The experiences of basic body awareness therapy in patients with schizophrenia

Effectiveness of Physical Exercise on Pain, Disability, Job Stress, and Quality of Life in Office Workers with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial

Neck pain is a widespread medical condition among office workers worldwide. This study aimed to compare physical exercises, including basic body awareness, neck-specific training exercises and ergonomic modifications, and ergonomic modifications alone in the management of chronic non-specific neck pain (NSNP) among office workers. Sixty participants were randomly allocated to an experimental group (physical exercises and ergonomic modifications) or a control group (ergonomic modifications) and received the intervention two times a week for eight weeks. The Numerical Pain Rating Scale, Neck Disability Index, Health and Safety Stress Tool, and Short Form Health Survey-36 were used to measure pain, disability, job stress, and quality of life at baseline, and at weeks 4 and 8 of the study period. A repeated measure ANOVA was used to determine the within-group significant differences and an independent t-test was utilized to compare group differences. The baseline data of the experimental and control groups showed no significant difference (p ≥ 0.05). The 2 × 3 mixed models ANOVA showed a significant difference in pain intensity (p = 0.001, ηp2 = 0.042), functional disability (p = 0.001, ηp2 = 0.052), work-related stress (p = 0.001, ηp2 = 0.036), and QoL (p = 0.012, ηp2 = 0.025). Four weeks post-intervention, the experimental group showed significant changes in primary (pain intensity and disability) (1.9; 95% confidence interval 1.65-2.14) and secondary (quality of life and work-related stress) outcomes (p < 0.001). The same gradual improvement in these variables was observed in the 8-week follow-up (p < 0.001). There was a significant improvement in clinical outcomes following the application of physical exercises with ergonomic modifications for chronic NSNP among office workers. This is significant for office workers because it suggests the importance of incorporating physical exercises into their daily routine and making ergonomic changes to their workspaces.

"InMotion"-Mixed physical exercise program with creative movement as an intervention for adults with schizophrenia: study protocol for a randomized controlled trial

Background

Schizophrenia is among the world's top 10 causes of long-term disability with symptoms that lead to major problems in social and occupational functioning, and in self-care. Therefore, it is important to investigate the efficacy of complementary treatment options for conventionally used antipsychotic medication, such as physical training, and psychosocial interventions.

Objective

To combine aerobic and strength training with cognitive, emotional and social stimulation in one intervention for people with schizophrenia and test the feasibility and effects of this intervention.

Methods

The study is a mixed-method randomized controlled trial to evaluate the effects of a 12-week intervention for adults with schizophrenia. The treatment group (30 participants) will receive the intervention in addition to standard care and the control group (30 participants) only standard care. The intervention consists of 24 biweekly sessions with a duration of 60 min. The pre-test (weeks from 4 to 2 prior to the intervention) and post-test (week 12) include clinical measure (PANSS), quality of life, social performance, movement quantity, brain function and eye tracking measures. In addition, a treatment subgroup of 12-15 participants and their family member or other next of kin will complete a qualitative interview as a part of their post-test. Two follow-up tests, including clinical, quality of life, brain function and eye tracking will be made at 6 and 12 months from the completion of the intervention to both study groups. The primary outcome is change in negative symptoms. Secondary outcome measures include general and positive symptoms, quality of life, social performance, movement quantity, brain function and eye tracking. Explorative outcome includes patient and family member or other next of kin interview.

Results

Pilot data was collected by June 2023 and the main data collection will begin in September 2023. The final follow-up is anticipated to be completed by 2026.

Conclusion

The InMotion study will provide new knowledge on the feasibility, efficacy, and experiences of a novel intervention for adults with schizophrenia. The hypothesis is that regular participation in the intervention will reduce clinical symptoms, normalize physiological measures such as brain activation, and contribute to new active habits for the participants.

Trial registration

ClinicalTrials.gov, identifier NCT05673941.

The effect of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke

OBJECTIVES

This study was conducted to examine the effects of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke.

METHODS

35 individuals between the ages of 21 and 78 who were diagnosed with stroke were included in the study. The body awareness of the individuals participating in the study was determined with the Body Awareness Questionnaire (BAQ), trunk control with Trunk Impairment Scale (TIS), the affected upper extremity functions with Motor Activity Log-28 (MAL,-28), and Fugl-Meyer Upper Extremity Assessment (FMUEA), balance with Berg Balance Scale (BBS), fear of falling with Tinetti Falls Efficacy Scale (TFES), functional level with Barthel Activities of Daily Living Index (BI) and level of independence with Functional Independence Measures (FIM).

