THE INFLUENCE OF LOCKDOWN DURING THE COVID-19 PANDEMIC IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN IN GREECE

P. Bilika¹, G. Τsatsakos², Z.A. Cheimonidou², S. Argyrou¹, K. Konstantinou³, G. Koutras⁴, S. Gigourtakis⁵, E. Kapreli¹

Background: Covid-19 pandemic changed people’s daily routine in almost every corner of the world, especially during the lock down period. Without previous experience, there was concern about the chronic musculoskeletal pain patients that had to dispense with their normal health care such as physiotherapy.  It was hypothesized that these patients could further be affected in the Covid-19 restrictive period due to a number of various factors such as reduced physical activity, limited access in medication and specialists’ advice, unemployment risk and economic consequences and finally isolation and adaptation of harmful habits such as unhealthy diet and imbalanced sleep routine (Parker, et al., 2017; Geneen, et al., 2017, Timmerman, et al., 2016). Although it is well known how all the above factors can contribute to chronic pain, there is no evidence regarding the effect that could have on chronic musculoskeletal pain patients during the period of self-isolation.

Purpose: The aim of the current study was to investigate the effect of a number of socioeconomic, psychological and life style factors on the health condition of chronic musculoskeletal patients during the Covid-19 pandemic lockdown in Greece.

Methods: Patients (>18 years old), with chronic musculoskeletal pain (>3 months, >3 VAS), attending physiotherapy before the lockdown were included in the study. Τhe survey, created in Google forms, was sent by e-mail to 9 local physiotherapy clinics of 5 different Greek cities (Athens, Thessaloniki, Lamia, Karystos and Heraklio in Crete). Each participant completed the survey twice: firstly during the first week of the lockdown period and secondly, during the first week after the termination of the restrictive measures (40 days period). The survey consisted of demographics and a battery of different questionnaires in order to assess anxiety, depression, sleep, quality of life, pain behavior, illness perceptions and functioning. Self-reported questionnaires include Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), Oswestry Disability Index (ODI) and Pittsburgh Sleep Quality Index (PAQI). All participants were informed and gave their consensus prior to their inclusion in the survey.

Results: Seventy-four patients (46.56 ± 12.13 years old) with chronic musculoskeletal pain agreed to participate. A total of 69.5% participants stated that they did less or no exercise during the lockdown period, 90.5% were more inactive than before and 62.2% had increased sleeping hours. Intensity of Painnow was reduced after the lifting of the restrictive measures (PainBefore =4.96±2.1, PainAfter=3.96±2.41, p=0.014). We found no significant differences in the performance scores of HADS, BIPQ, ODI and PSQI. Additionally, intensity of pain had a positive moderate correlaion with PSQI after self-isolation (r=0.301, p<0.05) and intensity of pain in a new body site with ODI after self-isolation (r=0.465, p<0.05).

Conclusion(s): In conclusion, patients with chronic pain had less pain during the early lockdown measures. New habits, such as more sleep and social changes during the self-isolation period led probably to less pain.

Implications: In the current study, chronic pain patients did not have a deterioration of their health condition (pain and functioning), neither considering the psychosocial factors tested.

Funding, acknowledgements: Unfunded work

Keywords: lockdown, chronic musculoskeletal pain, psychosocial impact

Topic: COVID-19

Did this work require ethics approval? Yes

Institution: Physiotherapy Department; University of Thessaly

Committee: Ethics Committee of the Physiotherapy Department; University of Thessaly

Ethics number: 335/5-5-2020