Ability in everyday activities and morale among older women with chronic musculoskeletal pain living alone : a behavioural medicine approach in physiotherapy

Abstract

The overall purpose of this thesis was to utilise a behavioural medicine approach in physiotherapy to study how older women with chronic musculoskeletal pain, who live alone and are dependent on formal care, perceive their everyday lives and to explore how their ability to perform everyday activities and morale could be promoted.

Method: This thesis used a descriptive, correlative design (Study I), a randomised two-group design (Study III) and a qualitative inductive explorative design (Study II and IV). Participants in Studies I-III: Older women (≥65 years) with chronic musculoskeletal pain, who live alone, are able to walk with or without walking aids indoors and are dependent on formal care to manage their everyday lives. Study IV: Home help service staff who were involved in study III.

Results: The results showed that many different factors appeared to have impact on the women’s health, everyday activities and morale. The target group of older women seemed to report the same pain-related problems, the same degree of pain-related disability and the same beliefs as those found in previous research on older individuals with chronic pain conditions. Despite their chronic musculoskeletal pain and other health complaints as well as their dependencies on others to manage their everyday lives, the results show how important it was for the women to live at home for as long as possible. A key factor in promoting the ability to perform everyday activities among the women was having a daily rhythm in a supportive environment. Another key factor in this context was the home help service staff, who had a strong will and desire to promote their care recipients’ independence and quality of life. Nonetheless, the resource that the staff represent could most likely be utilised in a better way. The behavioural medicine in physiotherapy intervention showed that more support from physiotherapists and home help services staff is needed to enhance the effect of this type of intervention among the target group. Nevertheless, the results imply that this type of intervention may improve levels of physical activity, self- efficacy in relation to exercise and management of everyday life, but further research is needed in larger samples.

Conclusions: This thesis demonstrates that there are many different factors that seem to affect the women’s health, ability in everyday activities and morale. The women describe how their ability in everyday activities can be promoted by performing their everyday activities in a daily rhythm, and home help service staff are a key resource in this context. Moreover, physical activity, self-efficacy in relation to exercise and management of everyday life can be improved by a behavioural medicine-based physiotherapy intervention in the target group. To promote the women’s abilities in everyday activities, to improve their morale and, in the end, to enable the target group of women to be “ageing in place” in the best possible way, society and health care professionals may have to pay them special attention.