RESULTS

For patients participating in the study, 26% were female, 74% were male and 43% showed left, 57% showed right hemisphere involvement. In simple linear regression analysis, BAQ measurement had a statistically significant effect on TIS (F = 25.439 p = 0.001), MAL-28 (F = 7.852 p = 0.008), FMUEA (F = 12.155 p = 0.001), BBS (F = 13.506 p = 0.001), TFES (F = 13.119 p = 0.001), BI (F = 19.977 p = 0.001) and FIM (F = 22.014 p = 0.001) in patients with stroke.

CONCLUSIONS

In conclusion, body awareness was found to be one of the factors affecting trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. It was thought that there was a need for assessment of body awareness and include bodyawareness in rehabilitation programs in patients with stroke.

Efficacy of basic body awareness therapy on functional outcomes: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

This study examined the efficacy of basis body awareness therapy (BBAT) on functional outcomes and quality of life (QoL) in patients with mental health problems and long-lasting conditions including musculoskeletal disorders, chronic and psychosomatic pain, and neurological conditions.

MATERIAL AND METHODS

Randomized controlled trials (RCTs) were obtained from MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro from inception to April 1st, 2022. A random effects meta-analysis was performed to explore the efficacy of BBAT versus non-active and active control conditions.

RESULTS

Eight RCTs (n BBAT = 307, n controls = 428) were included. There was no evidence for reductions in anxiety (standardized mean difference [SMD] = -1.42, 95% confidence interval [CI] = -3.30 to 0.46, p = 0.14), depression (SMD = -0.82, 95% CI = -1.85 to 0.21, p = 0.12), and no improvements in global assessment of functioning for functioning (GAF-F) (SMD = 0.58, 95% CI = -0.03 to 1.19, p = 0.06) or for symptoms (GAF-S) (SMD = 0.76, 95% CI = -0.44 to 1.96, p = 0.21) in BBAT versus non-active control conditions. BBAT reduced anxiety significantly more than active interventions (SMD = -0.84, 95% CI = -1.17 to -0.51, p < 0.001). No significant differences between BBAT and active control conditions were found for reduction in depression (SMD = -1.16, 95% CI = -2.74 to 0.41, p = 0.15) or in self-reported pain (SMD = 0.08, 95% CI = -0.25 to 0.40, p = 0.65). Active control conditions were superior in improving QoL (SMD = 0.83, 95% CI = 0.49 to 1.17, p < 0.001), GAF-F (SMD = 1.58, 95% CI = 0.29 to 2.86, p = 0.016) and GAF-S (SMD = 1.19, 95% CI = 0.85 to 1.53, p < 0.001).

CONCLUSIONS

Physiotherapists should be cautious in adopting BBAT, noting there is no high-quality evidence to support its' use to improve functionality and QoL in patients with mental health problems and/or long-lasting conditions.

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.

Physiotherapists' conceptions of movement awareness- A phenomenographic study

The phenomenon of movement awareness requires more attention to make it explicit in physiotherapy. The aim of this study was to explore the variation in physiotherapists' conceptions of movement quality, focusing on movement awareness. The informants were 15 physiotherapists from a variety of physiotherapy fields. We collected data through two group interviews and used the phenomenographic method to analyze them. Four themes emerged from the data: 1) Being in contact with one's own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness. These themes varied by four descriptive categories of the movement awareness phenomenon: (I) Hesitation regarding own movement experiences; (II) Momentary contact with own movement experiences; (III) Presence in movement awareness and (IV) Better understanding of others' movement awareness. The physiotherapists' understanding of the movement awareness phenomenon widened through three critical aspects in the descriptive categories: Recognizing one's own movement awareness, Distinguishing one's own and others' movement awareness and New insights into implementing actions related to movement awareness in physiotherapy. These results can expand the understanding of the phenomenon of movement awareness among physiotherapists, although further research is needed.

