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The relationship between fibromyalgia symptoms and physical function in middle-aged and older...
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The relationship between fibromyalgia symptoms and physical function in middle-aged and older adults
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Title
The
relationship
between
fibromyalgia
symptoms
and
physical
function
in
middle-aged
and
older
adults
Creator.PersonalName
Shillam
,
Casey
Raquel
Thesis.Degree
Ph.D.
Thesis.Major
Nursing
Thesis.DateDegreeAwarded
May
2008
Institution
Oregon Health & Science University
School
School of Nursing
Thesis.Chair
Jones, Kim Dupree
Thesis.Committee
Houck, Gail M.
Miller, Lois Lachmann
Winters-Stone, Kerri M.
Theis, Saundra L.
Subject.MeSH
Fibromyalgia
Exercise
Pain
Aged
Call Number
WY4 S556 2008
Description.Abstract
Background
:
Fibromyalgia
(FM)
, a
debilitating
multi-symptom
disorder
,
affects
nearly
10
million
Americans
, with an
annual
direct
cost
of
over
$20
billion
per
year
. As
our
population
continues
to
age
,
it
is
expected
that those
65
years
of
age
and
older
will
grow
to
70
million
people
by
2050
.
Considering
approximately
9%
of
older
adults
have
FM
, this
syndrome
poses
a
serious
health
concern
.
Mechanisms
underlying
FM
are
rapidly
emerging
,
yet
a
single
,
unifying
physiologic
framework
continues
to
elude
researchers
.
Therefore
treatment
relies
largely
on
managing
symptoms
and
promoting
physical
function
.
Poor
physical
function
in
older
adults
with
FM
poses
serious
limiting
effects
, and
is
correlated
with
greater
risk
for
disability
and
increased
financial
burden
that
ultimately
places
older
adults
at
risk
for
loss
of
independence
.
Comprehensive
symptom
management
interventions
are
proposed
to be the
most
effective
approach
to
preventing
or
minimizing
poor
physical
function
for those with
FM
.
However
, there
is
limited
study
of the
relationship
between
the
multiple
symptoms
of
FM
and
physical
function
in
FM
,
especially
specific
to
older
adults
. This
gap
may
impede
the
development
of
multi-modal
interventions
that
include
appropriate
symptom
management
,
aimed
to
prevent
poor
physical
function
.
Objectives
: The
purpose
of this
study
was to
describe
symptoms
in
adults
with
FM
,
determine
the
relationship
between
symptoms
and
physical
function
, and
assess
the
moderating
effect
of
comorbidity
and
age
on this
relationship
.
Design
: This
study
was a
cross-sectional
descriptive
correlational
study
. The
specific
aims
of the
study
were: to
describe
a
comprehensive
set
of
symptoms
in
terms
of the
frequency
,
severity
, and
distress
; to
examine
which
symptoms
best
predict
perceived
physical
function
; and to
examine
the
relationship
between
co-morbidity
,
age
,
symptoms
, and
perceived
physical
function
.
Methods
:
Adults
over
the
age
of
50
were
randomly
identified
from the
Oregon
Health
&
Science
University
FM
patient
database
.
Questionnaires
were
mailed
including
an
investigator-developed
29-item
Likert
scale
for
FM
specific
symptoms
.
Individual
symptom
domains
were
elicited
:
frequency
(1-4)
,
severity
(1-4)
, and
distress
(0-4)
, with
higher
numbers
indicating
greater
symptom
burden
, and a
composite
symptom
score
(2-12)
was
calculated
using
all
3
symptom
domains
.
Additionally
,
responders
completed
the
Late-Life
Function
&
Disability
Instrument
:
Function
Component
(LLFDI)
, a
wellvalidated
instrument
in
which
0-100
scaled
scores
indicate
physical
function
categories
ranging
from
no
functional
limitation
(>76)
to
severe
functional
limitation
(<42)
, and the
Charlson
Comorbidity
Index
, a
weighted
index
with
scores
ranging
between
0 to
41
.
Analysis
:
Descriptive
statistics
were
used
to
characterize
demographic
and
clinical
variables
.
Frequencies
and
plots
were
used
to
describe
the
frequency
,
severity
, and
distress
of
each
symptom
experienced
within
the
sample
.
Hierarchical
regression
modeling
was
used
to
examine
influence
of
each
symptom
on
physical
function
while
controlling
for
pain
.
Correlation
between
each
symptom
and
perceived
physical
function
were
evaluated
for
entering
symptoms
in the
regression
analysis
. The
final
regression
included
all
chosen
symptoms
entered
simultaneously
to
determine
the
effects
of
each
symptom
on
perceived
physical
function
controlling
for
all
other
symptoms
. The
moderating
effect
of
age
and
co-morbidity
on the
relationship
between
symptoms
and
physical
function
was
evaluated
in
additional
regression
analyses
.
Results
: The
sample
reported
experiencing
an
average
of
20
symptoms
in the
previous
seven
days
. The
rank-order
for the
dimensions
of
frequency
,
severity
, and
distress
differed
for
each
symptom
. The
symptoms
most
reported
by the
sample
were
pain
,
stiffness
,
fatigue
,
non-refreshing
sleep
,
forgetfulness
,
difficulty
staying
asleep
, and
muscle
spasms
.
Symptom
composite
correlations
of the
29
symptoms
with
perceived
physical
function
revealed
significant
findings
of
weak
to
moderate
correlations
for
fifteen
symptoms
. The
regression
model
determined
that
pain
,
anxiety
,
fatigue
,
stiffness
, and
dizziness
accounted
for
37%
of the
variance
in
perceived
physical
function
.
Although
a
significant
difference
in the
number
of
symptoms
was
present
between
the
middle-aged
and
older-aged
groups
,
age
was not
correlated
with
perceived
physical
function
, and
therefore
did
not have a
moderating
effect
on the
relationship
between
symptoms
and
perceived
physical
function
.
Comorbidity
did
have a
significant
correlation
with
perceived
physical
function
, but
further
analysis
revealed
no
moderating
effect
for
comorbidity
.
Conclusions
: This
study
yielded
five
novel
findings
:
1)
the
total
sample
reported
a
very
high
number
of
symptoms
, with the
middle-aged
group
reporting
significantly
more
symptoms
than the
older-aged
group
;
2)
the
distress
dimension
yielded
a
markedly
different
rank-order
than the
frequency
and
severity
dimensions
: the
most
distressing
symptom
was
fear
of
symptoms
worsening
while
the
most
frequent
symptoms
were
pain
,
fatigue
,
sleep-related
symptoms
, and
stiffness
, and the
most
severe
symptoms
were also
sleep-related
symptoms
and
fatigue
;
3)
five
symptoms
were
identified
that
account
for
37%
of the
variance
in
physical
function
:
pain
,
fatigue
,
anxiety
,
stiffness
, and
dizziness
;
4)
no
difference
existed
between
the
two
age
groups
on
perceived
physical
function
, and
5)
while
age
was not
correlated
with
physical
function
,
comorbidity
significantly
correlated
with
physical
function
and
accounts
for
6.8%
of the
variance
in
perceived
physical
function
;
neither
age
nor
comorbidity
have a
moderating
effect
on the
relationship
between
symptoms
and
perceived
physical
function
.
Further
research
is
needed
to
replicate
the
study
in a
larger
sample
consisting
exclusively
of
older
adults
, and to
confirm
the
self-report
findings
of
perceived
physical
function
with
objective
measures
of
physical
function
.
Language
eng
Type
Text
Format.Use
Needs Adobe Acrobat to view
Format.FileSize
1115504 Bytes
OCLC number
234103550
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