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Mingels S, Granitzer M, Luedtke K, Dankaerts W. What is the Status Quo of Patient-Centred Physiotherapy Management of People with Headache within a Biopsychosocial Model? - A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01306-7. [PMID: 39141253 DOI: 10.1007/s11916-024-01306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW Patient-centred care (PCC) is deemed essential in the rehabilitation of musculoskeletal pain. Integrating such care within a biopsychosocial framework, enables to address all facets of the individual pain experience, and to manage the individual instead of the condition. This narrative review describes the status quo of PCC physiotherapy management of people with headache within a biopsychosocial model. PubMed, EMBASE, Web of Science, Scopus were searched (update 07.05.2024). The search-query comprised terminology relating to "headache", "patient-centred", "biopsychosocial", "physiotherapy". Additional eligibility criteria were reviews, trials, cohort, case report, case-control studies in English, Dutch, French. RECENT FINDINGS Gaps are exposed in patient-centred physiotherapy management of migraine, tension-type headache, and cervicogenic headache. While a biopsychosocial approach is advised to manage migraine and tension-type headache, its use in clinical practice is not reflected by the literature. A biopsychosocial approach is not advised in cervicogenic headache. Psychosocial-lifestyle interventions are mainly delivered by health-care providers other than physiotherapists. Additionally, psychologically-informed practice is barely introduced in physiotherapy headache management. Though, managing the social context within a biopsychosocial framework is advised, the implementation by physiotherapists is unclear. Comparable conclusions apply to PCC. PCC is recommended for the physiotherapy management of primary and secondary headache. Such recommendation remains however theoretical, not reaching clinical implementation. Yet, a shift from the traditional disease-centred model of care towards PCC is ongoing and should be continued in physiotherapy management. With this implementation, clinical and economical studies are needed to evaluate its effectiveness.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium.
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
| | - Marita Granitzer
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research, Institute of Health Sciences, Universität Zu Lübeck, Zu Lübeck, Germany
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium
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Mingels S, Granitzer M, Luedtke K, Dankaerts W. Therapeutic Patient Education as Part of the Physiotherapy Management of Adults with Headache: A Scoping Review. Curr Pain Headache Rep 2024; 28:547-564. [PMID: 38613735 DOI: 10.1007/s11916-024-01253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE OF REVIEW Physiotherapy interventions for headache mostly include exercise and manual therapy. Yet, the complex nature of headache, sometimes characterized by symptoms of facilitated central pain mechanisms, demands an individualized approach in which therapeutic patient education could be supportive. This scoping review aimed to summarize the position of therapeutic patient education within the physiotherapy management of adults with headache. PubMed, EMBASE, Web of Science, and Scopus were searched. The search-query comprised terminology relating to "headache", "education", and "physiotherapy". Eligibility criteria were: adults with headache, interventions including education within the domain of physiotherapy, reviews, clinical trials, cohort, case report, case-control studies. RECENT FINDINGS Eleven publications were included from the 281 retrieved publications. These publications were clinical trials (n = 4), reviews (n = 4), case-reports (n = 2), and a guideline (n = 1). Type of headaches studied were migraine (n = 3), post-traumatic headache (n = 2), tension-type headache (n = 2), cervicogenic headache (n = 1), primary headaches (n = 1), chronic daily headache (n = 1), and mixed migraine-cervicogenic headache (n = 1). Education seems an umbrella-term for postural education, lifestyle advice, and pain education. Three themes emerged across the publications: handling headache triggers (migraine, post-traumatic headache), promoting active lifestyle (post-traumatic headache, chronic daily headache, migraine), evaluating posture (post-traumatic headache, chronic daily headache, tension-type headache, cervicogenic headache). All publications recommended education in the management of headache. Only one (of the 11 included) publication described the educational program and determined its efficacy. Based on this scoping review, therapeutic patient education seems supported within physiotherapy management of headache. However, it is unclear how such education is tailored to the specific needs of the individual, the headache subtype, or when it should be added to physiotherapy management of headache.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Tervuursevest, 101, 3001, Leuven, Belgium.
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
| | - Marita Granitzer
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research, Universität Zu Lübeck, Lübeck, Germany
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Tervuursevest, 101, 3001, Leuven, Belgium
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Deodato M, Granato A, Del Frate J, Martini M, Manganotti P. Differences in musculoskeletal dysfunctions and in postural alterations between chronic migraine and chronic tension type headache: A cross-sectional study. J Bodyw Mov Ther 2024; 37:404-411. [PMID: 38432837 DOI: 10.1016/j.jbmt.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/15/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The aim of present study is to assess postural alterations and musculoskeletal dysfunctions over all spine in patients with chronic migraine and chronic tension type headache, moreover to highlight the differences between these two forms of primary headache. METHODS A Cross sectional study was adopted to evaluate the musculoskeletal profile in patients with chronic migraine and with chronic tension type headache. The Bio photogrammetric evaluation was performed using the postural assessment software PAS/SAPO, while unilateral passive accessory intervertebral motion (PAIMs) were applied for manual examinations of spine segments from C0 to L5 vertebra. The One-way Analysis of Variance (ANOVA) test was used to compare the three groups with the software GraphPad InStat 3.06. RESULTS A total of 60 patients were recruited, 20 for chronic tension type group, 20 for chronic migraine group and 20 healthy controls. The most interesting findings was that patients with chronic primary headaches presented postural alterations in all parameters (cranio-vertebral angle and lumbar-pelvic angle) and musculoskeletal dysfunctions in all spine with respect to healthy controls. Finally, the most clinically relevant finding was that no differences were found between chronic migraine and chronic tension type headache concerning the postural alterations nor the musculoskeletal dysfunctions. CONCLUSION The sensitization acts as a substrate or consequence of these musculoskeletal dysfunctions in chronic primary headache. Therefore, non-pharmacological treatments targeted in the musculoskeletal system may be a good option in the management of chronic primary headache, especially when these therapies integrate various techniques that involve all spine.
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Affiliation(s)
- Manuela Deodato
- Department of Life Sciences, University of Trieste, Adress: via Pascoli 31, 34100, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Adress: via Pascoli 31, 34100, Trieste, Italy; Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Adress: via Pascoli 31, 34100, Trieste, Italy; Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Jessica Del Frate
- Department of Medical, Surgical and Health Sciences, University of Trieste, Adress: via Pascoli 31, 34100, Trieste, Italy.
| | - Miriam Martini
- Department of Medical, Surgical and Health Sciences, University of Trieste, Adress: via Pascoli 31, 34100, Trieste, Italy.
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Adress: via Pascoli 31, 34100, Trieste, Italy; Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
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González-Castro A, Leirós-Rodríguez R, Rodríguez-Nogueira Ó, Álvarez-Álvarez MJ, Pinto-Carral A, Andrade-Gómez E. Proposal for a physiotherapy assessment form for the evaluation of women patients with uro-gynecological disorders: A Delphi study. PLoS One 2023; 18:e0296092. [PMID: 38150427 PMCID: PMC10752553 DOI: 10.1371/journal.pone.0296092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The correct selection of treatment techniques and methods in physiotherapy depends directly on a well-structured anamnesis, examination and assessment. Within urogynecological and obstetric physiotherapy there is no standardized and protocolized assessment that allows to follow established steps. For all this, the main objective of this study was to identify the assessment items that should be included in the a physiotherapeutic uro-gynecological assessment. METHODS Delphi study through a group of experts. Prior to this, a systematic search was carried out, accompanied by a review of grey literature, to obtain the possible items to be included in the forms. Subsequently, a Delphi study with two consecutive rounds of questionnaires was developed. A total of 6 expert physiotherapists participated in the study. RESULTS The initial questionnaire had 97 items and after two rounds one item was eliminated to obtain a total of 96 items in the final questionnaire. CONCLUSIONS The experts agreed on most of the choices and finally obtained a standardized and protocolized assessment in uro-gynecological physiotherapy. Furthermore, this proposal should be considered by other professionals involved in the process of evaluation and treatment of pelvi-perineal alterations.
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Affiliation(s)
- Ana González-Castro
- Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Mª José Álvarez-Álvarez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
| | - Arrate Pinto-Carral
- SALBIS Research Group, Nursing and Physical Therapy Department, University of León, Ponferrada, Spain
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Satpute K, Bedekar N, Hall T. Cervical neuro-musculoskeletal impairments in people with cervicogenic headache: a systematic review and meta-analysis. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2187996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Kiran Satpute
- Department of Musculoskeletal Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Pune, India
| | - Nilima Bedekar
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, India
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Inter-individual variability in mechanical pain sensation in patients with cervicogenic headache: an explorative study. Sci Rep 2022; 12:20635. [PMID: 36450870 PMCID: PMC9712535 DOI: 10.1038/s41598-022-25326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Currently, evidence for effective physiotherapy interventions in patients with cervicogenic headache (CeH) is inconsistent. Although inter-individual variability in pain response is predictive for successful physiotherapy interventions, it was never explored in patients with CeH. Therefore the objective of the current study was to explore inter-individual variability in mechanical pain sensation, and its association with biopsychosocial-lifestyle (BPSL) characteristics in patients with CeH. A cross-sectional explorative analysis of inter-individual variability in mechanical pain sensation in 18 participants with CeH (29-51 years) was conducted. Inter-individual variability in mechanical pain sensation (standard deviations (SDs), F-statistics, Measurement System Analysis) was deducted from bilateral pressure pain thresholds of the suboccipitals, erector spine, tibialis anterior. BPSL-characteristics depression, anxiety, stress (Depression Anxiety Stress Scale-21), quality of life (Headache Impact Test-6), sleep-quality (Pittsburgh Sleep Quality Index), and sedentary time (hours/week) were questioned. Inter-individual variability in mechanical pain sensation explained 69.2% (suboccipital left), 86.8% (suboccipital right), 94.6% (erector spine left), 93.2% (erector spine right), 91.7% (tibialis anterior left), and 82% (tibialis anterior right) of the total variability in patients with CeH. The significant p-values and large F-statistic values indicate inter-individual differences in SDs. Significant associations between (1) lower quality of life and lower SDs of the suboccipital left PPT (p .005), and (2) longer sedentary time and higher SDs of the suboccipital left PPT (p .001) were observed. Results from our explorative study could suggest inter-individual variability in mechanical pain sensation at the left suboccipitals which associates with quality of life and sedentary time. These novel findings should be considered when phenotyping patients and 'individually' match interventions.
