There is growing acceptance for combining complementary and integrative health (CIH) therapies with standard rehabilitative care (SRC) for chronic pain management, yet little evidence on the best sequence of therapies. We investigated whether starting with CIH therapies or SRC is more effective in reducing pain impact. Participants were 280 service members with predominantly (88%) musculoskeletal chronic pain referred to an interdisciplinary pain management center who were randomized to a twice weekly program of either CIH therapies (n = 140) or SRC (n = 140) for the 3-week first stage of treatment. The composition of a second 3-week treatment stage depended upon response to the first stage. The primary outcome measure was the impact score (range 8-50) from the NIH Task Force on Research Standards for Chronic Low-Back Pain. Outcomes were measured after 3 and 6 weeks of treatment and at 3- and 6-month follow-ups. Most participants were men (76.8%) and mean age was 34.7 years (SD 8.0). At end of stage 1, pain impact decreased significantly more in the CIH group (29.8 points [SD 7.2] at baseline to 26.3 points [SD 7.9], change of -3.3 points [95% confidence interval, -4.2 to -2.5]) than in the SRC group (30.8 [SD 7.6] to 29.4 [SD 7.8], change of -0.9 points [95% confidence interval, -1.8 to -0.1]; P < 0.001). No significant between-group differences were observed after 6 weeks of treatment nor at 3- or 6-month follow-ups. Complementary and integrative health therapies may provide earlier improvement in pain impact than SRC, but this difference is not sustained.

INTRODUCTION:Arthritis, one of the most common chronic diseases among older people, greatly impairs quality of life through a variety of physical and psychological challenges. This study used network analysis to gain a deeper understanding of the relationships between the indicators of quality of life in older adults with arthritis depending on duration of disease. METHODS:This cross‐sectional study used data from 874 older adults with osteoarthritis and/or rheumatoid arthritis who answered the eighth (2019–2021) Korea National Health and Nutrition Examination Survey. We used network analyses of these data to investigate eight indicators of quality of life (pain, climbing stairs, vitality, working, depression, sleep, happiness and memory loss). Participants were divided into two groups depending on the duration of their arthritis (group A: < 10 years, group B: ≥ 10 years). RESULTS:For group A, depression, working and climbing stairs were the most central indicators affecting quality of life. For group B, the most central quality of life indicators were depression, working, happiness, pain and sleep. In group A, the strongest associations were between depression and happiness, pain and climbing stairs and working and climbing stairs. The same strong associations were observed in group B, along with additional strong associations between depression and memory loss, sleep and happiness, pain and working and happiness and vitality. The bootstrap analyses showed that the networks were very stable and the edge weights accurately estimated. CONCLUSION:Our findings suggest that healthcare professionals should routinely screen for depressive symptoms and activities of daily living, especially for older people with 10 or more years of arthritis. Both psychological and physical indicators should be prioritised as key factors in self‐management interventions that aim to improve quality of life for older adults with arthritis. IMPLICATIONS FOR PRACTICE:This study highlights the importance of multidimensional care plans to improve the quality of life for older adults with arthritis. Healthcare professionals should adopt care strategies that simultaneously address the key psychological and physical indicators to effectively enhance overall quality of life.

INTRODUCTION:First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment. MATERIALS AND METHODS:We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain. RESULTS:Our study's multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = - 0.43; 95% CI, -0.99 to -0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = - 0.80; 95% CI, -2.31 to -0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = - 0.64; 95% CI, -1.48 to 0.07). CONCLUSION:These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue.

OBJECTIVES:Older adults living in long-term care facilities (LTCFs) are at high risk for falls. Interventions to prevent falls and fall-related injury in this population may be individual-level or system-focused interventions. However, relatively little attention has been given to research on system-focused interventions. This scoping review seeks to synthesise previous studies on the effects of system-focused interventions for fall prevention in LTCFs. METHODS:We searched Ovid-Medline, CINAHL and Embase databases from 2007 to 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. We conducted a narrative synthesis to summarise findings from the included studies. RESULTS:In the initial search, 403 studies were identified and underwent title and abstract screening resulting in 116 articles retrieved for full-text review. 20 studies were included in the final data extraction. System-level fall prevention interventions evaluated in LTCFs include (1) multicomponent and multidisciplinary programmes, (2) environmental adaptations, (3) technological adaptations, and (4) staff education and training programmes. 11 out of 17 included quantitative studies reported significant effects of system-focused interventions to reduce falls in LTCFs. CONCLUSIONS:This scoping review reveals the effectiveness of system-level fall prevention strategies in LTCFs. Enhancing training, customising tools and fostering a supportive leadership culture are vital for improving fall prevention practices in LTCFs.

