Self-management strategies to reduce pain and improve function among older adults in community settings: a review of the evidence.
BACKGROUND
Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined.


OBJECTIVE
To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults.


METHODS
We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present.


RESULTS
Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above.


CONCLUSIONS
Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.
Reid
M Carrington
MC
Department of Medicine, Weill Cornell Medical College, New York, New York, USA. mcr2004@med.cornell.edu
Papaleontiou
Maria
M
Ong
Anthony
A
Breckman
Risa
R
Wethington
Elaine
E
Pillemer
Karl
K
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016239:MEDLINE; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000534:rehabilitation; D010146:Pain / Q000453:epidemiology* / Q000534:rehabilitation*; D020127:Recovery of Function; D012648:Self Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome