The role of social participation in maintaining mental and physical health in older people with musculoskeletal pain
Identifying factors that distinguish between older people with chronic musculoskeletal pain who maintain good mental and physical health, and those who do not, would inform practical programmes for promoting future physical and mental health in the many people with this condition. Social participation is one such potential factor. It is associated with lower levels of disabling musculoskeletal pain and better health in older people. There have been no longitudinal studies designed to investigate whether this is a causal association or not. This thesis uses data from a well-established UK prospective cohort study to investigate the hypothesis that active social participation is one determinant of the capacity of older people with musculoskeletal pain to maintain future physical and mental health.
After an initial systematic review, secondary analyses were performed on publicly available data using samples from a nationally representative cohort study initiated in 2002 among 12,099 adults aged =50 years (the English Longitudinal Study of Ageing (ELSA)). ELSA provided baseline measures relevant to the study hypothesis, and multiple follow-up time-points for longitudinal causal pathway analyses. Using a novel latent class analysis approach, individuals grouped by similar social participation activities were identified in ELSA at different follow-up points. Longitudinal regression models explored whether social participation: i) explained (effect mediation), ii) identified who experienced (effect modification), or iii) obscured (confounded), the relationship between baseline pain and future mental/physical health in ELSA participants.
The systematic review found no papers addressing whether participation determines which older people with musculoskeletal pain maintain their health. In ELSA, baseline musculoskeletal pain was associated with reduced mental and physical health two years later (OR = 0.24 and 0.35 respectively), and those reporting high social participation were more likely to report future good physical health (OR = 3.40; 95%CI: 2.90-3.98) and mental health (OR=2.40; 95%CI: 2.05-2.84), compared with people with infrequent participation, independent of musculoskeletal pain. In people with pain, however, and after adjustment for confounders, active social participation had only a weak effect on future mental health (OR= 1.46; 95%CI: 1.12-1.91) and no effect on physical health. Two individual components of social participation (‘sense of purpose’ and ‘physical activity’), although less common in persons with chronic musculoskeletal pain, did, after adjustment, predict future good health in such people, both mental (OR sense of purpose=3.95; 95%CI: 2.84-5.35) and physical (OR for sense of purpose=2.01; 95%CI: 1.54-2.60; OR for physical activity=1.57; 95%CI:1.19-2.05).
Current public health messages of the potential positive consequences for older people’s health of promoting active social participation are consistent with the results of the overall analyses of ELSA presented in this thesis. However, new evidence from this thesis suggests this would not directly contribute to maintaining future physical and mental health in older people with chronic musculoskeletal pain. Rather, the thesis has provided observational epidemiological evidence to support development of interventions targeting individual components of social participation (sense of purpose and physical activity) to research whether they could help maintain future mental and physical health in older people with musculoskeletal pain as part of pain management programmes.
|Publication Date||Mar 1, 2019|