Svensson Nanna Herning, Thorlund Jonas Bloch, Olsen Pia Øllgaard, Søndergaard Jens, Wehberg Sonja, Andersen Helene Støttrup, Caserotti Paolo, Thilsing Trine
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark.
BMC Geriatr. 2024 Jul 31;24(1):641. doi: 10.1186/s12877-024-05235-3.
Exercise referral schemes and self-management strategies have shown positive effects on patient-reported and objectively measured outcomes, such as increased functional capacity and physical activity level. However, the impact of these interventions on analgesic use remains uncertain. We hypothesised that exercise referral schemes, either utilised alone or in combination with self-management strategies, is more effective in reducing use of prescription analgesics compared with a self-management strategy only.
We utilised data from two completed randomised controlled trials, namely The Welfare Innovation in Primary Prevention (n = 121) and The SITLESS project (n = 338), and information from the national Danish health registries, including the National Prescription Registry. The two trials have investigated the effectiveness of interventions, which include exercise referral schemes and self-management strategies, on various aspects such as physical function and levels of physical activity among community-dwelling older adults. The studies were conducted in the period 2015-2020 and comprised older adults aged 65+ years, living in three different Danish municipalities. Participants were recruited through nationally regulated preventive home-visits. To estimate changes in use of prescription analgesics over time, a linear fixed effects regression model was applied. The outcome measure was the mean total yearly defined daily dose of analgesics.
All intervention groups showed a within-group increase in overall analgesic use, though not statistically significantly different from zero. There were no differences in estimated changes in mean total yearly defined daily dose when comparing the intervention groups to the group receiving the least extensive intervention (self-management strategies/control). The findings indicated that exercise referral schemes and self-management strategies, whether administrated individually or in combination, did not result in a reduction in analgesic use over time.
运动转诊计划和自我管理策略已对患者报告的以及客观测量的结果产生了积极影响，如功能能力增强和身体活动水平提高。然而，这些干预措施对镇痛药使用的影响仍不确定。我们假设，与仅采用自我管理策略相比，单独使用或与自我管理策略联合使用的运动转诊计划在减少处方镇痛药使用方面更有效。
我们利用了两项已完成的随机对照试验的数据，即初级预防福利创新试验（n = 121）和无久坐项目（n = 338），以及来自丹麦国家健康登记处的信息，包括国家处方登记处。这两项试验研究了包括运动转诊计划和自我管理策略在内的干预措施对社区居住的老年人身体功能和身体活动水平等各个方面的有效性。研究于2015年至2020年期间进行，涉及居住在丹麦三个不同直辖市的65岁及以上老年人。参与者通过国家规定的预防性家访招募。为了估计处方镇痛药使用随时间的变化，应用了线性固定效应回归模型。结果指标是镇痛药的年平均总限定日剂量。
所有干预组的总体镇痛药使用量在组内均有所增加，尽管与零无统计学显著差异。将干预组与接受干预最少的组（自我管理策略/对照组）进行比较时，年平均总限定日剂量的估计变化没有差异。研究结果表明，运动转诊计划和自我管理策略，无论是单独实施还是联合实施，随着时间的推移都不会导致镇痛药使用量的减少。
