Loco-motor activities limitations in older people

Lead Research Organisation: MRC Health Services Resrch Collaboration

Abstract

Pain (in muscles and joints) and disability (difficulty walking) are common in older people. This research programme is looking for effective ways to prevent and treat pain and disability that occurs in older age:||1. We are finding out why people develop pain and disability in older age, and why some people experience sudden change in their pain and disability levels. We know that some diseases, such as arthritis and stroke, contribute to pain and disability, but social circumstances, psychological factors and other influences are also important. To look into this more deeply we are examining data from surveys that include large numbers of people followed up over time. All of our surveys ask people to answer questions about themselves. Some of them also ask people to perform short tasks such as rising from chairs or walking across a room.||2. If we are going to design and test ways of improving pain and walking ability we first need to have appropriate ways of measuring any improvement. We are developing new ways of measuring pain and walking ability. To do so we are conducting theoretical work and practical work. We are developing a new framework to describe disability and we are looking at new ways to measure pain. We are also examining the data from our large-scale surveys to look at their accuracy, and we are asking small numbers of people to tell us what they think of our survey questions. ||3. Approaches to the prevention or treatment of pain and disability will need to include several different elements. By bringing together research that already exists, we are finding out which existing approaches are best at preventing people from developing more disability. Through our large-scale surveys we are finding out which groups of people might need help. By conducting interviews with smaller numbers of people we are finding out about peoples preferred types of treatment.|||

Technical Summary

Chronic pain (particularly in muscles and joints) and disability (especially difficulty walking) are common in older people. This research programme is looking for novel ways to prevent and treat pain and disability in older age. 1. Identifying the determinants of pain and disability Our first aim is to identify the determinants of pain and disability, and of changes in status such as sudden decline in older people. Some diseases, such as arthritis and strokes, make a contribution to pain and disability, but social circumstances, psychological factors and many other influences are also important. We are examining data from several cohort studies that assess large numbers of people over time, using outcomes such as self-reported limitations as well as direct measures of function, such as walking speed. We are also examining determinants of recovery after a major intervention - joint replacement surgery - through a study that is collecting pre- and post-operative data. 2. Improving measurement To be able to evaluate whether an intervention is successful we need to measure improvements in pain and activity accurately and appropriately. Using the WHOs ICF framework (impairments, activity limitations and participation restrictions) and behavioural approaches we are developing new measures. This work informs the development of a new model of disability which integrates psychological models of behaviour into the ICF. We are also developing novel ways of assessing pain and its impact using both quantitative and qualitative techniques, including quantitative sensory testing. The appropriateness of new and existing measures for older people with pain is being gauged using qualitative methods. 3. Informing the design of appropriate interventions and identifying unmet need To inform the design of novel interventions for disability in older age we are examining existing interventions and exploring current use of health services. Interventions to prevent or halt disability are often complex, reflecting multiple determinants of disability. Through literature reviews we are synthesising findings from existing complex interventions, which will help us to identify what factors make an intervention successful. We are also exploring new ways of testing how and why interventions work, including individual (n-of-1) trials and a modified Zelen design. To understand why some people get treated and others do not we are examining decision-making in clinical practice, using joint replacement surgery as an example. To ascertain what interventions are appropriate we are eliciting patients perspectives on living with pain and disability, as well as assessing the acceptability of existing services and interventions, including opioids for pain management. Concurrently, we are identifying groups of people with unmet need who might benefit from intervention by exploring health service utilization data in our large cohort studies. We are also exploring ways of involving users in planning research.

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