livsstilsændringer ved kroniske smerterwell as the additional effect of specific treatment...
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Livsstilsændringer
ved kroniske
smerter
Svetlana Solgaard Nielsen,
Ergoterapeut, kandidat i ergoterapi
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Hvad er ergoterapiens potentiale på
smerteområdet? Hvilken relevans har
ergoterapi for patienterne?
1. Evidens om ergoterapi til kroniske non-maligne smerter
2. Livstilsorienteret tilgang i behandlingen af kronisk smerteproblematik
3. Planlægning af en ergoterapeutisk livstilsorienteret intervention
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Definitioner
International Association for the Study of Pain (IASP, http://www.iasp-
pain.org):
“Pain is an unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage”
Andre betegnelser:
”Kropslig udtryk for sorg” (Spinoza)
”Kompleks lidelse uden behandlingskur” (Sidall & Cousins, 2004)
…
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Behandlingen af kroniske smerter
Det danske forbrug af opioider er i dag det højeste i Norden
(Sundhedsstyrelsen, 2016; The International Narcotics Control Board, 2017)
Det biopsykosociale syn på kroniske smerter
Multidisciplinær behandling
Effektiv ved kroniske smerter af forskellig ætiologi og komplekse tilstande
(Scascighini et al., 2008; Sundhedsstyrelsen. NKR til generaliserede smerter i
bevægeapparatet,https://sundhedsstyrelsen.dk/~/media/82268C6BAF19461399C4FC8D1647D
CC0.ashx)
Multimodal behandling
Kognitiv adfærdsterapi (CBT) betragtes som det mest effektive koncept for brug i
multi- og interdisciplinære sammenhænge
(Gatchel & Okifuji, 2006; Turk et al., 2008)
Ikke-farmakologiske behandlingsmuligheder
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Kronisk smerte påvirker de daglige aktiviteter
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(Breivik et al., 2006)
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Eksempler på påvirkning fra kroniske smerter
På aktivitetsudøvelsen (Aegler & Satink, 2009; Larson, 2004):
”Stop and go”, afbrudt aktivitetsudøvelse – ringe tilfredshed
Ventetid ved pauser, krav til selektiv og delt opmærksomhed
Aktivitetsafslutning
På aktivitetsdeltagelse (Mathews 2013; Præfontaine & Rochette, 2014):
Stillesiddende livsstil
Isolation
På aktivitetsidentitet (Henare et al., 2003; Robinson et.al., 2011a; van Huet,
Innes & Stancliff, 2013):
Tab af vaner og rutiner
Tab af roller
Lavere selvværd og selv-kompetence
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Hvad er ergoterapiens potentiale på
smerteområdet?
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Ergoterapiens fokusområder i
behandlingen af kroniske smerter
Aktivitetsbaseret og aktivitetsfokuseret tilgang
Klient-centreret målarbejde
Graduering af aktivitetskrav
Energibesparende teknikker
Pacing
Afspænding og stresshåndtering
Vejledning om arbejdsstillinger og arbejdsbevægelser
Ergonomisk vurdering af omgivelserne i hjemmet og på arbejdet
Råd og vejledning om hjælpemidler
(Marcus, 2000; Robinson et al., 2011a; van Huet et al., 2013).
