This study sought to better understand the relationship between religion/spirituality and physical health and mental health in 122 patients with chronic musculoskeletal pain. The current study conceptualized religion/spirituality as a multidimensional factor, and measured it with a new measure of religion/spirituality for research on health outcomes (Brief Multidimensional Measure of Religion/Spirituality). Pain patients' religious and spiritual beliefs appear different than the general population (e.g. pain patients feel less desire to reduce pain in the world and feel more abandoned by God). Hierarchical multiple regression analyses revealed significant associations between components of religion/spirituality and physical and mental health. Private religious practice (e.g. prayer, meditation, consumption of religious media) was inversely related to physical health outcomes, indicating that those who were experiencing worse physical health were more likely to engage in private religious activities, perhaps as a way to cope with their poor health. Forgiveness, negative religious coping, daily spiritual experiences, religious support, and self-rankings of religious/spiritual intensity significantly predicted mental health status. Religion/spirituality was unrelated to pain intensity and life interference due to pain. This study establishes relationships between religion/spirituality and health in a chronic pain population, and emphasizes that religion/spirituality may have both costs and benefits for the health of those with chronic pain.
Objective Fibromyalgia is a condition characterized by chronic widespread muscle pain and fatigue. The primary objective of this study was to determine if pain, perceived cognitive fatigue, and perceived physical fatigue were enhanced in participants with fibromyalgia compared to healthy controls during a cognitive fatigue task, a physical fatigue task and a dual fatigue task. Methods Twenty four people with fibromyalgia and 33 healthy controls completed pain, fatigue and function measures. A cognitive fatigue task (Controlled Oral Word Association Test) and physical fatigue task (Valpar peg test) were done individually and combined for a dual fatigue task. Resting pain, perceived cognitive fatigue and perceived physical fatigue were assessed during each task using visual analogue scales. Function was assessed with shoulder range of motion and grip. Results People with fibromyalgia had significantly higher increases in pain, cognitive fatigue and physical fatigue when compared to healthy controls after completion of a cognitive fatigue task, a physical fatigue task, or a dual fatigue task (p<0.01). People with fibromyalgia performed equivalently on measures of physical performance and cognitive performance on the physical and cognitive fatigue tasks, respectively. Conclusions These data show that people with fibromyalgia show larger increases in pain, perceived cognitive fatigue and perceived physical fatigue to both cognitive and physical fatigue tasks compared to healthy controls. The increases in pain and fatigue during cognitive and physical fatigue tasks could influence subject participation in daily activities and rehabilitation.
Background Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. Objective This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. Methods Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. Results A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). Conclusions In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. Trial Registration ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546
BACKGROUND Acceptance and Commitment Therapy (ACT) is a pragmatic approach to help individuals decrease avoidable suffering and pain. OBJECTIVE To evaluate the effects of Acceptance and Commitment Therapy (ACT) delivered via an automated mobile messaging robot on postoperative opioid utilization and patient reported outcomes (PROs) in orthopaedic trauma patients who underwent operative intervention for their injuries. METHODS Adult patients presenting to a Level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who utilized mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first two weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after operative intervention, follow-up was obtained in the form of an opioid medication pill count and postoperative administration of PROs. Mean number of opioid tablets utilized by patients were calculated and compared between groups. Mean PRO scores were also compared between groups. RESULTS Eighty-two subjects were enrolled in the study. Seventy-six (38 ACT, 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group utilized an average of 26.1±21.4 opioid tablets while the control group utilized 41.1±22.0 tablets, resulting in 36.5% less tablets utilized by subjects receiving the mobile phone-based ACT intervention (P= .004). Intervention group subjects reported a lower postoperative PROMIS Pain Intensity score of 45.9±7.2 compared to the control group’s 49.7±8.8 (P= .04). CONCLUSIONS In this study the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid utilization in selected orthopaedic trauma patients. Subjects receiving the ACT-based intervention also reported lower pain intensity after two weeks, though this may not represent a clinically important difference. CLINICALTRIAL ClinicalTrials.gov registry number: NCT03991546.
Background We conducted a randomized controlled trial to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) delivered via a mobile phone messaging robot to patients who had their total hip (THA) or total knee arthroplasty (TKA) procedures postponed due to the Covid-19 pandemic. Methods Ninety patients scheduled for THA or TKA who experienced surgical delay due to the Covid-19 pandemic were randomized to the ACT group, receiving 14 days of twice daily automated mobile phone messages, or the control group, who received no messages. Minimally clinical important differences (MCIDs) in pre and post intervention patient reported outcome measures (PROMs) were utilized to evaluate the intervention. Results Thirty-eight percent of ACT group participants improved and achieved MCID on the Patient-Reported Outcome Measure Information System (PROMIS) Physical Health compared to 17.5% in the control group (p=0.038; Number needed to treat [NNT]:5). For the joint specific Hip Disability and Osteoarthritis Outcome Score (HOOS-Jr) and Knee Disability and Osteoarthritis Outcome Score (KOOS-Jr), 24% of ACT group achieved MCID compared to 2.5% in the control group (p=0.004; NNT:5). An improvement in the KOOS-Jr was found in 29% of the ACT group compared to 4.2% in the control group (p=0.028; NNT:5). Fourteen percent of the ACT group participants experienced a clinical important decline in the KOOS-Jr compared to 41.7% in the control group (p=0.027; NNT: 4). Conclusions Psychotherapy delivered via a text messaging robot improved physical function and prevented decline of PROMs in patients who experienced an unexpected surgical delay during the Covid-19 pandemic. Level of Evidence 1
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