Objectives: This study aimed to investigate the risks and impacts associated with fractures, osteoporosis, frailty, physical function, and dementia in older adults in community and LTC setting. The study aims to identify important factors influencing these health issues and identify strategies for improving management and outcomes. Methods: The research integrates data from three primary sources: Project 1 (ICES Data Repository): Healthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures and osteoporosis management among adults aged 66 and older from April 1, 2014, to March 31, 2018. Osteoporosis management was assessed through pharmacotherapy records. Sex-specific and age-standardized rates were compared based on pre-fracture residency and discharge location (e.g., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS). Project 2 (Canadian Longitudinal Study on Aging - CLSA): Participants aged 45 to 85 years who completed both the baseline and three-year follow-up assessments were included. Outcomes examined include frailty (Fried Frailty Phenotype), and physical function limitations. MSK conditions were self-reported diagnosis by a health care professional and included rheumatoid arthritis (RA), osteoarthritis (OA), low-back pain, osteoporosis, and related fractures. Project 3: The review employed Arksey and O'Malley's framework, guided by Joanna Briggs Institute methodology and PRISMA-ScR guidelines. A comprehensive search strategy was implemented across MEDLINE, EMBASE, CINAHL, and grey literature. Independent reviewers used Covidence software for study selection and data extraction. A narrative synthesis was conducted to summarize findings, identify patterns, and highlight gaps in the literature. Findings: We found increasing hip fracture rates and low osteoporosis treatment in LTC settings, highlighting to the need for improved screening and management of osteoporosis treatment in LTC. In community, hip fracture rates decreased. We found that older adults with musculoskeletal (MSK) conditions at baseline were more likely to experience frailty at the three-year follow-up compared to those without MSK conditions. However, this association was not significant in the unadjusted analysis. Individuals with cognitive decline experience worse outcomes following hip fractures, underscoring the need for integrated care addressing both physical and cognitive health. Conclusion: Hip fractures, frailty, physical function decline, and cognitive decline are prevalent and interrelated issues among older adults aged 65 and older. These findings underscore the need for improved screening and integrated care strategies to enhance management and prevention of these complex health challenges. / Thesis / Doctor of Philosophy (PhD) / Aging is associated with increased risks of osteoporosis, fractures, frailty, physical function decline, and dementia, particularly for older adults in long-term care (LTC). This study explores these health challenges by analyzing data from three key sources: ICES, the Canadian Longitudinal Study on Aging (CLSA), and a scoping review of patient-important outcomes following a hip fracture in older adults with cognitive impairment or dementia. First, we found increasing hip fracture rates in LTC and among older adults living in community at time of fracture and transferred to LTC post fracture. Osteoporosis treatment was low among high fracture risk LTC residents. Second, we found that older adults with baseline musculoskeletal (MSK) conditions (osteoporosis, fractures, osteoarthritis (OA), rheumatoid arthritis, and back pain) were more likely to become frail and have physical function limitation over three years compared to those without MSK conditions. However, after adjusting for covariates, these associations were no longer significant. Among the individual MSK conditions, we found older adults with only OA and osteoporosis-related fractures to be significantly associated with physical functional limitations. Lastly, we found that following a hip fracture, older adults with cognitive impairment or dementia have poorer functional outcomes, reduced quality of life, higher hospitalization and mortality rates, and are significantly more likely to be institutionalized compared to older adults without cognitive impairment or dementia, highlighting the need for integrated care that addresses both physical and cognitive health

Yes / Integrated models of care intend to provide seamless and timely access to health and social care services. This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from which patients were triaged. Staff (n = 15) involved in service development and delivery were interviewed about how, why and to what extent integration impacted service delivery. The analysis focused on staff experiences of using an on-line patient self-referral form and co-located clinics to enhance decision-making in triage, and on the provision of educational materials and de-medicalising language in patient consultations to support self-management. Single point of access, including online self-referral, were operationalised during data collection, but co-located clinics were not. Triage staff explained that the volume of referrals and quality of information provided in online self-referrals sometimes constrained decision-making in triage. Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co-located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self-management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Findings emphasise that restructuring services requires engagement from diverse stakeholders. Collaborating with stakeholders to address their concerns about the impact of restructures on well-established pathways may help cultivate this engagement. / Newcastle upon Tyne Hospitals NHS Foundation Trust