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Brug for viden om effekten af ergoterapi
på smerteområdet
Risiko for yderligere stigmatisering af mennesker med kronisk
smerteproblematik (Robinson, 2011a; Robinson, 2011b)
At arbejde evidensbaseret
At være med uden at miste ekspertisen
At kende evidens der allerede findes, fx rehabilitering på arbejdspladsen som
eksempel (Snodgrass, 2011; von der Heyde, 2011)
At skabe evidens som ikke findes endnu: at undgå ”silo-tænkning” og tænke
holistisk (Prefontaine & Rochette, 2013)
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Livsstilsorienteret ergoterapi ved
kroniske smerter
Kroniske smertepatienter oplever behov for ergoterapi især i forhold til sin
livsstil og aktivitetsdeltagelse (Müllersdorf, 2002)
Fælles mekanismer i udviklingen af kroniske tilstande
Hjernens plasticitet (Marcus et al., 2000):
Sensoriske, perceptuelle og neurofysiologiske forandringer
Spredning af det smertende område
Reversibilitet
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Livstilsfaktorer med betydning for
kronisk smertetilstand
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(van Hecke, Torrance & Smith, 2013)
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Ergoterapeutiske interventioner med fokus på
modificerbare livstilsfaktorer blandt voksne
med kroniske non-maligne smerter
Review af publikationer som beskriver og evaluerer ergoterapeutiske
interventioner med fokus på livsstil blandt voksne med kroniske non-maligne
smerter
Formål: at identificere evidensen om indflydelsen af ergoterapi på
modificerbare livsstilsfaktorer, for at informere udviklingen af en
ergoterapeutisk livsstilsorienteret intervention
Litteratursøgning i fem videnskabelige databaser, referencesøgning og manuel
søgning af studier som beskriver den ergoterapeutiske indsats til en bred
målgruppe, hvis hverdag er påvirket i væsentlig grad af kroniske smerter
Fem systematiske reviews og en kritisk vurdering identificeret
Diagnoser: gigt, fibromyalgia og uspecificerede kroniske smerter
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Fund - kort opsummeret
Overordnet var der mangel på studier om livstilsorienteret ergoterapi
Dokumentation for ergoterapeuternes arbejde med modificerbare
livstilsfaktorer som overvægt, rygning, alkoholindtag, søvn og ernæring
mangler især
Ofte var konklusioner baseret på outcomes der kunne have været af potentiel
relevans for ergoterapi, men ingen krav om, at ergoterapeuter var involveret
i interventionsprocessen
Få eller ingen interventioner i de inkluderede reviews var aktivitetsbaserede
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Lifestyle Redesign®
”… holistic approach that gives most attention to occupation, the activities
with which people “occupy” themselves and are the building blocks of
lifestyle (e.g. productive activity, social activity, and physical activity)”
(http://chan.usc.edu/academics/continuing-education/life-management-series)
Life Management series
Chronic Pain and Headache Management
Weight Management, Diabetes and Related Co-morbid Conditions
Biopsychosocial Dimensions of Creating Life Balance
Autism Spectrum Disorders
Multiple Sclerosis
Stress
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Livstilsorienteret indsats forbedrer
livskvalitet, selvtillid og funktion
Lifestyle Redesign® for Chronic Pain Management: A Retrospective Clinical
Efficacy Study (Uyeshiro & Collins, 2017)
Kvantitative signifikante effekter af den livstilsorienterede ergoterapeutiske
tilgang anvendt til kronisk smerteproblematik
Forskerne bag studiet vil inspirere ergoterapeuter fra alle praksisområder som
kommer i berøring med kronisk smerte, evt. som sekundær problematik
Studiets resultater fortæller stakeholdere og beslutningstagere om relevansen af
aktivitetsfokuseret tilgang til personer med kroniske smerter, også hvor smerte
ikke nødvendigvis er en primær diagnose
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Livstilsorienteret ergoterapi anvendt til
danske smertepatienter
Lifestyle-oriented occupational therapy intervention for patients with chronic
non-malignant pain – A randomized controlled trial
(Ergoterapeutisk livsstilsintervention til patienter med kroniske non-maligne
smerter - et randomiseret kontrolleret forsøg)
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Projektpræsentation
Formål: at undersøge den ekstra effekt af en ergoterapeutisk
livsstilsbehandling integreret i den nuværende behandling for kroniske
smertepatienter
Projektet udføres i 2019-2021 i et samarbejde mellem Tværfagligt
smertecenter, Næstved sygehus, og Afdelingen for Fysioterapi og Ergoterapi
(Næstved, Slagelse og Ringsted Sygehuse)
I det kliniske forsøg vil i alt 228 ambulante smertepatienter bliver fordelt ved
lodtrækning i en behandlings- og en kontrolgruppe
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Inklusions- og eksklusionskriterier
Inklusionskriterier: alder 18<65 år, kronisk smerte ≥ 3 mdr. ved opstart
Eksklusionskriterier: Akutte/ subakutte smerter; cancer-relaterede smerter;
ustabil indtag af smertestillende medicin (1 md. før opstart); opioid indtag
>30 mg/dg.; hovedpine/ migræne; aktuel depression, misbrug af alkohol eller
stoffer; alvorlige psychiatriske diagnose (fx skizofreni, skizoaffektive
forstyrrelser eller psykoser); beskedne skriftlige og mundtlige kundskaber i
dansk der forhindrer gennemførelse af de planlagte undersøgelser, samt
deltagelse I andre programmer for personer med kroniske smerter
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Endpoints
Patienterne bliver undersøgt ved opstart, samt 12, 24 og 52 uger efter opstart
Efter 1 år forventes patienter, der modtager den ergoterapeutiske
livsstilsbehandling i tillæg til nuværende behandling, at opleve signifikante
større forbedringer sammenlignet med patienter, der alene modtager den
nuværende behandling.