EFFECT OF EXTREME CONDITIONING TRAINING ON BODY PERCEPTION

ABSTRACT Introduction Extreme conditioning training (ECT) has become a popular method, characterized by a wide variety of exercises. For good technical performance, practitioners must have good perception of the different parts of the body; however, it is not known whether this perception differs between practitioners and non-practitioners of ECT. Objective To analyze the perception of body dimensions among subjects submitted to an ECT session. Methods Adult men were divided into TRAINED (n = 10) and UNTRAINED (n = 10). All subjects were submitted to a combination of high-effort multiarticular exercises for a set period of nine minutes (“the largest possible number of repetitions” [AMRAP]). For the procedure of marking the body pattern, the subjects were scored in terms of acromioclavicular joints, waist and trochanter. Results Regarding the general perception of body size, the TRAINED and UNTRAINED groups were classified as adequate for each stage. In the dimension of body segments, there was an overestimation of the shoulder region in both groups (TRAINED Pre = 105.2 ± 8.37; Post = 117.23 ± 22.11 [ES = 0.79]; 30 min = 101.34 ± 14.21 [ES = 0.34] and UNTRAINED Pre = 96.72 ± 12.79; Post = 99.47 ± 12.17 [ES = 0.22]; 30 min = 111.05 ± 11.06 [ES = 1.27]). The perception of the waist region improved significantly after training (TRAINED Pre = 114.11 ± 16.4; Post = 117.7 ± 20.16 [ES = 0.20]; 30 min = 104.59 ± 11.46 [ES = 0.68] and UNTRAINED Pre = 114.66 ± 9.88; Post = 104.64 ± 12.87; [ES = 0.88]; 30 min = 108.36 ± 12.32 [ES = 0.57]). Conclusion ECT can promote better perception of body dimensions. In addition, the assessment of body size in active, but untrained individuals showed a better body perception, albeit a transitory effect. Level of evidence II; Therapeutic studies - investigation of treatment results.

Patients' Experiences of a Stress-Management Programme in Primary Care

Introduction

Stress and stress-related ill health have a multifactorial impact; both on physical and mental health. To better meet this category of patients a primary care unit started a stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

Purpose

To describe participant´s experiences of a primary care stress-management programme using cognitive behavioural therapy and basic body awareness therapy.

Methods

In a qualitative study, a semi-structured interview guide was used in individual interviews with 9 people, all women aged 41–57, working or on sick leave, who had enrolled in the stress-management programme. The material was analysed through qualitative content analysis.

Results

The analysis resulted in the theme “Process of change for a sustainable everyday living”. The participants described having gained awareness of the symptoms of their stress, knowledge and tools to manage their stress, ways to relax, awareness of their body, and the means to develop better habits and to change their behaviour. Fundamental in the material was the importance of participants’ identification with the others in the group.

Conclusion

The participants started a process of change with new knowledge and growth, but they encountered difficulties and obstacles. Behavioural change is a time-consuming process.

Body-Centered Interventions for Psychopathological Conditions: A Review

World-wide, billions of dollars are spent each year on body-centered interventions to alleviate both physical and psychological pathologies. Given the high demand and increasing popularity of body-centered interventions, there is need for a systematic organization of empirical evidence associated with body-centered therapies. This article reviews the psychological effects of body-centered interventions on emotional well-being, including both self and other-administered (receptive) therapies. Theory behind body-centered interventions rely upon the bidirectional communication pathway between the brain and body. We investigated the bidirectional communication pathway between the brain and body by evaluating evidence across multiple body-centered therapies. The research reviewed includes studies that investigate effects of massage therapy, reflexology, acupuncture, functional relaxation, emotional freedom technique, Rolfing, yoga, tai-chi, and dance/movement therapy on psychological conditions across the lifespan. Results demonstrated that overall, massage therapy, tai-chi, dance/movement therapy, functional relaxation, reflexology, acupuncture and emotional freedom technique seem to alleviate stress, depression, anxiety, bipolar disorder and facilitate pain reduction. Of these, the most robust evidence available was for massage therapy, indicating it is an effective intervention for numerous age groups and populations. Rolfing and reflexology had the least amount of support, with few studies available that had small sample sizes. Although these conclusions are limited by scarcity of high-quality empirical data and contradictory findings, available evidence indicates that body-centered interventions can be effective in reducing psychopathology and supports the proposed mechanism of the bidirectional pathway between the brain and body: the body holds the potential to influence the mind. Integrating body-centered therapies in both clinical settings and as self-care could lead to better outcomes. Lastly, we propose the first taxonomy of body-centered interventions and empirical evidence of their effectiveness for clinicians and researchers.

