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Mirza M, Trimboli C, Hartman J, Gamble A, Rfat M, Bentley J, Gross M, Alheresh R, Hussein Q, Markos T. Examining Barriers to Rehabilitation and Addressing Rehabilitation Needs among Persons with Forced Migration Experiences: Interdisciplinary Perspectives. Arch Phys Med Rehabil 2024:S0003-9993(24)00990-0. [PMID: 38763346 DOI: 10.1016/j.apmr.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024]
Abstract
Globally, human displacement is at a record high. According to the United Nations High Commissioner for Refugees, 110 million people have been forcibly displaced worldwide due to persecution, mass conflict, or human rights violations. Conflicts continue to rage in different part of the world such as Ukraine, Palestine, Sudan, and Tigray. Large-scale political upheaval is also on the rise in many countries including Haiti, Venezuela, and Iran among others. Natural disasters fueled by climate change will further contribute to large-scale forced migration. Persons with forced migration experiences (PFME) tend to have significant rehabilitation needs due to high risk of physical injuries, mental trauma, and exacerbation of pre-existing health problems during displacement. Rehabilitation practitioners in host countries must be well equipped to address the complex needs of this population. However, there is currently limited literature to guide best practice. In this paper, a group of interdisciplinary professionals examine rehabilitation needs among PFME, provide examples of established and emerging rehabilitation interventions with PFME in the context of asylum and resettlement, identify barriers to accessing rehabilitation services in host countries, and propose avenues for professional advocacy in this area.
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Affiliation(s)
- Mansha Mirza
- University of Illinois Chicago, Department of Occupational Therapy.
| | | | - Jeff Hartman
- University of Wisconsin School of Medicine and Public Health, Doctor of Physical Therapy Program
| | - April Gamble
- Wchan Organization for Victims of Human Rights Violations, Kurdistan, Iraq
| | - Mustafa Rfat
- Washington University in St. Louis, Brown School of Social Work
| | - Jacob Bentley
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | - Rawan Alheresh
- University of Jordan, Department of Occupational Therapy
| | - Qusay Hussein
- The University of Texas at Austin, Steve Hicks School of Social Work
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Bertilsson I, Melin J, Brogårdh C, Opheim A, Gyllensten AL, Björksell E, Sjödahl Hammarlund C. Measurement properties of the Body Awareness Scale Movement Quality (BAS MQ) in persons on the autism spectrum: A preliminary Rasch analysis. J Bodyw Mov Ther 2024; 38:464-473. [PMID: 38763594 DOI: 10.1016/j.jbmt.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/21/2023] [Accepted: 01/08/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Persons on the autism spectrum exhibit poorer body awareness than neurotypical persons. Since movement quality may be regarded as an expression of body awareness, assessment of movement quality is important. Sound assessments of measurement properties are essential if reliable decisions about body awareness interventions for persons on the autism spectrum are to be made, but there is insufficient research. OBJECTIVE To assess measurement properties of the Body Awareness Scale Movement Quality (BAS MQ) in an autism and a neurotypical reference group. METHODS Persons on the autism spectrum (n=108) and neurotypical references (n=32) were included. All were assessed with BAS MQ. Data were analyzed according to the Rasch model. RESULTS BAS MQ was found to have acceptable unidimensionality, supported by the fit statistics. The hierarchical ordering showed that coordination ability was the most difficult, followed by stability and relating. Response category functioning worked as intended for 19 out of 23 items. There were few difficult items, which decreased targeting. Reliability measures were good. BAS MQ discriminated between the autism and the reference groups, with the autism group exhibiting poorer movement quality, reflecting clinical observations and previous research. CONCLUSIONS BAS MQ was found to have acceptable measurement properties, though suffering from problems with targeting item difficulty to person ability for persons on the autism spectrum. The BAS MQ may, along with experienced movement quality, contribute to clinically relevant information of persons on the autism spectrum, although we encourage refinements and further analyses to improve its measurement properties.
