The effect of psychomotor physical therapy on subjective health complaints and psychological symptoms

A breathing space: how young Norwegian women engaging psychomotor physiotherapy to address long-term health disorders narrate their experiences

INTRODUCTION

In Norway, as elsewhere, young people may experience psychological distress and long-lasting pain. Such health disorders can be complex, leading some young people to seek psychomotor physiotherapy treatment. Thus far, however, there has been little qualitative investigation of their experiences.

OBJECTIVE

The purpose of this study was to gain new knowledge about the illness experiences of young people with long-term health disorders engaging psychomotor physiotherapy.

METHOD

Qualitative interviews with ten Norwegian women aged 16-24 in psychomotor physiotherapy were analyzed within a narrative framework.

FINDINGS

The participants' treatment experiences take place in the context of a long history of pain, distress, and lack of understanding and support. Their stories tell of being threatened by illness and other difficult life events, and of being placed under further stress by a prolonged and disruptive quest for help within the healthcare system. For participants, psychomotor physiotherapy represents a breathing space where their illness experiences are acknowledged, enabling them to find rest and explore their bodily reactions and habits.

CONCLUSION

Long-term health disorders represent significant disruptions to the daily lives and relationships of young women. It is important to acknowledge the illness experiences of these young women and establish trustful therapeutic relationships. Psychomotor physiotherapy may offer significant potential as a means to help young people explore and make sense of their illness experiences.

Identifying contrasting embodied voices of identity: a qualitative meta-synthesis of experiences of change among patients with chronic musculoskeletal pain in long-term physiotherapy

BACKGROUND

The aim is to identify and synthesize qualitative research findings about patients with chronic musculoskeletal pain in long-term Norwegian psychomotor physiotherapy, in connection to their voices of meaning of embodied experiences of change and the possible influence on their identities.

METHODOLOGY

We systematically searched for qualitative studies in English in ten databases: AMED, Cinahl, Cochrane, Embase, Medline, PsychInfo, Scopus, SportDiscus, Svemed, and Web of Science. We included and analyzed nine publications using meta-ethnography. Bachtin's polyphonic voice perspective influenced the analysis.

RESULTS

Three overarching themes emerged: 1) voices of body and mind as disconnected and connected; 2) ambiguous voices in the therapeutic relationship; and 3) identification of embodied voices of constraint and freedom influence identity.

CONCLUSIONS

The patients' polyphonic voices of ambiguous and contrasting expressions of embodied sensations and the therapeutic relationship in inner and external dialog seemed to facilitate the choices of change and the creation of new identities. In practice, the physiotherapists' consciousness of the patients' concurrent polyphonic voices may improve change in treatment.

Physical Therapy and Mental Health: A Scoping Review

OBJECTIVES

Coexistence of mental and physical health conditions is prevalent. To achieve optimal physical therapy outcomes, neither should be treated in isolation. This review aimed to map intersections between physical therapy and mental health.

METHODS

This was a scoping review searching MEDLINE, CINAHL, PsycInfo, Cochrane, and PEDro databases. Two independent researchers screened studies of physical therapy practice with adolescents/adults with mental health disorders or research using primary mental health outcomes in physical health conditions or clinicians' perspective. Data were extracted on study type, participants, topics, publication year, and country.

RESULTS

The search yielded 3633 studies with 135 included. Five studies included adolescents. More than one-half were published since 2015. Studies specific to participants with mental health diagnoses included schizophrenia (n = 12), depressive disorders (n = 8), eating disorders (n = 6), anxiety disorders (n = 4), bipolar disorders (n = 1), somatic disorders (n = 5), and trauma and stressor-related disorders (n = 8) or varied mental health diagnoses (n = 14). Forty-one studies had primary mental health outcomes or clinical practice approaches with a mental health emphasis with participants with physical health conditions (musculoskeletal [n = 13], neurological [n = 7], other [n = 21]). Systematic reviews or randomized controlled trials predominantly involved exercise therapy and/or physical activity. Descriptions of physical therapists as participants (n = 35) included 4 main topics: (1) mental health screening; (2) knowledge, attitudes, and experiences; (3) key practice components; and (4) research priorities.

