatments and medications provided, it affects 62 percent of people over 75 years old.

Pain in relation to musculoskeletal conditions is the most common type of chronic pain. Its consequences can be devastating, such as poor global health, poor physical function, disabilities, higher risks of falling, fear of movement and catastrophising, anxiety, social isolation, poor quality of life, et cetera. In older adults, chronic pain is even more associated with risk of increasing disability, less movement, sedentarity and frailty.

While physical activity has been identified in the literature as a way for older people with chronic pain to maintain the possibility to perform daily activities, a behavioural medicine approach in physiotherapy (BMPT) has also been developed and recommended as an evidence based intervention for middle-aged adults suffering from chronic pain.

The intervention is based on a biopsychosocial approach. This is particularly relevant here, as pain is a multidimensional experience. It aims at modifying behaviour of people in order to reach goals associated with disabilities directly affecting daily life. Built on the basis of each patient, it takes into consideration all the dimensions involved in such context – i.e., medical, physical, behavioural, cognitive, psychological, environmental and social.

Although this specific BMPT was found efficient to improve the level of physical activity, self-efficacy for exercise and management of pain of everyday life among older women, additional research is necessary to further assess the level of evidence.

Therefore, the present study investigated the effects of a BMPT on pain related disability and physical function as well as on pain severity, pain-related beliefs, physical activity levels, falls efficacy, and health-related quality of life. This was found as a suitable intervention for older adults, even for those who are very old and frail.

The authors found that a behavioural medicine approach in physiotherapy had benefits in terms of pain-related disability, pain severity, level of physical activity, health-related quality of life, management of everyday life as well as self-efficacy, compared to the control group with usual care.

They concluded that such intervention may be a suitable evidence based approach for older adults as it is in favour of activity, active aging and 'age in place' which are key factors to protect and promote in this specific population.

> From: Cederbom et al., Clin Interv Aging 14 (2019) 1207-1220 . All rights reserved to The Author(s). Click here for the online summary.

Expert opinion

The results of the present study seem quite promising, especially as this RCT is one of (if not the) first focusing on BMPT in older people. Not only does it show positive benefits in various fields of global health, but it also highlight the fact that such multidimensional approach (in line with the biopsychosocial model) is particularly adapted and accepted by older people who were able to participate.

The results here are in line with the results from a previous qualitative study assessing how older adults perceive to participate in a BMPT and their perceived gains. The benefits of the intervention were identified by the participants in various dimensions (physical, psychological, social, and functional), which is the case in the present RCT as well.

Another interesting point is that BMPT is an intervention easily applicable at home, which is a key advantage for older and dependent people who may not be able to benefit from certain approaches due to their disabilities or limitations of movement. According to this study, even frailer older adults can participate and get beneficial effets from BMPT and the authors therefore assume that the results found here may be generalised to a large number of community older adults suffering from chronic musculoskeletal pain.

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