Pain requires processing - How the experience of pain is influenced by Basic Body Awareness Therapy in patients with long-term pain

BACKGROUND AND PURPOSE

Long-term pain is common and entails large costs to society. One physiotherapy treatment with documented positive effects for patients with long-term pain is Basic Body Awareness therapy (BBAT). However, studies are lacking about patients' experience of BBAT's influence on their pain. Therefore, the aim of this study was to investigate how patients experience BBAT's influence on their long-term pain.

METHODS

For this qualitative interview study, participants were selected from two supervised BBAT groups. To qualify for the study, participants had to meet two inclusion criteria: having pain for at least 6 months, and attending BBAT for at least 6 months. Six females between the ages of 25 and 61 years were included. Pain duration ranged from 9 to 20 years, and duration of practicing BBAT ranged from 8 to 120 months. Semi-structured interviews were conducted and qualitative content analysis was performed.

RESULTS

The analysis revealed four main categories of BBAT experience: increases motivation, requires processing, increases control over pain and changes attitude to oneself, body and pain.

DISCUSSION

Patients with long-term pain experienced BBAT as being helpful in processing their pain because they were forced to face the pain instead of trying to ignore it. Participants experienced a decrease in pain through development of an increased sense of control as well as a changed attitude to themselves, their bodies and their pain. It is important for physiotherapists to understand that pain can increase during BBAT and to support the patients in this process during the therapy.

Further validation of the Japanese version of the Multidimensional Assessment of Interoceptive Awareness

Objective

The Multidimensional Assessment of Interoceptive Awareness (MAIA) is a validated measure to assess interoceptive awareness. Although an earlier study evaluated the Japanese version of the MAIA, it did not examine the measure’s test–retest reliability and the data fit of the factor structure. This study aims to further validate the Japanese version of the MAIA.

Results

In this cross-sectional study, 268 Japanese individuals participated. They completed the Japanese version of the MAIA and concurrent validity measures. The test–retest reliability of the Japanese version’s subscales ranged from adequate to high (intra-class coefficients = 0.76–0.85). Confirmatory factor analysis demonstrated that the Japanese six-factor structure had a good fit in Japanese. The MAIA subscales were moderately associated with scores on the Body Awareness Scale (rho = 0.25–0.49). The results indicated high test–retest reliability and further confirmed the validity of the six-factor structure of the Japanese version of the MAIA. Hence, the Japanese version of the MAIA is a useful measure to assess interoceptive awareness in the Japanese population.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4556-x) contains supplementary material, which is available to authorized users.

Experiences from group basic body awareness therapy by patients suffering from fibromyalgia: A qualitative study

The aim of this study was to obtain a deeper understanding of how patients with fibromyalgia experienced movement awareness through a basic body awareness therapy group treatment program. A total of 19 participants with fibromyalgia diagnosis were interviewed individually and in groups. Data collection was done from three sources: (1) interviews from the Basic Body Awareness Rating Scale (BARS) part 2 at baseline, at end of treatment, as well as at 12 and 24 weeks follow up; (2) focus group discussions that took place at the end of each session, and at the end of treatment; and (3) an in-depth focus group. Giorgi's method was followed for data construction and analysis. The researchers conducted 57 individual interviews, 10 focus groups, and one in-depth focus group. The findings revealed the following categories: "creating a new relation to self"; "change the pattern of body awareness"; "being in a group"; and "experiencing physical capacity", showing influences among them. Body awareness seems to have an impact in the therapeutic process in patients suffering from fibromyalgia.

Therapeutically efficient components of Basic Body Awareness Therapy as perceived by experienced therapists - A qualitative study

BACKGROUND

Basic Body Awareness Therapy (BBAT) is a physiotherapeutic method used in rehabilitation to increase physical and emotional balance. The aim was to identify and describe perceived therapeutically efficient components of BBAT.

METHODS

Twenty-four experienced BBAT therapists participated in focus group interviews. The data were analysed with content analysis.

RESULTS

One central theme, the therapeutic space consisted of two categories; the therapeutic encounter and the therapeutic tools, which emerged as the core of the perceived therapeutically efficient components. The therapeutic encounter entailed the therapeutic approach, affect attunement, continuous interaction during treatment, affect mirroring and communicating by use of a person-centred approach. The therapeutic tools included adjustment and adaptation, the use of manual, verbal and non-verbal guiding, and creating an atmosphere of safety and sanctuary.