Bakgrund: Vid smärtsamma muskuloskeletalatillstånd är patienten beroende av sjuksköterskans omvårdnadsåtgärder och stöd till smärtlindring. Transkutan elektrisk nervstimulering (TENS) är en icke farmakologisk smärtlindringsmetod som med fördel kan kombineras med analgetiska läkemedel vid både akuta och långvariga smärttillstånd. För att optimera smärtlindringen i vardagen vid långvarig smärta kan patienten utbildas i att använda TENS i sin egenvård. Syfte: Syftet var att beskriva effekten av transkutan elektrisk nervstimulering som en del av smärtbehandlingen för personer med muskuloskeletala smärttillstånd. Metod: Allmän litteraturstudie med induktiv ansats där två kvalitativa artiklar samt sju kvantitativa artiklar granskats. Resultat: I resultatet framkom två teman: TENS effekt vid akut smärtaoch TENS effekt vid långvarig smärta. Resultatet visade att behandling med TENS kunde ge adekvat smärtlindring och var en säker metod med få negativa konsekvenser för patienten. Det framkom även att behandlingen medförde en reducering av intag av analgetiska preparat för patienterna. Patienter som behandlades med TENS visade även på en högre grad av fysisk funktion och psykiskt välbefinnande. Konklusion: För sjuksköterskans omvårdnad av patienter med muskuloskeletala tillstånd ter sig TENS vara en effektiv och säker omvårdnadsåtgärd med fler fördelar än enbart  smärtlindrande effekt. Kunskap och utbildning för sjuksköterskan av denna behandlingsmetod kan ge sjuksköterskan ytterligare verktyg för multimodal omvårdnad av både akut och långvarig smärta. Sjuksköterskans kunskap om TENS ger även möjlighet till patientutbildning och kan stärka patientgruppens möjlighet till egenvård vid smärta. / Background: In painful musculoskeletal conditions, the patient is dependent on the nurse's nursing measures and support for pain relief. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological pain relief method that can be advantageously combined with analgesic drugs for both acute and long-term pain conditions. To optimize the pain relief in everyday life in the event of long-term pain, the patient can be trained in using TENS in their self-care. Aim: The aim was to describe the effect of transcutaneous electrical nerve stimulation as part of the pain treatment for people with musculoskeletal pain conditions. Method: A General literature study with inductive approach, where two qualitative articles and seven quantitative articles were examined. Results: The results revealed two themes: TENS effect in acute pain and TENS effect in long lasting pain. The results showed that treatment with TENS could provide adequate pain relief and was a safe method with few negative consequences for the patient. Itwas also found that the treatment resulted in a reduction in the intake of analgesic pharmaceuticals for the patients. Patients treated with TENS also showed a higher degree of physical function and mental well-being. Conclusion: For the nurse's nursing of patients with musculoskeletal conditions, TENS appears to be an effective and safe nursing measure with more benefits than just a pain-relieving effect. Knowledge and training for the nurse of this treatment method can provide the nurse with additional tools for multimodal care of both acute and long lasting pain. The nurse's knowledge of TENS  also provides opportunities for patient education and can strengthen the patient group's opportunities for self-care in case of pain.

<p>Construction manual workers are at a high risk of suffering from occupational related low back pain because of high-risk activities involved and the nomadic nature of the workforce. Low back pain and its associated disability continue to plague the construction industry. The prevalence of occupational related low back pain among manual workers in construction companies is believed to be due to high exposure to awkward postures for long hours, heavy manual work and exposure to whole-body vibration in the work environment. As a result of these risky exposures, low back pain has consistently been the leading cause of both occupational disability and absenteeism in the construction industry. The purpose of this study was to determine the effect of occupationalrelated low back pain on the functional activities of the manual workers in a construction company in Cape Town. The prevalence and the predisposing factors of low back pain among construction manual workers were established as well as the effect of occupational-related low back pain on the functional activities of the manual workers was also determined. A crosssectional descriptive study using quantitative method was utilized. A convenient sampling method was employed and all the 212 available participants at two construction settings were recruited for the study. The population was categorised into four main occupational groups / &nbsp / masons, handymen, labourers and foremen. Data was collected using a structured questionnaire as a closed ended interview guide. The questionnaire comprised of four parts. Part one was used to determine the demographic data while parts two, three and four utilised three standardizedclose-ended validated questionnaires. These are / the Nordic Musculoskeletal Disorder Questionnaire, the Profile Fitness Mapping questionnaire and the Pain and Disability Questionnaire. Data was captured and analyzed using the statistical package for social sciences (SPSS) version 17.0 spreadsheet for statistical analysis. The study was conducted under the adherence of the ethical considerations. Descriptive and inferential statistical analyses describe the association between the investigated independent variables with the occurrence of occupational related low back pain in the study. Results are presented using tables, charts and graphs. The results revealed a 25% prevalence of low back pain while the one month and one week prevalence rates were 69% and 54% respectively. Masons recorded the highest low back pain prevalence rate (58%). Initial onset of low back pain was mainly attributed to bending (48%) and load lifting (28%). The chi-square test at p&lt / 0.05 was done. The results revealed a lack of association between low back pain and the socio-demographic characteristics. Participants confirmed suffering physical, emotional, financial and functional problems with 41.5% reporting sickness absence and a mean of 4 days being lost during the past year. Further chi-square test for proportion revealed an association between low back pain and participants ‟ability to / lift (p=0.006), bend back forwards (p=0.001) and ability to bend back backwards (p=0.014). To prevent impairment, activity limitation and participation restriction among construction manual workers, a number of factors must be addressed at epidemiological level as highlighted in the recommendations of this study.</p>

