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Grenier JP, Rothmund M. A critical review of the role of manual therapy in the treatment of individuals with low back pain. J Man Manip Ther 2024:1-14. [PMID: 38381584 DOI: 10.1080/10669817.2024.2316393] [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: 09/03/2023] [Accepted: 02/04/2024] [Indexed: 02/23/2024] Open
Abstract
The number of low back pain (LBP) cases is projected to increase to more than 800 million by 2050. To address the substantial burden of disease associated with this rise in prevalence, effective treatments are needed. While clinical practice guidelines (CPG) consistently recommend non-pharmacological therapies as first-line treatments, recommendations regarding manual therapy (MT) in treating low back pain vary. The goal of this narrative review was to critically summarize the available evidence for MT behind these recommendations, to scrutinize its mechanisms of action, and propose some actionable steps for clinicians on how this knowledge can be integrated into a person-centered approach. Despite disparate recommendations from CPG, MT is as effective as other available treatments and may be offered to patients with LBP, especially as part of a treatment package with exercise and education. Most of the effects of MT are not specific to the technique. MT and other interventions share several mechanisms of action that mediate treatment success. These mechanisms can encompass patients' expectations, prior experiences, beliefs and convictions, epistemic trust, and nonspecific contextual effects. Although MT is safer than opioids for patients with LBP, this alone is insufficient. Our goal is to encourage clinicians to shift away from outdated and refuted ideas in MT and embrace a person-centered approach rooted in a comprehensive biopsychosocial framework while incorporating patients' beliefs, addressing illness behaviors, and seeking to understand each patient's journey.
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Affiliation(s)
- Jean-Pascal Grenier
- Department of Physiotherapy, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- Department of Internal Medicine II, University Clinic Innsbruck, Innsbruck, Austria
| | - Maria Rothmund
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic for Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
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Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, Runge N, Goossens Z, Labie C, Bilterys T, Van Campenhout J, Polli A, Wyns A, Hendrix J, Xiong HY, Ahmed I, De Baets L, Huysmans E. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. J Clin Med 2024; 13:644. [PMID: 38337338 PMCID: PMC10855981 DOI: 10.3390/jcm13030644] [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: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic pain is the most prevalent disease worldwide, leading to substantial disability and socioeconomic burden. Therefore, it can be regarded as a public health disease and major challenge to scientists, clinicians and affected individuals. Behavioral lifestyle factors, such as, physical (in)activity, stress, poor sleep and an unhealthy diet are increasingly recognized as perpetuating factors for chronic pain. Yet, current management options for patients with chronic pain often do not address lifestyle factors in a personalized multimodal fashion. This state-of-the-art clinical perspective aims to address this gap by discussing how clinicians can simultaneously incorporate various lifestyle factors into a personalized multimodal lifestyle intervention for individuals with chronic pain. To do so the available evidence on (multimodal) lifestyle interventions targeting physical (in)activity, stress, sleep and nutritional factors, specifically, was reviewed and synthetized from a clinical point of view. First, advise is provided on how to design a personalized multimodal lifestyle approach for a specific patient. Subsequently, best-evidence recommendations on how to integrate physical (in)activity, stress, sleep and nutritional factors as treatment targets into a personalized multimodal lifestyle approach are outlined. Evidence supporting such a personalized multimodal lifestyle approach is growing, but further studies are needed.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Goteborg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- REVAL, Universiteit Hasselt, 3590 Diepenbeek, Belgium
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Wouter Van Bogaert
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Elin Johansson
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Nils Runge
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Zosia Goossens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Céline Labie
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Division of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Jente Van Campenhout
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Arne Wyns
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Jolien Hendrix
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Huan-Yu Xiong
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Ishtiaq Ahmed
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
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McGrath RL, Shephard S, Parnell T, Verdon S, Pope R. Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review. Physiother Theory Pract 2023:1-31. [PMID: 38009858 DOI: 10.1080/09593985.2023.2284823] [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: 08/01/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
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.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Sarah Verdon
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Rodney Pope
- Department of Rural Health, University of Melbourne, Shepparton, Australia
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