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Cagnie B, Castien R, Scholten-Peeters GGM. Translating the new International IFOMPT Cervical Framework into a framework flowchart for clinical practice and education. J Back Musculoskelet Rehabil 2022; 36:331-336. [PMID: 36404531 PMCID: PMC10041416 DOI: 10.3233/bmr-220155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2020, a revised version of the International IFOMPT Cervical Framework was published. This framework provides both physical therapists and educators the necessary information to guide the assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned Orthopaedic Manual Therapy (OMT) interventions. OBJECTIVE The objective was to develop a framework flowchart which is useful in clinical practice and education to assist physical therapists to improve the safety of OMT, and apply this in a case report. METHODS The framework was developed in co-creation with manual therapy experts, researchers, educators in manual therapy, patients, medical specialists and the Manual Therapy Association in The Netherlands and Belgium. Manual therapists and patients tested the framework for intelligibility and usefulness. RESULTS A framework flowchart is developed and presented, that is easy to use in both clinical practice and education. It is a visual representation of the sequence of steps and decisions needed during the process. A case description of a patient with neck pain and headache is added to illustrate the clinical usefulness of the framework flowchart. CONCLUSION The framework flowchart helps physical therapists in their clinical reasoning to provide safe OMT interventions.
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Affiliation(s)
- Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Rene Castien
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Rani M, Kaur J. Effectiveness of spinal mobilization and postural correction exercises in the management of cervicogenic headache: A randomized controlled trial. Physiother Theory Pract 2022:1-15. [PMID: 35139723 DOI: 10.1080/09593985.2022.2037032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The study aims to assess the effect of spinal mobilization and postural correction exercises in patients suffering from cervicogenic headache. METHODS A randomized controlled trial was conducted with 72 patients. Patients were randomly allocated into three groups: spinal mobilization (n = 24), postural correction exercises (n = 24), and control group (n = 24). The primary outcome measure was headache impact test-6, and secondary outcomes were headache intensity, neck pain intensity, and neck pain-related disability measured at baseline, postintervention, and follow-up period. RESULT Comparison of baseline data (at 0 weeks) among groups showed a statistically nonsignificant difference. There was statistically significant improvement at postintervention (immediately after fourth week) in postural correction exercises group [headache disability: 14.95 ± 7.91 (p < .001); headache intensity: 2.58 ± 1.24 (p < .001); neck disability: 27.66 ± 18.71 (p < .001); neck pain: 1.91 ± 1.44 (p < .001)] and spinal mobilization group [headache disability: 13.83 ± 6.21 (p < .001); headache intensity: 2.29 ± 1.23 (p < .001); neck disability: 23.39 ± 19.51 (p < .001); neck pain: 1.72 ± 0.84 (p < .001)] as compared to the control group. The result of within-group analysis suggests that there was a statistically significant improvement in postintervention (immediately after fourth week) and follow-up (immediately after eighth week) scores as compared to baseline (at 0 weeks) scores for all outcomes in postural correction exercises [headache disability (p < .001), headache intensity (p < .001), neck disability (p < .001), neck pain (p < 0 .001)] as well as in spinal mobilization group [headache disability (p < .001), headache intensity (p < .001), neck disability (p < .001), neck pain (p < .001 for pre versus post; p = .001 for pre versus follow-up)]. There was a statistically nonsignificant difference between postintervention and follow-up scores of all the outcomes in the postural correction exercise and spinal mobilization group, which indicates that improvement in these groups was maintained during the follow-up period. CONCLUSION Spinal mobilization and postural correction exercises are effective in the management of cervicogenic headache.
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Affiliation(s)
- Monika Rani
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology Hisar-Delhi Bypass Road, Hisar, India
| | - Jaspreet Kaur
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology Hisar-Delhi Bypass Road, Hisar, India
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