<p>Construction manual workers are at a high risk of suffering from occupational related low back pain because of high-risk activities involved and the nomadic nature of the workforce. Low back pain and its associated disability continue to plague the construction industry. The prevalence of occupational related low back pain among manual workers in construction companies is believed to be due to high exposure to awkward postures for long hours, heavy manual work and exposure to whole-body vibration in the work environment. As a result of these risky exposures, low back pain has consistently been the leading cause of both occupational disability and absenteeism in the construction industry. The purpose of this study was to determine the effect of occupationalrelated low back pain on the functional activities of the manual workers in a construction company in Cape Town. The prevalence and the predisposing factors of low back pain among construction manual workers were established as well as the effect of occupational-related low back pain on the functional activities of the manual workers was also determined. A crosssectional descriptive study using quantitative method was utilized. A convenient sampling method was employed and all the 212 available participants at two construction settings were recruited for the study. The population was categorised into four main occupational groups / &nbsp / masons, handymen, labourers and foremen. Data was collected using a structured questionnaire as a closed ended interview guide. The questionnaire comprised of four parts. Part one was used to determine the demographic data while parts two, three and four utilised three standardizedclose-ended validated questionnaires. These are / the Nordic Musculoskeletal Disorder Questionnaire, the Profile Fitness Mapping questionnaire and the Pain and Disability Questionnaire. Data was captured and analyzed using the statistical package for social sciences (SPSS) version 17.0 spreadsheet for statistical analysis. The study was conducted under the adherence of the ethical considerations. Descriptive and inferential statistical analyses describe the association between the investigated independent variables with the occurrence of occupational related low back pain in the study. Results are presented using tables, charts and graphs. The results revealed a 25% prevalence of low back pain while the one month and one week prevalence rates were 69% and 54% respectively. Masons recorded the highest low back pain prevalence rate (58%). Initial onset of low back pain was mainly attributed to bending (48%) and load lifting (28%). The chi-square test at p&lt / 0.05 was done. The results revealed a lack of association between low back pain and the socio-demographic characteristics. Participants confirmed suffering physical, emotional, financial and functional problems with 41.5% reporting sickness absence and a mean of 4 days being lost during the past year. Further chi-square test for proportion revealed an association between low back pain and participants ‟ability to / lift (p=0.006), bend back forwards (p=0.001) and ability to bend back backwards (p=0.014). To prevent impairment, activity limitation and participation restriction among construction manual workers, a number of factors must be addressed at epidemiological level as highlighted in the recommendations of this study.</p>

Magister Scientiae (Physiotherapy) - MSc(Physio) / Construction manual workers are at a high risk of suffering from occupational related low back pain because of high-risk activities involved and the nomadic nature of the workforce. Low back pain and its associated disability continue to plague the construction industry. The prevalence of occupational related low back pain among manual workers in construction companies is believed to be due to high exposure to awkward postures for long hours, heavy manual work and exposure to whole-body vibration in the work environment. As a result of these risky exposures, low back pain has consistently been the leading cause of both occupational disability and absenteeism in the construction industry. The purpose of this study was to determine the effect of occupational related low back pain on the functional activities of the manual workers in a construction company in Cape Town. The prevalence and the predisposing factors of low back pain among construction manual workers were established as well as the effect of occupational-related low back pain on the functional activities of the manual workers was also determined. A crosssectional descriptive study using quantitative method was utilized. A convenient sampling method was employed and all the 212 available participants at two construction settings were recruited for the study. The population was categorised into four main occupational groups; masons, handymen, labourers and foremen. Data was collected using a structured questionnaire as a closed ended interview guide. The questionnaire comprised of four parts. Part one was used to determine the demographic data while parts two, three and four utilised three standardizedclose-ended validated questionnaires. These are; the Nordic Musculoskeletal Disorder Questionnaire, the Profile Fitness Mapping questionnaire and the Pain and Disability Questionnaire. Data was captured and analyzed using the statistical package for social sciences (SPSS) version 17.0 spreadsheet for statistical analysis. The study was conducted under the adherence of the ethical considerations. Descriptive and inferential statistical analyses describe the association between the investigated independent variables with the occurrence of occupational related low back pain in the study. Results are presented using tables, charts and graphs. The results revealed a 25% prevalence of low back pain while the one month and one week prevalence rates were 69% and 54% respectively. Masons recorded the highest low back pain prevalence rate (58%). Initial onset of low back pain was mainly attributed to bending (48%) and load lifting (28%). The chi-square test at p&lt; 0.05 was done. The results revealed a lack of association between low back pain and the socio-demographic characteristics. Participants confirmed suffering physical, emotional, financial and functional problems with 41.5% reporting sickness absence and a mean of 4 days being lost during the past year. Further chi-square test for proportion revealed an association between low back pain and participants ‟ability to; lift (p=0.006), bend back forwards (p=0.001) and ability to bend back backwards (p=0.014). To prevent impairment, activity limitation and participation restriction among construction manual workers, a number of factors must be addressed at epidemiological level as highlighted in the recommendations of this study. / South Africa