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Abstract Introduction: About 20-30% of the Danish population suffer from chronic non-malignant
pain. Current evidence suggests that a bio-psychosocial treatment delivered by multidisciplinary teams is the most effective treatment of chronic non-malignant pain. However, evidence is still missing on the optimal multimodal treatment combination as well as the additional effect of specific treatment modalities.
Methods: This two-arm RCT conducted at the Multidisciplinary Pain Center, Zealand, Denmark will randomize 228 patients with chronic non-malignant pain (1:1 allocation ratio) to either a lifestyle-oriented intervention added to the current multimodal treatment, or the current multimodal treatment only. Quality of life (EQ-5D-5L) will be the primary outcome. Occupational performance, balance and participation in meaningful everyday activities, pain self-efficacy and lifestyle-related parameters will be evaluated as secondary outcomes.
Analysis: The differences in change in the primary and secondary outcomes between the groups from baseline to 12, 24 and 52 weeks will be analysed by repeated measures mixed model.
Ethics and dissemination: The study will be ethically approved at The Regional Committee on Health Research Ethics in Region Zealand (Denmark) and The Danish Data Protection Agency. The results will be reported in peer-reviewed journals and presented at conferences.
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Flow chart
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Primary outcome
Differences in self-reported health-related QoL (scored by EQ-5D-5L Index)
will be the primary outcome for the study. The patients will evaluate their
subjective health state in domains Mobility, Self-care, Usual activities, Pain/
Discomfort and Anxiety/ Depression on a 5-point Likert scale from 1= having
no problems, having slight problems, having moderate problems, having
severe problems and 5= being unable to do/having extreme problems. The
outcome measure will allow a later cost-effectiveness analysis.
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Secondary outcome
A. Self-reported Occupational Performance and satisfaction (COPM), observed
Motor and Process Skills (AMPS), self-reported Occupational balance (OBQ)
and Pain Self-efficacy (PSEQ) to investigate meaningful everyday activities,
participation and coping capacity;
B. Physical wake-time activity (actigraphs); BMI (weight and height scale),
waist circumference (measuring tape), blood pressure (sphygmomanometer)
(35), and blood sugar (glucometer) will be measured by verified methods, to
evaluate lifestyle-associated conditions and risks.
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Intervention group
Twelve sessions: combination of group sessions of 2 hours and individual sessions of 1 hour, both led by occupational therapists
The groups will be composed of 8-10 participants
Each group session will include relaxation and simple physical exercises suitable for practicing at home
The individual sessions will be planned in cooperation with every individual patient according to the actual needs, and executed either at-home, or home-close environments
Cooperation with the multidisciplinary team at the MPC and inter-sectoral units will be provided according to the patient’s needs and on interdisciplinary basis
Subsequently, the intervention group will continue with the regular treatment
The control group will receive the regular multimodal treatment at MPC, without the OT component
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Individual sessions at home
Individual goal setting
Executing ADL routines in self-care, leisure and productivity
Applied energy and time management
Ergonomics at home
Social relations
Family and relatives involvement
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Group sessions
Introduction
Meaningful activity and its impact on health
Occupational balance and value-based activity choice
Identification of Values, Roles, Interests and Habits
ADL, I-ADL and activity levels on day- and week-basis
At each group session:
Assistive devices advise
Simple physical activity indoor or outdoor
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Group sessions topics Self-care
Movement and well-being
Eating routines and enjoying meals
Sleep routines
Energy and fatique management
Time management
Stress management
Risk behavior
Pain rescue plan
Social activities and leisure
Socialization
Pleasurable activities
Transportation and exploring the environments
Productivity
Household management
Ergonomics at home and workplace
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Multidisciplinary and cross-sectional co-
operation (optional)
Multidisciplinary Pain Centre, Naestved
Exercise program (physical therapist)
Social-worker advise
Psychologist consultation
Physician consultation
Municipal social, health and activity facilities
Social-worker advise
Stop-smoking program
Local activity centres
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Patienterne om livsstil
Smertepatienter har ikke overskud til at tænke på sundhed hver dag
Men man kan ikke sætte livet på pause pga. smerter
Livsstilsændringer skal der til for at stå stærkere mod udfordringerne
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Afrundning
Ergoterapi kan sikre et holistisk tilgang i behandlingen af kroniske non-
maligne smertepatienter
Flere studier vil styrke evidensgrundlaget
Projektet vil skabe viden om anvendelsen af den livstilsorienterede tilgang på
smerteområdet i Denmark
Tak, fordi I lyttede!