CONCLUSION

The significance of interaction by use of a person-centred approach combined with the ability to continuously adjust the treatment constituted useful guidelines when designing rehabilitation using BBAT treatment.

THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE

BACKGROUND

This study is to investigate the effect of Body Awareness Therapy (BAT) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache (TTH).

MATERIALS AND METHOD

Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study. The individuals were randomly grouped into 3 as BAT (n=20), aerobic exercise (n=20) and control group (n=20). Pain severity of the individuals was evaluated by Visual Analog Scale (VAS) and pain diary, disability with ache; by Pain Disability Index (PDI) and Headache Impact Tests (HIT) and quality of life was evaluated by SF-36. Subsequent to first assessments, 3 sessions of 60 minutes per week throughout 6 weeks totally.

RESULTS

When the groups were compared at the end of the study, a significant decrease was observed in VAS, PDI and HIT values in the individuals in the BAT and aerobic exercise groups. With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly.

CONCLUSION

BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain, in increasing the quality of life and in reducing pain-related daily constraints of the individuals.

Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists

BACKGROUND

After a stroke many patients have muscle weakness, spasticity and compromised sensation leading to decreased postural stability. Basic Body Awareness Therapy includes slow movements that challenge postural control.

AIM

The aim was to describe experiences of 8 weeks of Basic Body Awareness Therapy from the perspective of both patients with stroke and physiotherapists.

METHOD

This study had a qualitative design. Twenty-one patients and four physiotherapists were interviewed. The interviews were analysed using manifest and latent content analysis.

RESULTS

One overall theme emerged "Simple yet challenging" which was based on six categories: "Facing one's limitations", "Individualized movements", "A feeling of harmony", "Improved balance", "Integrated knowledge" and "Frustration and doubt". The patients described improvement in balance and stability, as well as increased wellbeing.

CONCLUSION

The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body.

Effect of body awareness training on balance and walking ability in chronic stroke patients: a randomized controlled trial

[Purpose] To investigate the effects of body awareness training on balance and walking ability in chronic stroke patients. [Subjects] The subjects were randomly assigned to a body awareness training group (n=6) and a control group (n=6). [Methods] Patients in the body awareness training group received body awareness training for 20 minutes, followed by walking training for 30 minutes a day, 5 days a week for 4 weeks. The control group received walking training for 30 minutes a day, 5 days a week for 4 weeks. [Results] After the intervention, both groups showed significant improvements in the Berg Balance Scale, Timed Up and Go Test, and 10 m walk test compared with baseline results. The body awareness training group showed more significant improvements in the Berg Balance Scale and Timed Up and Go Test than the control group. There was no significant difference in the 10 m walk test between the groups. [Conclusion] The results of this study suggest that body awareness training has a positive effect on balance in patients with chronic stroke.

Treatment of traumatised refugees with basic body awareness therapy versus mixed physical activity as add-on treatment: Study protocol of a randomised controlled trial

Background

Treatment of traumatised refugees is one of the fields within psychiatry, which has received little scientific attention. Evidence based treatment and knowledge on the efficiency of the treatment for this complex patient group is therefore scarce. This leads to uncertainty as to which treatment should be offered and potentially lowers the quality of life for the patients.

Chronic pain is very common among traumatised refugees and it is believed to maintain the mental symptoms of trauma. Hence, treating chronic pain is believed to be of high clinical value for this patient group.

In clinical studies, physical activity has shown a positive effect on psychiatric illnesses such as depression and anxiety and for patients with chronic pain. However, scientific knowledge about physical activity as part of the treatment for traumatised refugees is very limited and no guidelines exist on this topic.

Methods/design

This study will include approximately 310 patients, randomised into three groups. All three groups receive psychiatric treatment as usual for the duration of 6–7 months, consisting of consultations with a medical doctor including pharmacological treatment and manual-based Cognitive Behavioural Therapy. The first group only receives treatment as usual while the second and the third groups receive either Basic-Body Awareness Therapy or mixed physical activity as add-on treatments. Each physical activity is provided for an individual 1-hour consultation per week, for the duration of 20 weeks. The study is being conducted at the Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup in the Capital Region of Denmark.