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Affiliation(s)
- I Bertilsson
- Habilitation & Health, Region Västra Götaland, Lövängsvägen 3, 549 49, Skövde, Sweden; Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden.
| | - J Melin
- RISE Research Institutes of Sweden AB, Sven Hultins Plats 5, 412 58, Gothenburg, Sweden
| | - C Brogårdh
- Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden
| | - A Opheim
- Habilitation & Health, Region Västra Götaland, Bergslagsgatan 2, 411 04, Gothenburg, Sweden; Department of Rehabilitation Medicine, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 413 46, Gothenburg, Sweden
| | - A L Gyllensten
- Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden
| | - E Björksell
- Habilitation, Region Kronoberg, 351 88, Växjö, Sweden
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The experience of Basic Body Awareness Therapy and its transfer to daily life amongst Danish military veterans with PTSD. J Bodyw Mov Ther 2021; 28:202-211. [PMID: 34776142 DOI: 10.1016/j.jbmt.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The prevalence of Post-Traumatic Stress Disorder (PTSD) among Danish military veterans is estimated to be around 10%, and treatment primarily consists of recommended psychological trauma-focused therapy. AIM The aim of the study was to explore veterans' experiences of their body and its potential transfer of that experience in their daily life after BBAT. METHODS A hermeneutic-phenomenological qualitative study using semi-structured individual interviews was used. A slightly modified Interpretive Phenomenological Analysis was applied in the data analysis. The participants were four Danish military veterans with PTSD who had completed 12 individual sessions of BBAT in addition to psychological trauma-focused therapy. RESULTS All participants found the BBAT treatment sessions calming and reported the overall treatment was a positive experience. Three participants experienced increased body awareness and were able to apply the exercises and principles of BBAT in their daily lives to varying degrees. All participants estimated the benefits would have been greater with more sessions. CONCLUSION BBAT showed potential for enhancing the bodily awareness of military veterans with PTSD experience and their ability to apply that awareness in their daily life. The degree of transfer of this skill to everyday life appeared to be dependent on the participants' mentalizing capacity. IMPLICATIONS OF THIS STUDY The results indicate a benefit in using body-oriented therapies such as BBAT in the treatment of military veterans with PTSD, as a supplement to trauma-focused treatment although it is hard to distinguish which treatment had which effect or if the combination of psychotherapy and BBAT had a joint effect. Future studies are needed due to the limited research in this field.
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Experiences with basic body awareness therapy as an add-on to cognitive behavioural therapy among Danish military veterans with PTSD: An interview study. J Bodyw Mov Ther 2021; 27:550-559. [PMID: 34391286 DOI: 10.1016/j.jbmt.2021.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/05/2021] [Accepted: 03/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Danish Veterans Centre offers a body-orientated therapy, Basic Body Awareness Therapy (BBAT), in addition to the psychological trauma-focused therapy to military veterans suffering from symptoms of post-traumatic stress disorder (PTSD). This study explored how the veterans a) experienced BBAT as a physiotherapeutic approach and as an add-on treatment to their usual Cognitive Behavioural Therapy (CBT) and b) whether it makes sense for the individual veteran to incorporate BBAT into their treatment. MATERIALS AND METHODS Individual semi-structured interviews with four veterans who had completed 12 BBAT sessions concurrently with their usual CBT treatment. Interviews were transcribed and analysed using Malterud's version of Giorgi's 4-step systematic text condensation. RESULTS Three main categories emerged: "Effects of treatment", "The setting of the treatment" and "Complementary nature of BBAT and CBT". Within each category were 2-5 underlying subgroups. Participants found it made sense to combine BBAT with their CBT since it benefitted them differently and addressed their bodily symptoms and improved body perception/awareness. CONCLUSION BBAT showed potential as a supplement to CBT and seemed to benefit the veterans through focusing on bodily symptoms and how to calm them. Future studies are needed because of the limited research on the topic.
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McGowan E, Beamish N, Stokes E, Lowe R. Core competencies for physiotherapists working with refugees: a scoping review. Physiotherapy 2020; 108:10-21. [PMID: 32693237 DOI: 10.1016/j.physio.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To summarise the existing knowledge base that can inform the development of a core competency profile for physiotherapists to support and deliver rehabilitation services to refugees. METHOD In this scoping review, a comprehensive search of peer-reviewed and grey literature was conducted. The search parameters included studies relevant to the physiotherapy profession and published between 2000 and 2019. MEDLINE, EMBASE, CINAHL, PEDro, and Ovid PsycINFO databases were searched. Grey literature was accessed through website searches, Google Scholar, and direct requests. FINDINGS Three themes were identified in the literature. The first theme encompassed the physical and mental health of refugees. The second theme explored the cultural competence physiotherapists need to work with refugees. This theme included the cultural influences on health and healthcare and communication strategies that could be used to optimise healthcare for refugees. The last theme described refugees and the healthcare system which encompassed the challenges that refugees face in accessing healthcare and navigating the healthcare system. The main physiotherapy competencies detected in the literature were an understanding of refugee health, the administration of culturally competent care and knowledge of healthcare systems as they relate to refugees. CONCLUSION This comprehensive search identified three themes that can be used to inform the development of a competency profile for physiotherapists working with refugees. These themes are, however, rather vague and non-specific and signal the need for research to further examine the physiotherapy competencies necessary to provide the highest quality of care for this growing population.
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Affiliation(s)
- Emer McGowan
- Discipline of Physiotherapy, Trinity College, The University of Dublin, Dublin, Ireland.
| | | | - Emma Stokes
- Department of Physiotherapy & Rehabilitation Science, QU Health, Qatar University, Doha, Qatar.
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Seagle EE, Dam AJ, Shah PP, Webster JL, Barrett DH, Ortmann LW, Cohen NJ, Marano NN. Research ethics and refugee health: a review of reported considerations and applications in published refugee health literature, 2015-2018. Confl Health 2020; 14:39. [PMID: 32577125 PMCID: PMC7305588 DOI: 10.1186/s13031-020-00283-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Public health investigations, including research, in refugee populations are necessary to inform evidence-based interventions and care. The unique challenges refugees face (displacement, limited political protections, economic hardship) can make them especially vulnerable to harm, burden, or undue influence. Acute survival needs, fear of stigma or persecution, and history of trauma may present challenges to ensuring meaningful informed consent and establishing trust. We examined the recently published literature to understand the application of ethics principles in investigations involving refugees. Methods We conducted a preliminary review of refugee health literature (research and non-research data collections) published from 2015 through 2018 available in PubMed. Article inclusion criteria were: participants were refugees, topic was health-related, and methods used primary data collection. Information regarding type of investigation, methods, and reported ethics considerations was abstracted. Results We examined 288 articles. Results indicated 33% of investigations were conducted before resettlement, during the displacement period (68% of these were in refugee camps). Common topics included mental health (48%) and healthcare access (8%). The majority (87%) of investigations obtained consent. Incentives were provided less frequently (23%). Most authors discussed the ways in which community stakeholders were engaged (91%), yet few noted whether refugee representatives had an opportunity to review investigational protocols (8%). Cultural considerations were generally limited to gender and religious norms, and 13% mentioned providing some form of post-investigation support. Conclusions Our analysis is a preliminary assessment of the application of ethics principles reported within the recently published refugee health literature. From this analysis, we have proposed a list of best practices, which include stakeholder engagement, respect for cultural norms, and post-study support. Investigations conducted among refugees require additional diligence to ensure respect for and welfare of the participants. Development of a refugee-specific ethics framework with ethics and refugee health experts that addresses the need for stakeholder involvement, appropriate incentive use, protocol review, and considerations of cultural practices may help guide future investigations in this population.