CONCLUSION

Physical therapy intersects with people experiencing mental health disorders across a broad spectrum of diagnoses, covering a range of interventions with a small but growing evidence base.

IMPACT

Exercise and physical activity studies dominated the highest levels of evidence and future focus, although economic evaluations and consumer-driven or patient experience studies are needed. There is a contrast between the confidence and knowledge of specialized physical therapists working within mental health settings and those in general practice settings. Inspiring, integrated education is required to further improve health care outcomes following physical therapy for people with mental health disorders or symptoms.

Embodied Knowledge - the Phenomenon of Subjective Health Complaints reflected upon by Norwegian Psychomotor Physiotherapy specialists

Background: Many patients report subjective health complaints (SHCs) during primary health care consultations. Objective: To elucidate Norwegian Psychomotor Physiotherapy (NPMP) specialists' clinical experiences in treatment of patients suffering from SHCs. Methods: Twelve NPMP specialists were interviewed. The transcripts were qualitatively analyzed using systematic text condensation. Results: "Embodied knowledge" seemed to be an unfamiliar concept to those suffering from SHCs. The NPMP specialists regarded increased body awareness to be a vital element in the process of recovery from SHCs. Differences between NPMP specialists' professional view and that of some medical doctors were reported. Three categories emerged from the material: 1) "The process of establishing a joint understanding of subjective health complaints"; 2) "The process of increasing the patients' embodied awareness"; and 3) "The challenge of sharing embodied knowledge in inter-professional communication." Conclusion: The NPMP specialists emphasized the importance of increasing patients' consciousness of their embodied knowledge. They searched to adjust their therapeutic approaches, depending on the individual patient's specific problems and degree of emotional and/or bodily strain. The NPMP specialists experienced the importance of creating a shared understanding of the meaning embedded in SHCs between patients, NPMP specialists, and medical doctors.

Norwegian Psychomotor Physiotherapy versus Cognitive Patient Education and active physiotherapy-A randomized controlled trial

BACKGROUND AND PURPOSE

Norwegian Psychomotor Physiotherapy (NPMP) has been an established treatment approach for more than 50 years, mostly in the Scandinavian countries, usually applied to patients with widespread and long-lasting musculoskeletal pain and/or psychosomatic disorders. Few studies have investigated the outcomes of NPMP, and no randomized clinical trials (RCT) with a comparing treatment group have systematically been tried out on individuals.

METHODS

This is a pragmatic, single-blinded RCT where 128 participants with long-lasting widespread musculoskeletal pain and/or pain located to the neck and shoulders were block randomized to NPMP or Cognitive Patient Education combined with active individualized physiotherapy (COPE-PT). Intention-to-treat with linear mixed models were used to estimate the group differences in treatment effects. The outcomes at 3, 6, and 12 months follow-up were pain intensity, function, anxiety and depression, quality of life, sleep, fear of movement, and subjective health complaints. Risk profile (Örebro) was examined at 3 and 6 months. All participants underwent physical tests at baseline and 6 months.

RESULTS

One-year data were available for 66.4% of the original participants. Calculated with intention-to-treat analysis, at 3 months statistically significant differences were found in favor of COPE-PT for pain, anxiety and depression, quality of life-physical dimension, risk profile and fear of movement. At 6 months, statistically significant differences in favor of COPE-PT were found for anxiety and depression, and sleep. At 12 months, the improvements were still statistically significant for anxiety, depression and sleep. Both groups improved, but no statistically significant differences were found between the groups on the physical tests at 6 months.

CONCLUSIONS

COPE-PT, which is targeted towards pain-coping and increasing activity, contribute to more improvements than NPMP.

The effect of psychomotor physical therapy on health-related quality of life, pain, coping, self-esteem, and social support

BACKGROUND

Norwegian psychomotor physiotherapy (NPMP) is commonly applied for patients with long-lasting pain and psychological symptoms. The approach is based on a bio-psychosocial model of health and might have benefits to physical, psychological, and physical domains of health-related quality of life (HRQOL). No previous randomized controlled clinical trials have been performed to examine the effectiveness of NPMP as individual treatment. The aim was therefore to assess the effect of a 6-month intervention of NPMP on HRQOL and on pain, coping, social support, and self-esteem.

