Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England.
School of Healthcare, University of Leeds, Leeds, England.
J Geriatr Phys Ther. 2023;46(1):3-14. doi: 10.1519/JPT.0000000000000334. Epub 2021 Dec 13.
Chronic, noninflammatory musculoskeletal pain is common in the aged population and management can be challenging for older people due to multimorbidity, social isolation, and physical frailty. The aim of this scoping review is to summarize and discuss the evidence related to home-based health care interventions for older adults, with chronic, musculoskeletal pain.
A review of the literature using 8 electronic databases (Embase, MEDLINE, CINAHL, PubMed, Cochrane Library, Physiotherapy Evidence Database [PEDro], Scopus, and Web of Science) was performed, following the PRISMA-ScR guidelines. English language published studies that assessed home-based health care intervention/s, in men and women 75 years and older, with chronic, noninflammatory musculoskeletal pain where included. Two authors independently reviewed the articles and extracted data into a preformulated chart.
The database search identified 4722 studies of which 7 studies met the inclusion criteria. Six of the 7 studies were randomized controlled trials and 5 studies focused on a single-site pain. The type of home-based interventions in the included studies was physical therapy (n = 2), psychotherapy (n = 3), and multimodal therapy (combination of multiple therapies) (n = 2). Participation completion rate was more than 74% in 6 out of 7 studies. Most studies used pain and/or physical function as their primary outcome (n = 6). Music therapy showed a statistically significant reduction in visual analog scale score for pain, and there was a trend toward improvement of pain and function in the physical therapy studies. No significant differences in outcomes between intervention and control groups were observed in the multimodal studies.
This review highlights the scarcity of evidence related to home-based health interventions in older people 75 years and older, living with chronic, noninflammatory musculoskeletal pain. The findings were that physical, psychotherapeutic, and multimodal interventions are usually well tolerated and can be delivered as a safe self-management option. There remains a substantial need for more high-quality research with wider range of home-based interventions and comprehensive assessment of outcomes for this age group.
慢性、非炎症性肌肉骨骼疼痛在老年人群中很常见，由于多病共存、社会孤立和身体虚弱，老年人的管理可能具有挑战性。本综述的目的是总结和讨论与 75 岁及以上患有慢性肌肉骨骼疼痛的老年人的家庭保健干预措施相关的证据。
根据 PRISMA-ScR 指南，对 8 个电子数据库（Embase、MEDLINE、CINAHL、PubMed、Cochrane 图书馆、物理治疗证据数据库[PEDro]、Scopus 和 Web of Science）进行文献综述。纳入了评估家庭保健干预措施的研究，研究对象为 75 岁及以上的男性和女性，患有慢性、非炎症性肌肉骨骼疼痛。两名作者独立审查文章并将数据提取到预先制定的图表中。
数据库搜索确定了 4722 项研究，其中 7 项研究符合纳入标准。7 项研究中有 6 项为随机对照试验，5 项研究侧重于单一部位疼痛。纳入研究中家庭干预措施的类型为物理治疗（n=2）、心理治疗（n=3）和多模式治疗（多种疗法的组合）（n=2）。6 项研究中有 74%以上的参与者完成了研究。大多数研究将疼痛和/或身体功能作为其主要结局（n=6）。音乐疗法显示疼痛视觉模拟量表评分有统计学意义的降低，物理治疗研究中疼痛和功能有改善趋势。多模式研究中未观察到干预组和对照组之间的结局有显著差异。
本综述强调了 75 岁及以上患有慢性、非炎症性肌肉骨骼疼痛的老年人家庭保健干预措施相关证据的稀缺性。研究结果表明，物理、心理治疗和多模式干预通常耐受性良好，可作为安全的自我管理选择。对于这个年龄段的人，仍然需要更多高质量的研究，涵盖更广泛的家庭干预措施，并全面评估结果。