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Affiliation(s)
- Emma E Seagle
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, Georgia USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee USA
| | - Amanda J Dam
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,Eagle Global Scientific, LLC, Atlanta, Georgia USA
| | - Priti P Shah
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee USA
| | - Jessica L Webster
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee USA
| | - Drue H Barrett
- Office of Scientific Integrity, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Leonard W Ortmann
- Office of Scientific Integrity, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Nicole J Cohen
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA
| | - Nina N Marano
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Road, MS EO3, Atlanta, GA 30333 USA
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Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Gibbons N, Pham P, Zipfel S, Junne F. Pain, somatic complaints, and subjective concepts of illness in traumatized female refugees who experienced extreme violence by the "Islamic State" (IS). J Psychosom Res 2020; 130:109931. [PMID: 31981895 DOI: 10.1016/j.jpsychores.2020.109931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/21/2019] [Accepted: 01/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Refugees with a history of war or sexual violence often experience somatic symptoms along with mental disorders. After being held in captivity by the so-called "Islamic State" (IS), 1100 especially vulnerable Yazidi women and children (around 400 women) received special medical and psychological support. We report on their (psycho-) somatic complaints and concepts of illness. METHODS Female refugees (N = 116) were surveyed regarding their somatic complaints and concepts of illness. The Impact of Event Scale-Revised (IES-R) and self-developed questionnaire items with ratings on a five-point Likert scale from 0 ("not at all") to 4 ("extremely") were used. Subgroup analyses and a multiple linear regression model were computed. RESULTS Pain (M = 2.43, SD = 1.70) is the main somatic complaint with a moderate rated severity, followed by feelings of suffocation (M = 2.37, SD = 1.53), and movement disorders (M = 1.62, SD = 1.70). In a linear regression model, pain explains variance (R2 = 0.325) in the refugees' self-reported health-related wellbeing. Somatic symptoms are mainly attributed to psychological causes, followed by physical (e.g., physical origin of symptoms), religious, and supernatural causes. Women with pain symptoms attributed their symptoms more to physical causes (M = 1.90, SD = 1.78) than did women without pain symptoms (M = 1.07, SD = 1.59). CONCLUSION Female Yazidi refugees being kept in IS captivity mainly suffer from pain, which is attributed to an explanatory psychological model. The study results show the specific psychosomatic and psychotherapeutic needs and demands for specifically tailored psychotherapy.
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Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Gyllensten AL, Jacobsen LN, Gard G. Clinician perspectives of Basic Body Awareness Therapy (BBAT) in mental health physical therapy: An international qualitative study. J Bodyw Mov Ther 2019; 23:746-751. [DOI: 10.1016/j.jbmt.2019.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/26/2019] [Indexed: 12/11/2022]
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Rometsch-Ogioun El Sount C, Windthorst P, Denkinger J, Ziser K, Nikendei C, Kindermann D, Ringwald J, Renner V, Zipfel S, Junne F. Chronic pain in refugees with posttraumatic stress disorder (PTSD): A systematic review on patients' characteristics and specific interventions. J Psychosom Res 2019; 118:83-97. [PMID: 30078503 DOI: 10.1016/j.jpsychores.2018.07.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/20/2018] [Accepted: 07/25/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Chronic pain in patients with posttraumatic stress disorder (PTSD) is a frequent symptom and a complicating factor in the treatment of patients. The study' purpose is to systematically review the scientific literature on patients' characteristics and the effects of specific interventions implemented for the treatment of chronic pain in traumatized refugees. METHOD A systematic search of the current literature was conducted in PubMed and Web of Science, from 1996 to 2017. A structured screening process in accordance with the PRISMA-statement was used with eligibility criteria based on the modified PICOS-criteria including refugees with chronic pain and diagnosed PTSD to investigate sample size, gender, country of origin, residential status, pain locations, predictors and correlations and type and efficacy of specific interventions. RESULTS The initial search resulted in a total of 2169 references, leading to 15 included studies. Most frequently, patients reported headaches, backaches, and pain in the arms and legs. Pain symptoms were associated with higher age, female gender, general living difficulties and PTSD symptoms. Cognitive behavioral therapy (CBT) and, Narrative Exposure Therapy (NET) with biofeedback, manualized trauma psychotherapy, Traditional Chinese Medicine (TCM) and Emotional Freedom Techniques were evaluated as specific interventions, resulting in positive outcomes for both pain severity and PTSD symptoms. CONCLUSIONS To date, the existing literature shows scarce evidence evaluating specific interventions that address the needs of traumatized refugees with chronic pain. However, the current reported evidence allows for a preliminary evaluation of the characterizations of patient dimensions as well as promising results found in intervention studies.
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Affiliation(s)
- C Rometsch-Ogioun El Sount
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany.
| | - P Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - J Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - K Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - C Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - D Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - J Ringwald
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - V Renner
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
| | - F Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, University of Tuebingen, Osianderstr. 5, 72076 Tuebingen, Germany
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Gard G, Nyboe L, Gyllensten AL. Clinical reasoning and clinical use of basic body awareness therapy in physiotherapy – a qualitative study? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1549592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gunvor Gard
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Lene Nyboe
- Research unit for PTSD, Section for depression and anxiety, Aarhus University Hospital, Risskov, Denmark
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