METHODS

The study was a pragmatic randomized controlled trial comparing an intervention group with a control group. Participants were recruited from 36 physiotherapists specialized in NPMP, working in private practice. The intervention group received NPMP once weekly for 6 months, whereas the control group received no intervention. Measurements were performed at baseline and after 6 months. A total of 105 participants were included. HRQOL was measured by the 36-item Short Form Health Survey, SF-36. To examine the effect of the intervention, independent sample t tests were performed with the "difference in mean values," delta (=∆, posttest result - baseline result).

RESULTS

Significant differences between the two groups were observed in six of the eight SF-36 domains: Physical Functioning, Bodily Pain, General Health, Mental Health, Social Functioning, and Vitality. Effect size ranged from 0.9 for Vitality to 0.3 for Role Physical and Role Emotional. Furthermore, there was a significant difference between groups regarding pain and self-esteem in favour of the intervention group. The Cohen's d effect sizes of the different dimensions of HRQOL ranged from 0.3 to 0.9 with a median of 0.6.

CONCLUSION

The results of this study demonstrate that 6-month intervention of NPMP increased HRQOL and self-esteem as well as reduced pain.

Study protocol for Norwegian Psychomotor Physiotherapy versus Cognitive Patient Education in combination with active individualized physiotherapy in patients with long-lasting musculoskeletal pain - a randomized controlled trial

Background

Norwegian Psychomotor Physiotherapy (NPMP) has been an established treatment approach for more than 50 years, although mostly in the Scandinavian countries, and is usually applied to patients with widespread and long-lasting musculoskeletal pain and/or psychosomatic disorders. Few studies have been investigating outcome of NPMP and no randomized clinical trials (RCT) have been systematically tried out on individuals.

Methods/design

This is a study protocol for a pragmatic, single blinded RCT, which will take place in a city of Norway. The participants will be block randomized either to receive NPMP or Cognitive Patient Education in combination with active individualized physiotherapy (COPE-PT). The intervention will reflect usual care and will be conducted in physiotherapy clinics by five experienced physiotherapists in each of the two treatment approaches.

Discussion

The findings of the present study may give an important contribution to our knowledge of the outcome of NPMP, on patients with long-lasting widespread musculoskeletal pain and/or pain located to the neck and shoulder region.

Trial registration

The study has been registered with ClinicalTrials.gov (June 9 th 2015, NCT02482792).

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1159-8) contains supplementary material, which is available to authorized users.

Examination and treatment of patients with unilateral vestibular damage, with focus on the musculoskeletal system: a case series

BACKGROUND AND PURPOSE

Persistent dizziness and balance problems have been reported in some patients with unilateral vestibular pathology. The purpose of this case series was to address the examination and treatment of musculoskeletal dysfunction in patients with unilateral vestibular hypofunction.

CASE DESCRIPTION

The musculoskeletal system was evaluated with the Global Physiotherapy Examination, dynamic balance was measured during walking with triaxial accelerometers positioned on the lower and upper trunk, and symptoms and functional limitations were assessed with standardized self-report measures. The 4 included patients had symptoms of severe dizziness that had lasted more than 1 year after the onset of vestibular dysfunction and a moderate level of perceived disability. Musculoskeletal abnormalities typically included postural misalignment, restricted abdominal respiration, restricted trunk movements, and tense muscles of the upper trunk and neck. The patients attended a modified vestibular rehabilitation program consisting of body awareness exercises addressing posture, movements, and respiration.

OUTCOMES

After the intervention, self-reported symptoms and perceived disability improved. Improvements in mobility and positive physical changes were found in the upper trunk and respiratory movements. The attenuation of mediolateral accelerations (ie, body oscillations) in the upper trunk changed; a relatively more stable upper trunk and a concomitantly more flexible lower trunk were identified during walking in 3 patients.

DISCUSSION

The recovery process may be influenced by self-inflicted rigid body movements and behavior strategies that prevent compensation. Addressing physical dysfunction and enhancing body awareness directly and dizziness indirectly may help patients with unilateral vestibular hypofunction break a self-sustaining cycle of dizziness and musculoskeletal problems. Considering the body as a functional unit and including both musculoskeletal and vestibular systems in examination and treatment may be important.