Rutledge, D. N., Rakovski, C., & Zettel-Watson, L. (2012). Healthcare underutilization among overweight Mexican-Americans with chronic pain. Ethnicity and Inequalities in Health and Social Care, 5 (4), 123-132.
To determine healthcare utilization issues for low income Hispanic immigrants who have both excess weight and chronic pain. Community health workers conducted at-home interviews with 101 middle-aged and older Mexican Americans (aged 40 – 79 years, M = 52.1 ± 8.8) associated with a community agency in southern California to evaluate healthcare underutilization and reported reasons for not using medical or pharmaceutical care. Almost all participants (91%) reported having received at least some medical care in the year preceding the study interview. However, at some point during the prior year, 62% had not seen a doctor when it was needed and 45% had not taken a prescribed medication. While the primary reason for underutilization was financial, communication and trust reasons were also reported. Although cross-sectional and geographically restricted, this study lays the foundation for additional research on reasons for underutilization of recommended healthcare and lack of pain management in low income Hispanic immigrants who are overweight and have chronic pain. Implications for providers include the need for accurate pain assessment and better communication about medication to prevent non-adherence in this population. The current study highlights the existence of healthcare underutilization among overweight and obese Mexican Americans with chronic pain and identifies specific barriers to care, care-seeking, and pain management.
Cherry, B. J., Zettel-Watson, L., Shimizu, R., Roberson, I., Rutledge, D. N., & Jones, C. J. (2012). Cognitive performance in individuals with and without fibromyalgia. Journal of Gerontology, Series B: Psychological Sciences and Social Sciences, 69 (2), 199-208.doi: 10.1093/geronb/gbs122
Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years).METHOD: Measures included explicit memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test).RESULTS: Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding).DISCUSSION: Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.
Rakovski, C., Zettel-Watson, L., & Rutledge, D. N. (2012). Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia. Disability & Rehabilitation, 34 (15), 1277-1283. doi: 10.3109/09638288.2011.64165
This study examines physical and mental health symptoms among people with fibromyalgia (FM) by employment status and working conditions.METHOD: Secondary data analysis of the 2007 National Fibromyalgia Association Questionnaire study resulted in employment and symptom information for 1702 people of working age with FM. In this cross-sectional internet study, six factors of symptom clusters (physical, mental health, sleeping, concentration, musculoskeletal, support) were seen in the data. Linear regression models used employment, age, income, gender, and education to predict symptom clusters. Among those employed, working conditions were also associated with symptom severity.RESULTS: In the predominately female sample, 51% were working. Of these, 70% worked over 30 hours/week and half had flexible hours. Employment, higher income, and education were strongly associated with fewer symptoms. Working conditions, including level of physical and mental exertion required on the job as well as coworkers' understanding of FM, were related to symptoms, particularly physical and mental health symptoms. Many participants reported modifying their work environment (66%) or changing occupations (33%) due to FM.CONCLUSIONS: Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.
Cherry, B. J., Zettel-Watson, L., Chang, J., Shimizu, R., Rutledge, D. N., & Jones, C. J. (2012). Positive associations between physical and cognitive performance measures in fibromyalgia. Archives of Physical Medicine & Rehabilitation, 93, 63-71. doi:10.1016/j.apmr.2011.08.006
To investigate the associations between perceived physical function (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM).DESIGN: Correlational study.SETTING: Exercise testing laboratory in Southern California.PARTICIPANTS: Community-residing ambulatory adults meeting the American College of Rheumatology 1990 criteria for FM (N=68; mean age, 59.5y).INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Composite Physical Function scale, Senior Fitness Test (3 items), Fullerton Advanced Balance scale, 30-foot walk, Trail Making Test parts A and B, Digit Symbol Substitution Test, a composite score of these 3 cognitive measures, attention/executive function composite, processing speed composite, problem solving, inhibition, and episodic memory composite.RESULTS: Hierarchical regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assessments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition.CONCLUSIONS: Researchers should continue to investigate the relationship between physical and cognitive function in both clinical and nonclinical populations, as well as explore changes across time. Because physical activity has been associated with neural improvements, further research may identify whether particular mechanisms, such as neurogenesis, synaptogenesis, or changes in inflammatory marker levels, are involved
Traska, T. K., Rutledge, D. N., Weiss, J., Mouttapa, M., & Aquino, J. (2011) Strategies used for managing symptoms for persons with fibromyalgia. Journal of Clinical Nursing, 21, 626-635. doi: 10.1111/j.1365-2702.2010.03501.x.
The goal of this study was to describe how persons with fibromyalgia (FM) manage their lives given the multiple symptoms they experience, in particular how they use non-pharmacologic strategies, or how they incorporate these strategies along with pharmacologic agents. BACKGROUND. Persons with FM, a widespread chronic pain condition, often suffer from considerable fatigue, sleep disturbances, and morning stiffness. Medical management does not lead to a cure, and sufferers must self-manage in order to maintain a good quality of life. DESIGN/METHODS. Data for this qualitative descriptive study were obtained in a single group interview with eight women with FM. Women’s mean age was 61 years (range 54 to 81). Participants were invited to participate in a 1 ½-hour group interview focused on symptom management. In the interview, open-ended questions allowed them to speak freely about managing multiple FM symptoms. Content analysis by the first and second authors led to identification of themes, which were validated by the co-authors who attended the interviews. RESULTS. Participants reported many strategies to cope with FM symptoms and manage their lives. Main strategies included: pacing/planning, distraction techniques, coping with touch sensitivity, putting on the mask, and medications. In addition, social support from others with FM and from family members was reported to be very important. CONCLUSIONS. Study findings demonstrate that women with FM can develop strategies that enable them to cope with a life encumbered with chronic pain and fatigue. Moreover, this study confirmed effective FM management strategies reported in other studies. Further research is needed on risks/benefits of these and other self-management strategies used by women with FM. RELEVANCE TO CLINICAL PRACTICE. Our findings suggest that nurses should discuss the self-management strategies found with persons who have FM in the context of individual patient experiences.