The primary endpoint of the study is symptoms of Post Traumatic Stress Disorder; the secondary endpoints are depression and anxiety as well as quality of life, functional capacity, coping with pain, body awareness and physical fitness.

Discussion

This study will examine the effect of physical activity for traumatised refugees. This has not yet been done in a randomised controlled setting on such a large scale before. Hereby the study will contribute to important knowledge that is expected to be used in future clinical guidelines and reference programs.

Trial registration

ClinicalTrials.gov NCT01955538. Date of registration: 18 September 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-015-0974-9) contains supplementary material, which is available to authorized users.

Considering the Role of Physical Therapists Within the Treatment and Rehabilitation of Individuals With Eating Disorders: An International Survey of Expert Clinicians

PURPOSE

Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research.

METHODS

An international cross-sectional survey design was undertaken with experienced physical therapists within the field of EDs. Physical therapist responses were analysed with descriptive statistics and thematic analysis as appropriate.

RESULTS

Twenty-eight international physical therapists participated. On average, participants had 6.9 years (95% confidence interval: 3.1-10.7, n = 27) of clinical experience working in ED settings and devoted approximately 39.3% (95% confidence interval: 23.8-54.8, n = 27) of their time to treating individuals with EDs. Participants reported that physical therapy interventions have a diverse range of benefits on the physical, mental and disease-specific factors (e.g. binges) in people with EDs. The key role of physical therapists includes improving body awareness, especially during physical activity combined with psycho-education about healthy doses of physical activity. Physical therapists were able to identify a range of barriers and facilitators to physical activity in people with EDs.

DISCUSSION

This paper provides a first step towards understanding the role and value of physical therapists working with individuals with EDs. Copyright © 2015 John Wiley & Sons, Ltd.

Opening toward life: experiences of basic body awareness therapy in persons with major depression

Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants’ experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.

Effects of body awareness training on mild visuospatial neglect in patients with acute stroke: a pilot randomized controlled trial

[Purpose] This study aimed to investigate the effects of body awareness training (BAT) on mild visuospatial neglect in patients following acute stroke. [Subjects] The subjects were 12 stroke patients randomly assigned to either the experimental group (n₁=6) or control group (n₂=6). [Methods] The experimental group underwent BAT for 15 minutes and then task-oriented training for 30 minutes a day, five times a week for three weeks. The control group underwent task-oriented training for 30 minutes a day, five times a week for three weeks. Assessments were made using the Motor-free Visual Perception Test (MVPT), Line Bisection Test (LBT), and modified Barthel index (MBI). [Results] Following the interventions, the experimental group showed a significant change in MVPT, LBT, and MBI scores. [Conclusion] The results of this study suggest the feasibility and suitability of BAT with task-oriented training for mild visuospatial neglect in patients with acute stroke.

Barriers, benefits, and strategies for physical activity in patients with schizophrenia

BACKGROUND

Patients with schizophrenia have a substantially increased risk of cardiovascular disease and premature death compared with the general population. High prevalence of an unhealthy lifestyle contributes to the increased risk in these patients. Patients with schizophrenia are often physically inactive, and there is limited knowledge on the factors, such as barriers and incentives, that can influence physical activity in this patient group.

OBJECTIVE

The aim was to study the perception and experience of barriers to and incentives for physical activity in daily living in patients with schizophrenia, as reported by the patients themselves.

DESIGN

An explorative study applying conventional qualitative content analysis was conducted.

METHODS

A purposeful sample of 20 patients with schizophrenia or schizoaffective disorder (13 men, 7 women; 22-63 years of age) registered at 3 psychiatric outpatient clinics in Sweden were interviewed using semistructured interviews.

RESULTS

The analysis resulted in 3 main themes: (1) barriers-factors that complicate or obstruct physical activity, (2) reward-the motivation for physical activity, and (3) helpful strategies.

LIMITATIONS

The results may not reflect important factors related to physical activity in older patients (>65 years of age), newly diagnosed patients, or inpatients.

CONCLUSIONS

In accordance with patients' perceptions, there may be biopsychosocial determinants of physical activity behavior that are unique for this group of patients. Future studies should investigate whether physical activity interventions for patients with schizophrenia benefit from individual analyses of barriers and reward for physical activity in combination with the use of tailored strategies such as personal support and activity planning.

Are there associations among physical activity, fatigue, sleep quality and pain in people with mental illness? A pilot study

Good mental health is imperative to well-being. Symptoms of fatigue, chronic pain and poor sleep are common in people with mental illness and contribute to substantial loss of functioning. Physical exercise interventions have shown to decrease these symptoms in a range of populations; however, their possible association with physical activity related to day-to-day functioning have not been explored in people hospitalized with severe mental illness. Inpatients (n = 4) of a metropolitan mental health facility were fitted with an Actiwatch, which collected physical activity and sleep measures for an anticipated 14-day data collection period. During this time, morning and evening pain and fatigue scores were collected on an 11-point numerical rating scale. Significant associations were found between morning pain and morning fatigue scores (β = -0.44, P = 0.023), morning pain and physical activity (β = 12.34, P = 0.042), and physical activity and evening pain scores (β = 0.20, P = 0.017). Fatigue tended towards interfering more with quality of life than did pain, but this was not significant (P = 0.07). This study provided preliminary data suggesting associations between pain and fatigue, and intensity of pain and physical activity levels. This information can be used to generate hypotheses for future clinical trials.

Exercise or basic body awareness therapy as add-on treatment for major depression: a controlled study

BACKGROUND

While physical exercise as adjunctive treatment for major depression has received considerable attention in recent years, the evidence is conflicting. This study evaluates the effects of two different add-on treatments: exercise and basic body awareness therapy.

METHODS

Randomized controlled trial with two intervention groups and one control, including 62 adults on antidepressant medication, who fulfilled criteria for current major depression as determined by the Mini International Neuropsychiatric Interview. Interventions (10 weeks) were aerobic exercise or basic body awareness therapy (BBAT), compared to a single consultation with advice on physical activity. Primary outcome was depression severity, rated by a blinded assessor using the Montgomery Asberg Rating Scale (MADRS). Secondary outcomes were global function, cardiovascular fitness, self-rated depression, anxiety and body awareness.

RESULTS

Improvements in MADRS score (mean change=-10.3, 95% CI (-13.5 to -7.1), p=0.038) and cardiovascular fitness (mean change=2.4ml oxygen/kg/min, 95% CI (1.5 to 3.3), p=0.017) were observed in the exercise group. Per-protocol analysis confirmed the effects of exercise, and indicated that BBAT has an effect on self-rated depression.

LIMITATIONS

The small sample size and the challenge of missing data. Participants׳ positive expectations regarding the exercise intervention need to be considered.

CONCLUSIONS

Exercise in a physical therapy setting seems to have effect on depression severity and fitness, in major depression. Our findings suggest that physical therapy can be a viable clinical strategy to inspire and guide persons with major depression to exercise. More research is needed to clarify the effects of basic body awareness therapy.

Complex symptomatology among young women who present with stress-related problems

INTRODUCTION

In Scandinavia and globally, mental health and stress-related problems among adolescent girls and young women are public health concerns that need attention. The aim of this study was to investigate mental health and somatic symptoms with a special focus on internalised problems, self-image and body-mind aspects of body perception in a group of adolescent girls and young women presenting with stress-related problems at a youth-friendly Swedish health centre, and to compare them with normative and clinical reference groups.

METHODS

The participants were 47 adolescent girls and young women, aged 17-25 years. The adult self-report (ASR), social analysis of social behaviour (SASB) and body perception questionnaire (BPQ) were used to measure multiple symptom areas.

RESULTS

Compared to reference groups, adolescent girls and young women report complex symptomatology with high levels of internalised problems such as anxiousness, depression and somatic complaints. This manifested in attention problems, negative self-image and perceived bodily discomfort and distrust.

CONCLUSION

Adolescent girls and young women emerging into adulthood present complex symptomatology of stress-related problems. This study gathered valuable information about their symptoms when they were seeking help. These young women showed higher symptom frequency than normative groups, and similar or higher symptom frequency than other clinical groups. Our findings of internalised and cognitive problems, including impaired self-image and body perceptions, point to the need for preventive strategies and tailored multidisciplinary interventions involving body-based methods to meet this complexity. Using tenets of stress theory, the complex symptomatology may be understood as logical responses to overwhelming stimuli and demands that exceed their ability to cope and disturb their 'equilibrium'. However, the complex gendered interplays between various external/internal stressors and a broad range of stress responses and health outcomes need further study in a long-term perspective.