Objective The purpose of this study was to apply network analysis methodology to better understand the relationships between pain-related measures among people with chronic pain. Methods We analyzed data from a cross-sectional sample of 4614 active duty service members with chronic pain referred to 1 military interdisciplinary pain management center between 2014 and 2021. Using a combination of Patient-Reported Outcomes Measurement Information System measures and other pain-related measures, we applied the “EBICglasso” algorithm to create regularized partial correlation networks that would identify the most influential measures. Results Pain interference, depression, and anxiety had the highest strength in these networks. Pain catastrophizing played an important role in the association between pain and other pain-related health measures. Bootstrap analyses showed that the networks were very stable and the edge weights accurately estimated in 2 analyses (with and without pain catastrophizing). Conclusions Our findings offer new insights into the relationships between symptoms using network analysis. Important findings highlight the strength of association between pain interference, depression and anxiety, which suggests that if pain is to be treated depression and anxiety must also be addressed. What was of specific importance was the role that pain catastrophizing had in the relationship between pain and other symptoms suggesting that pain catastrophizing is a key symptom on which to focus for treatment of chronic pain.

ABSTRACT Introduction Providing effective treatment for debilitating chronic pain is a challenge among many populations including military service members. Cognitive behavioral therapy for chronic pain (CBT-CP) is a leading psychological pain treatment. Pain catastrophizing is a pivotal mediator of pain-related outcomes. The purpose of this study was (1) to identify patient subgroups who differ in response to CBT-CP and (2) to explore the characteristics that define these patient subgroups. The overall goal was to obtain a better understanding of factors that may influence response to CBT-CP. Materials and Methods This study was a secondary analysis of data from a clinical trial of 149 U.S. active duty service members with chronic pain. Participants underwent group-based CBT-CP for 6 weeks and completed pre- and posttreatment assessments. Finite mixture models were employed to identify subgroups in treatment response, with pain impact score as the primary outcome measure. Results We identified two classes of nearly equal size with distinct pain impact responses. One class reported improved pain impact scores following CBT-CP. This improvement was significantly associated with lower (better) baseline depression scores and greater improvement in posttreatment pain catastrophizing. In contrast, the other class reported slightly worse mean pain impact scores following CBT-CP treatment; this response was not related to baseline depression or change in pain catastrophizing. Conclusions Our findings demonstrate that a sizable proportion of individuals with chronic pain may not respond to group-based CBT-CP and may require a more individualized treatment approach.

We undertook a study to describe and compare sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with childhood systemic lupus erythematosus (cSLE) to a healthy comparison group of youth and test the associations between sleep and symptoms of pain, fatigue, and depressed mood in youth with cSLE. Forty-three youth (23 youth with cSLE; 20 age- and sex-matched healthy youth) wore actigraphs and completed sleep diaries for 10 days and completed self-report questionnaires on sleep quality, pain, fatigue, and depressed mood. On average, both groups had a total sleep time of less than 7 hours. Youth with cSLE had worse sleep efficiency (73.3

Background Sickle cell disease (SCD) is a hereditary blood disorder with chronic pain that affects over 100,000 people in the United States. Previous research suggests a complex interaction between SCD pain outcomes and social determinants of health (SDOH). Objective To explore the impact of SDOH on pain outcomes in SCD. Design We used a scoping review design to explore the broad topic of social factors that affect SCD pain. Data Sources We searched the PubMed/MEDLINE, CINAHL, and Embase databases using combined search and Medical Subject Headings terms (“social determinants of health,” “sickle cell,” and “pain”). Review Methods We used a content analysis with a summative approach to identify and describe interactions between SDOH and SCD pain outcomes. Findings Eight articles reporting studies with 7,992 total participants and a focus on SCD pain outcomes met the inclusion criteria. Three themes related to SDOH and pain were produced: education and employment, social and emotional functioning, and healthcare access. Conclusion The key findings highlight the complex interplay between socioeconomic, psychological, and biological factors in SCD pain experiences. This underscores the need for nursing care to consider SDOH in an integrated, holistic approach to SCD pain. Implications for Nursing To improve pain management among their SCD patients, nurses can assess pain holistically, develop customized individual pain management plans with educational and health literacy support options, and strengthen social support.

Abstract Older adults residing in long-term care facilities (LTCFs) are at high risk for falls. In addition to individual resident-level interventions to prevent falls and fall-related injury (FRI), system-focused interventions are also necessary to adequately address fall prevention. Relatively little attention has been given to research involving systems-focused interventions. We aimed to synthesize studies on the effects of system-focused interventions for fall and FRI prevention in LTCFs with the goal of identifying promising strategies and gaps. We searched Medline, CINAHL, and EMBASE databases from 2017 to 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. We conducted a narrative synthesis to summarize included studies. In the initial review, 301 studies were identified and underwent title and abstract screening resulting in 98 articles were retrieved for full-text review. Fifteen studies were included in data extraction. Fall prevention interventions evaluated in LTCF settings include: (1) multicomponent fall prevention programs, (2) staff education programs, (3) training in safe handling/transfers, (4) environmental adaptations, (5) electronic health record algorithms and prompts, (6) local culture change, (7) video analysis of falls to change local interventions, and (8) facility-level physical activity programs. About half of reported studies reported significant effects of system-focused interventions to reduce fall and FRI in LTCFs. Multicomponent fall prevention programs and physical activity interventions are the most effective systems-level interventions, while electronic health record interventions were the least effective. Overall, little attention has been given in the literature to evaluation of environmental adaptations at the systems level.

INTRODUCTION:Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by recurrent episodes of pain. This study aimed to describe the temporal daily relationships between sleep and pain in adolescents with SLE. METHOD:Twenty-three adolescents with SLE recruited from a pediatric hospital wore actigraphy and completed diaries. Generalized estimating equation models were used. RESULTS:On average, evening pain negatively predicted subsequent sleep quality that night, and, on average, sleep quality negatively predicted morning pain. Shorter total sleep time significantly predicted higher morning pain (95% confidence intervals [CI], -0.38 to -0.03, p = .02), whereas sleep efficiency and sleep quality were not significantly associated with morning pain (95% CI, -0.03 to 0.03; 95% CI, -0.08 to 0.06, respectively). Subsequent evening pain did not predict daily nighttime sleep DISCUSSION: Our findings suggest that sleep is a target for pain interventions to include among adolescents with SLE.

Older adults who are Asian American and Pacific Islander (AAPI) represent one of the fastest growing populations in the United States and face a significant burden of Alzheimer's disease and related dementias (ADRD). Little is known about ADRD among AAPI subgroups. The current study aimed to: (a) explore perceptions and beliefs of memory loss and dementia among Korean, Samoan, Cambodian, and Chinese older adults in the United States; and (b) identify culturally relevant facilitators and barriers of participation in a brain health program among four AAPI subgroups. Seven focus groups comprising 14 Cambodian, 21 Chinese, 14 Korean, and 13 Samoan older adults were conducted. Data were analyzed using inductive and indigenous coding approaches. Similar and unique perceptions and experiences related to memory loss were identified. Future research could include developing and testing culturally tailored and language congruent strategies regarding ADRD education and resources to facilitate ADRD early detection among AAPI older adults. [Journal of Gerontological Nursing, 48(6), 40-48.].

Abstract Introduction Systemic Lupus Erythematosus (SLE) is a chronic, inflammatory autoimmune disorder characterized by recurrent episodes of pain and is more prevalent in youth of color. Although sleep deficiency (poor quality and an inadequate amount of sleep) and pain are interrelated, most of what is known about SLE pain and sleep rely on reports from adults. Less is known about these associations in youth with SLE, leaving a critical gap in care for this population. This study aims to describe the temporal daily relationships between sleep deficiency and pain in 11-to 18-year-old youth with SLE. Methods Twenty-three youth (n=21 girls, n=9 Hispanic) with SLE (mean age=14.7 □ 2.2) participated in the study. Youth wore actigraphy and completed electronic sleep diaries for consecutive 10 days. Actigraphic sleep variables (Total Sleep Time [TST], Sleep Efficiency [SE]) and self-reported Sleep Quality (diary SQ) were examined as predictors of next-day pain in the morning. Average daytime pain was examined as a predictor of nighttime sleep (both actigraphic and self-reported sleep variables). Pubertal stage and ethnicity (Hispanic vs. Non-Hispanic) were entered as covariates in all models. Results Of the sample, the mean TST was 7 □ 1.2 hours and the mean SE was 73.5 □ 9.2% as measured by actigraphy. On average, diary SQ negatively predicted next-day pain in the morning (p <.001). On average, pain negatively predicted TST (p <.05) and diary SQ (p <.001). The within-subject relationships between sleep and next-day pain were not significant. Daytime pain predicted neither actigraphic nor self-reported sleep quality. Conclusion Poor sleep is a modifiable behavior, and improving sleep quality may reduce pain intensity in youth with SLE. Although further study is needed, the findings suggest that sleep is a potential target for interventions to alleviate symptoms of pain in this population. Support (if any) This work was funded by NIH/NINR P30NR016585 (MPI: MMH, TMW), R21NR017471 (TMW); University of Washington, School of Nursing, Research and Intramural Funding (RIFP); Hester McLaws Nursing Scholarship.