Zettel-Watson, L., Rakovski, C., Levine, B., Rutledge, D. N., & Jones, C. J. (2011) Impact of employment and caregiving roles on the well-being of people with fibromyalgia. Journal of Musculoskeletal Pain, 19 (1), 8-17. doi:10.3109/10582452.2010.538824
Examine associations between social roles and health status, quality of life, physical functioning, and depression in individuals 50+ years with/without Fibromyalgia Syndrome [FMS]. METHODS: Cross-sectional study. RESULTS: FMS participants had significantly worse health status, quality of life, and physical functioning, as well as more depression symptoms, than those without FMS. While positively linked with depression, number of roles was not significantly associated with health status, quality of life, or physical functioning for those without FMS. For individuals with FMS, increased roles were associated with all outcomes. CONCLUSION: Fulfilling multiple roles may enhance overall well-being of individuals with FMS.
Rakovski, C., Zettel-Watson, L., & Rutledge, D. N. (Under review). Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia. Disability & Rehabilitation.
This study examines physical and mental health symptoms among people with fibromyalgia (FM) by employment status and working conditions. Results found that work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.
Zettel-Watson, L., Rutledge, D. N., *Aquino, J. K., Cantero, P., *Espinoza, A., & Leal, F., & Jones, C. J.,. (In press). Typology of chronic pain among overweight Mexican Americans. Journal of Healthcare for the Poor and the Underserved
Having a better understanding of the intersection between chronic pain and obesity in the Mexican American community can be valuable for pain management specialists in determining treatment, service, and prevention strategies. The objectives of this study were (1) to describe the type and severity of chronic pain among overweight/obese Hispanic adults aged 40 years and older, and (2) to determine the association between chronic pain indices and key demographic variables, including excessive weight. Hispanic adults (N=101) were interviewed using validated questionnaires and measured for BMI and waist circumference. Data analyses revealed that most participants had widespread pain; 60% were suffering severe pain (including back, knee, and shoulder pain); the most common pain location was head (headache, 80%), followed by knee and upper back (75-76%), shoulder (73%) and lower back (73%). Greater obesity was associated with some negative pain outcomes. Results are relevant for pain management with this at-risk population.
Cherry, B. J., Zettel-Watson, L., *Shimizu, R., *Roberson, I., Rutledge, D. N., & Jones, C. J. (Revisions underway). Neuropsychological performance in individuals with and without fibromyalgia
Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years). Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.
Rutledge, D. N., Cherry, B., Rose, D., Rakovski, C., & Jones, C. J. (2010). Do fall predictors in elders predict fall status in persons 50+ with fibromyalgia?An exploratory study. Research in Nursing & Health, 33, 192-206. doi: 10.1002/nur.20376.
We explored potential predictors of fall status in 70 community-dwelling persons >50 years of age with fibromyalgia (FM). Over 40% of the sample reported one or more falls in the year prior to the study. A logistic regression model using 10 variables known to predict falls in middle aged and older persons predicted 45% of the variance in fall status. Three variables offered significant independent contributions to the overall model predicting fall status: perception of postural instability, balance performance, and executive function processing speed. The results support prior work in both nonclinical and clinical populations of middle aged and older adults indicating that falls are associated with multiple risk factors. Prospective designs with larger samples are needed to (a) validate and extend these findings, and (b) identify risk factors related to fall status that are unique to persons with FM.
Jones, C. J., Rutledge, D. N., & Aquino, J. (2010). Predictors of physical performance and functional ability in persons 50+ with and without fibromyalgia. Journal of Physical Activity and Aging, 18,353-368. PMID: 20651419
The purposes of this study were to determine whether persons with and without FM aged 50 years and above showed differences in physical performance and perceived functional ability, and to determine whether age, gender, depression, and physical activity level altered the impact of FM status on these factors. Dependent variables included perceived function and 6 six performance measures (multidimensional balance, aerobic endurance, overall functional mobility, lower body strength, and gait velocity – normal, fast). Independent (predictor) variables were FM status, age, gender, depression, and physical activity level. Results indicated significant differences between adults with and without FM on all physical performance measures and perceived function. Linear regression models showed the contribution of significant predictors was in expected directions. All regression models were significant, accounting for 16-65% of variance in the dependent variables.
Cherry., B. J., Zettel-Watson, L., *Shimizu, R., *Chang, J., Rutledge, D. N., & Jones, C. J. (submitted to Archives of Physical Medicine & Rehabilitation). Physical activity predicts cognitive function in fibromyalgia.
The objective of this study was to investigate thea associations between percieved physical funciton (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM). Hierarchial regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assesments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition.