ABSTRACT
Purpose: Osteoarthritis (OA) can cause pain, discomfort, stiffness and progressively limit your ability to perform everyday tasks. Currently, there is no cure for OA, hence most patients experience chronic pain. Evidence suggests a shared mechanism between chronic pain and mental disorders. Patients living with OA- related chronic pain and depression have complex needs due to high rates of persistent physical and mental health symptoms, issues around inadequate pain relief, risks with opioid use, frequent lack of access to primary care, 80% unemployment rates, and complicated family/social relationships. Thus, they require physical, cognitive, and social treatments delivered by a multidisciplinary team that integrates physical and mental health approaches. The pandemic posed a major challenge for patients with osteoarthritis. Public health measures postponed non-emergency in-person treatment programs. People suffering from osteoarthritis are typically older which makes them more vulnerable to SARS-COV-2 infection. Telemedicine is a method that enables remote or virtual appointments between patients and health care practitioner. While remote care offers a wide range of benefits it is unclear if these interventions can provide similar effects with face-to-face care. In this study, we aimed to evaluate the effectiveness of remote biopsychosocial interventions in comparison to sham, traditional, or alternative remote treatments in patients with osteoarthritic pain and mental health symptoms using a network meta-analysis approach. Method(s): Eligible studies were randomized trials of remote biopsychosocial interventions that included at least one treatment arm provided remotely/virtually and compared to an alternative (sham, non-intervention, face-to-face treatment or alternative virtual/remote intervention). Patients had OA-related chronic musculoskeletal pain and at least 60% of participants had a mental health comorbidity or the analysis was disaggregated by mental health comorbidity. The primary outcome of interest was pain intensity at 12-weeks follow-up. Secondary outcomes were depression levels, dropouts/withdrawals and any adverse or serious adverse events reported. Potential mediators extracted were patient characteristics such as mean age, sex/gender and duration of symptoms/follow-up. We extracted data from the closest timepoint to 12-weeks follow-up for all outcomes. We critically appraised the included trials with the Cochrane risk of bias tool. Effect estimates were presented as standardized mean differences (SMD) and were comparisons between remote interventions and wait-list control. For all estimates, we reported the medians with corresponding 95% credibility intervals (CrIs) from the 2.5th and 97.5th percentile of the posterior distribution. The prespecified minimal clinically important between-group difference was -0.37 SD units. We estimated the probability of the effect of remote interventions of being superior to facilitate the interpretation of estimated treatment effects. We used a Bayesian random-effects network meta-analysis model. Analysis was conducted with OpenBUGS and STATA 16.0. Result(s): Overall, 21 trials with 4,426 patients with OA were included in this network meta-analysis. We identified 11 different interventions (combination or alone) such as usual care, exercise, education, cognitive behavioural therapy (CBT) guided or unguided delivered in different remote formats (internet, tele, mobile application or face-to-face). At 12-weeks follow-up, internet-delivered exercise (SMD -0.25, 95%Crl -0.59 to -0.09), Tele-CBT (SMD -0.22, 95%Crl -0.56 to 0.12) and a combination of Tele-CBT with education plus exercise (SMD -0.25, 95%Crl -0.66 to 0.15) had more pronounced treatment effects on pain reduction compared to wait-list control and 94%, 92% and 90% probability of being superior (respectively). For depression outcomes, a combination of tele-CBT with education plus exercise, had more pronounced treatment effects (SMD -0.31 95%Crl -1.16 to 0.53) when compared to wait-list-control and 86% pr bability of being superior. Conclusion(s): Internet-delivered exercise, Tele-CBT, and a combination of Tele-CBT with education plus exercise displayed higher probability of being superior than the other interventions, and had more pronounced effects in reducing pain intensity and depression levels when compared to wait-list control. However, none of these interventions excluded the null threshold.Copyright © 2023
ABSTRACT
INTRODUCTION: Exploratory Factor Analysis (EFA) measures the underlying relationships between questionnaire items and the factors ("constructs") measured by a questionnaire. The Home and Family Work Roles Questionnaire has not been assessed using EFA; therefore, our objective was to identify the factors measured by this questionnaire. METHODS: We recruited 314 persons to complete the questionnaire and to answer several demographic questions. We determined if the data was factorable by performing Bartlett's test of sphericity and the Kaiser-Meyer-Olkin measure of sampling adequacy. We used the Factor package in Jamovi statistical software to perform EFA. We employed an Oblimin rotation and a Principal Axis extraction method. We also calculated the internal consistency of the questionnaire as a whole as well as each individual question. RESULTS: Our sample consisted of 265 (85%) women, 45 (14%) men, and 3 (1%) non-binary or other genders. The mean age of our participants was 34.65 (SD = 11.57, range = 18-65) years. EFA suggested a three-factor model. Questions 11, 13, 14, 15, and 16 measured one factor (we interpreted this as "Caregiving Roles"), questions 1, 3, 4, 8, 9, 10, 18, and 19 measured a different factor ("Traditionally Feminine Roles"), and questions 2, 5, 6, and 12 measured the "Traditionally Masculine Roles". The questionnaire and each individual question demonstrated excellent internal consistency (Cronbach's α > 0.90). CONCLUSION: The Home and Family Work Roles Questionnaire may measure three distinct factors, which we have named Caregiving, Traditionally Feminine, and Traditionally Masculine Roles. This aligns with the theory used in developing the questionnaire. Separation of the Home and Family Work Roles Questionnaire into three sub-scales with distinct scores is recommended to measure each of the recommended constructs.