Body awareness therapy in persons with stroke: a pilot randomized controlled trial

OBJECTIVE

To investigate the effects of body awareness therapy on balance, mobility, balance confidence, and subjective health status in persons with stroke.

DESIGN

A pilot randomized controlled study with follow-up at one and 4-6 weeks after the intervention period.

SETTING

Four primary healthcare centres in Örebro County Council.

SUBJECTS

Persons more than six months post stroke, with walking ability of 100 metres.

INTERVENTION

The experimental intervention was body awareness therapy in groups once a week for eight weeks. The controls were instructed to continue their usual daily activities.

MAIN MEASURES

Berg Balance Scale, Timed Up and Go Test, Timed Up and Go Test with a cognitive component, 6-minute walk test, and Timed-Stands Test. Self-rated balance confidence was assessed using the Activities-specific Balance Confidence Scale, and subjective health status using the Short Form 36 (SF-36) questionnaire.

RESULTS

A total of 46 participants were included (mean age 64 years); 24 in the experimental intervention group and 22 in the control group. No significant differences in changed scores over time were found between the groups. Within the experimental intervention group, significant improvements over time was found for the tests Berg Balance Scale, Timed Up and Go cognitive, and 6-minute walk test. Within the control group, significant improvements over time were found for the Timed Up and Go Cognitive, and the Timed-Stands Test.

CONCLUSION

In comparison to no intervention, no effects were seen on balance, mobility, balance confidence, and subjective health status after eight weeks of body awareness therapy.

Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia

BACKGROUND

Although schizophrenia is the fifth leading cause of disability-adjusted life years worldwide in people aged 15 to 44 years, the clinical evidence of physical therapy as a complementary treatment remains largely unknown.

PURPOSE

The purpose of this study was to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of physical therapy for people with schizophrenia.

DATA SOURCES

EMBASE, PsycINFO, PubMed, ISI Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were searched from their inception until July 1, 2011, for relevant RCTs. In addition, manual search strategies were used.

STUDY SELECTION

Two reviewers independently determined study eligibility on the basis of inclusion criteria.

DATA EXTRACTION

Reviewers rated study quality and extracted information about study methods, design, intervention, and results.

DATA SYNTHESIS

Ten RCTs met all selection criteria; 6 of these studies addressed the use of aerobic and strength exercises. In 2 of these studies, yoga techniques also were investigated. Four studies addressed the use of progressive muscle relaxation. There is evidence that aerobic and strength exercises and yoga reduce psychiatric symptoms, state anxiety, and psychological distress and improve health-related quality of life, that aerobic exercise improves short-term memory, and that progressive muscle relaxation reduces state anxiety and psychological distress.

LIMITATIONS

The heterogeneity of the interventions and the small sample sizes of the included studies limit overall conclusions and highlight the need for further research.

CONCLUSIONS

Physical therapy offers added value in the multidisciplinary care of people with schizophrenia.

How can movement quality be promoted in clinical practice? A phenomenological study of physical therapist experts

BACKGROUND

In recent years, physical therapists have paid greater attention to body awareness. Clinicians have witnessed the benefits of supporting their patients' learning of movement awareness through the promotion of their movement quality.

OBJECTIVE

The aim of this study was to investigate how physical therapist experts promote movement quality in their usual clinical settings.

DESIGN

A phenomenological research design that included a sampling strategy was devised. Using specific criteria, 6 lead physical therapists nominated a group of physical therapist experts from the fields of neurology, primary health care, and mental health. Fifteen informants, 5 from each field, agreed to participate.

METHODS

In-depth interviews were conducted with a semistructured interview guide. The informants were invited to simply describe what they had experienced to be successful therapeutic processes for promoting movement quality. Each interview was audiotaped and transcribed. The data analysis was based on a multistep model.

RESULTS

Three main themes emerged from the data. First, the physical therapists' embodied presence and movement awareness served as a precondition and an orientation for practice. Embodied presence is a bodily felt sense, a form of personal knowing that evokes understanding and fosters meaning. Second, creating a platform for promoting movement quality revealed implementation of psychological attitudes. Third, action strategies for promoting movement quality suggested a movement awareness learning cycle and components for clinical use.

CONCLUSIONS

This study demonstrated specific attitudes and skills used by physical therapist experts to promote movement quality in their clinical practice. These results may serve as a therapeutic framework for promoting movement quality in clinical physical therapy, although further research is needed.