Biopsychosocial Management of Chronic Low Back Pain Patients with Psychological Assessment and Management Tools

Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review

BACKGROUND

Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope.

OBJECTIVE

To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress.

METHODS

A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically.

RESULTS

3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management.

CONCLUSION

While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.

Life events, anxiety, social support, personality, and alexithymia in female patients with chronic pain: A path analysis

INTRODUCTION

This study sought to identify a model that explains the relationship between psychosocial factors and chronic pain in female patients, and to explore all of these constructs in a single study and provide a more holistic examination of the overall psychosocial factors that female patients with chronic pain encounter.

METHODS

Female patients with chronic pain (n = 147), aged 20-65 (M = 34.9 years, SD = 11.25), from an outpatient pain clinic completed a cross-sectional self-report questionnaire on anxiety, life events, personality, social support, and alexithymia. Data were analyzed by means of path analysis.

RESULTS

The direct effect of anxiety on female patients with chronic pain was greatest among all the paths. Personality and alexithymia led to chronic pain in female patients only indirectly, mediated by life events. The personality factors of neuroticism and extraversion were associated positively with social support, which had an indirect effect on the influence of life events on chronic pain. However, alexithymia was associated negatively with social support, which had an indirect effect on the influence of life events on chronic pain.

DISCUSSION

Our findings provide evidence that life events are a mediator in the relationship between personality, social support, alexithymia, and chronic pain in female patients.

Musculoskeletal physiotherapists' use of psychological interventions: a systematic review of therapists' perceptions and practice

BACKGROUND

Research has demonstrated that incorporating psychological interventions within physiotherapy practice has numerous potential benefits. Despite this physiotherapists have reported feeling inadequately trained to confidently use such interventions in their day-to-day practice.

OBJECTIVE

To systematically review musculoskeletal physiotherapists' perceptions regarding the use of psychological interventions within physiotherapy practice.

DATA SOURCES

Eligible studies were identified through a rigorous search of AMED, CINAHL, EMBASE, MEDLINE and PsychINFO from January 2002 until August 2013.

STUDY ELIGIBILITY CRITERIA

Full text qualitative, quantitative and mixed methodology studies published in English language investigating musculoskeletal physiotherapists' perceptions regarding their use of psychological interventions within physiotherapy practice.

STUDY SYNTHESIS AND APPRAISAL

Included studies were appraised for risk of bias using the Critical Appraisal Skills Programme qualitative checklist. Meta-analysis was not possible due to study heterogeneity.

RESULTS

Six studies, all with a low risk of bias, met the inclusion criteria. These studies highlighted that physiotherapists appreciate the importance of using psychological interventions within their practice, but report inadequate understanding and consequent underutilisation of these interventions.

LIMITATIONS

These results should be noted with some degree of caution due to various limitations associated with the included studies and with this review, including the use of a qualitative appraisal tool for mixed methodology/quantitative studies.

CONCLUSION

These findings suggest that musculoskeletal physiotherapists are aware of the potential benefits of incorporating psychological interventions within their practice but feel insufficiently trained to optimise their use of such interventions; hence highlighting a need for further research in this area and a review of physiotherapist training.