Background Sleep deficiency affects a majority of pregnant women with significant impact on daily function, mood, and pregnancy and birth outcomes. This ongoing study combines two evidence-based strategies for improving sleep and mood, mindfulness meditation and cognitive-behavioral therapy for insomnia (CBT-I), in a unique online format to address the particular needs of pregnant women. The purpose of this study is to test the feasibility and estimate the efficacy of this novel 6-week online mindfulness meditation intervention to help pregnant women in remission from depression self-manage insomnia. Methods This is a two-arm, parallel group randomized controlled trial. A total of 50 pregnant women between 12 and 28 weeks gestation will be recruited from the community and randomly assigned to a mindfulness or education-only control group in a 1:1 ratio. During the study, all participants will complete six weekly online modules, daily sleep diaries, and optional participation in a treatment-specific online discussion forum. Feasibility outcome measures will include study recruitment, retention, intervention adherence (number of online modules completed, number of meditation days per week), and intervention acceptability (8-item questionnaire). The primary clinical outcome measure will be sleep quality measured with the Pittsburgh Sleep Quality Index. Secondary outcome measures will include sleep measured with actigraphy and diaries (sleep efficiency, total sleep time, total wake time), Patient-Reported Outcomes Measurement Information System (PROMIS) measures (fatigue, sleep-related impairment, sleep disturbance); mood (depression, anxiety, positive affect, quality of life); and self-management and behavior change (potential self-efficacy, self-regulation, sleep problem acceptance, and trait mindfulness). Assessments will occur at baseline and post-intervention; an additional acceptability survey will be completed 4 weeks postpartum. Analyses will examine within-group differences in outcome change scores from baseline to post-intervention. Open-ended feedback will be analyzed using qualitative content analysis. Discussion This research is innovative in addressing sleep in pregnancy using a self-management research design and methods that can be accessible and cost-effective for large numbers of pregnant women. The results from this study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial. Trial registration ClinicalTrials.gov, NCT04016428 . Registered on 11 July 2019. Updated version registered on 26 July 2019.

Journal of Clinical NursingVolume 28, Issue 3-4 p. e1-e1 LETTER TO THE EDITOR Letter regarding “sleep disturbance in people with diabetes: A concept analysis” Dahee Wi, Corresponding Author Dahee Wi daheew@uw.edu orcid.org/0000-0002-8951-2816 School of Nursing, University of Washington, Seattle, Washington Correspondence Dahee Wi, School of Nursing, University of Washington, Seattle, WA. Email: daheew@uw.eduSearch for more papers by this author Dahee Wi, Corresponding Author Dahee Wi daheew@uw.edu orcid.org/0000-0002-8951-2816 School of Nursing, University of Washington, Seattle, Washington Correspondence Dahee Wi, School of Nursing, University of Washington, Seattle, WA. Email: daheew@uw.eduSearch for more papers by this author First published: 17 October 2018 https://doi.org/10.1111/jocn.14690Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume28, Issue3-4February 2019Pages e1-e1 RelatedInformation

Purpose: The purpose of this study was to investigate the relationship among knowledge and attitude toward palliative care and perception of death for Neonatal Intensive Care Unit (NICU) nurses. Methods: A cross-sectional descriptive study was conducted with 110 nurses who work in NICUs in South Korea. The participants filled out a questionnaire regarding their knowledge, attitude towards palliative care and perception of death. The attitude scale was divided into 3 subscales: comfort level, nurses’ role and nurses’ involvement with family. Results: Comfort level regarding attitude towards palliative care was positively correlated with knowledge (r=.220, p=.016) and the perception of death (r=.194, p=.042). Nurses’ role showed a positive correlation with perception of death (r=.395, p=.001). Conclusion: NICU nurses’ knowledge of palliative care was below standard across the board, implying that there is a definite need for palliative care education for nurses. The education program for palliative care should include a section that focuses on fostering a positive perception of death as well as defining and delineating the role of nurses.