Svetlana Solgaard Nielsen, [email protected]
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Referencer1. Breivik H, et al. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal
of Pain. 2006;10:287–333.
2. Clark, F. A., Blanchard, J., Sleight, A., Cogan, A., Florindez, L., Gleason, S., . . . Vigen, C. (2015). Lifestyle
Redesign®: The intervention tested in the USC Well Elderly Studies, Second Edition. Bethesda, MD: AOTA Press.
3. Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of
comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006;7(11):779-93.
4. Gatchel RJ, et al. Interdisciplinary Chronic Pain Management: Past, Present, and Future. Am Psychol.
2014;69(2):119-30.
5. Henare D. 'It just isn't me anymore' moving forward to a new identity. New Zealand Journal of Occupational Therapy.
2003;50(1):4-10
6. Larson EA. The time of our lives: The experience of temporality in occupation. Can J Occup Ther. 2004;71:24-34.
7. Marcus DA. Treatment of nonmalignant chronic pain. Am Fam Physician. 2000;61(5):1331-8, 1345-6
8. Mathews M. Neurosurg Clin N Am. 2014;25:803–808
9. Prefontaine A, Rochette A. A literature review on chronic pain: the daily overcoming of a complex problem. British
Journal of Occupational Therapy. 2013;76(6):280-286.
10. Robinson K, Kennedy N, Harmon D. The Issue Is—Is Occupational Therapy Adequately Meeting the Needs of People
With Chronic Pain? AJOT, 2011a;65:106-113.
11. Robinson K, Kennedy N, Harmon D. Review of occupational therapy for people with chronic pain. AJOT, 2011b;58:74-
81.
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Referencer (fortsat)
12. Scascighini L, et al. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Journal of Rheumatology. 2008;47:670–678.
13. Sidall PJ, Cousins MJ. Persistent Pain as a Disease entity: Implications for Clinical Management. Anaesthethic Analgesia, 2004; 99: 510-520.
14. Snodgrass J. Effective occupational therapy interventions in the rehabilitation of individuals with work-related low back injuries and illnesses: A systematic review. AJOT. 2011;65:37–43.
15. Sundhedsstyrelsen. Kortlægning af opioidforbruget i Danmark. Sundhedsstyrelsen, 2016. (https://www.sst.dk/da/nyheder/2016/~/media/69913B827BAA4850A9A70E0CF76CB305.ashx.)
16. The_International_Narcotics_Control_Board. Narcotic Drugs - Estimated World Requirements for 2017, Statistics for 2015. INCB, New York, US, 2016. (https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2016/Narcotic_Drugs_Publication_2016.pdf.)
17. Turk DC, et.al. Psychological approaches in the treatment of chronic pain patients - when pills, scalpels, and needles are not enough. Can J Psychiatry. 2008;53(4):213-23.
18. Uyeshiro SA, Collins CER. Lifestyle Redesign® for Chronic Pain Management: A Retrospective Clinical Efficacy Study. Am J Occup Ther. 2017;71(4):7104190040p1-7104190040p7.
19. van Hecke O, Torrance N, Smith B. Chronic pain epidemiology – where do lifestyle factors fit in? British Journal of Pain. 2013;7(4):209–217.
20. Van Huet H, Innes E, Stancliff R. Occupational therapists perspectives of factors influencing chronic pain management. Australian Occupational Therapy Journal. 2013;60:56-65
21. Von der Heyde R. Occupational Therapy Interventions for Shoulder Conditions: A Systematic Review. AJOT. 2011;65:16-23.
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