The present study is a randomised controlled trial which covers 105 older adults aged 75 and over and suffering from chronic musculoskeletal pain. Participants were living at home and required assistance to complete everyday activities and were recruited on a voluntary basis after meeting inclusion and exclusion criteria. They were randomly assigned to one of the two following groups:
- Intervention group (52 participants): the intervention was based on nine visits as well as a supportive phone call from a physical therapist during the twelve-week programme. A Functional Behavioural Analysis (FBA) was completed at start to identify the goal behaviour (e.g., being able to walk outdoors without increasing low back pain, safely climbing stairs, standing without any support, etc.). Functional exercises were also provided to participants in connection with the identified goal behaviour. The intensity of exercises was tailored to each individual and increased progressively. General advice about physical activity were also provided (intervention and control group), including information about the evidence-based benefits of being physically active to fight chronic musculoskeletal pain
- Control group (53 participants): participants had standard care; i.e., recommendation about physical activity, advice to be physically active (based on phone calls during the time of intervention while the intervention group received visits from the therapist). There was no exercise nor any advice about potential exercises provided in these calls.
Measurements were taken by trained physical therapists blinded to group allocation. The primary outcomes were pain-related disability (assessed through the pain interference score of the Brief Pain Inventory or BPI which is a self-report pain assessment tool) and physical function (measured via the Short Physical Performance Battery or SPPB).
Secondary outcome measures were pain severity (assessed in the pain items of the BPI), pain catastrophising (measured by two items of the Coping Strategies Questionnaire), falls-efficacy (with the Falls-Efficacy Scale International or FES-I), the level of physical activity (measured via the Frändin-Grimby scale, health-related quality of life (assessed through the Short-Form Health Survey or SF-12, which is a shortened version of the SF-36)
Participants’ perceived results from the intervention were also assessed via standard survey, while achievement of goal behaviour and level of self-efficacy were also checked.
All the participants were assessed at baseline and post intervention (i.e. ,after twelve weeks).
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.
