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Browne A, Cahalan R, O’ Sullivan K. How is cognitive behavioural therapy for insomnia delivered to adults with comorbid persistent musculoskeletal pain and disordered sleep? A scoping review. PLoS One 2024; 19:e0305931. [PMID: 39024361 PMCID: PMC11257322 DOI: 10.1371/journal.pone.0305931] [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: 09/02/2022] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Disordered sleep and persistent musculoskeletal pain are highly comorbid. Behavioural interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I) have shown promise in the management of both disordered sleep and persistent musculoskeletal pain. The aim of this review was to examine how CBT-I is delivered in randomised controlled trials involving people with comorbid disordered sleep and persistent musculoskeletal pain. METHODS The protocol for this scoping review was registered with the Open Science Framework. Electronic searches of ten database and three clinical trials registries were performed up to 25 October 2023. The methodological quality of each study was evaluated by two independent reviewers using the PEDro tool. The reporting of CBT-I interventions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist. RESULTS Twelve studies met the eligibility criteria. TIDieR scores ranged from 7-11/12, with a mean score of 8.8/12. CBT-I always involved two core components-sleep restriction and stimulus control. Furthermore, an additional five components were usually involved-a cognitive component, sleep hygiene, sleep education, relaxation/deactivation procedures and relapse planning. There was also considerable consistency in the frequency (weekly) and duration (5-9 weeks) of CBT-I programmes. Aspects inconsistently reported included who delivered the intervention; what modifications were made, if any; and the session content and duration. PEDro scores ranged from 5-8/10, with a mean score of 6.7/10. CONCLUSIONS These findings demonstrate considerable consistency in the components of CBT-I delivered in clinical trials along with the number of sessions. The frequency of sessions was also consistent where almost all studies held weekly session. However, some aspects were either not reported (e.g., precise content of components) or inconsistent (e.g., use of terminology). CBT-I was delivered both individually and in groups. Greater consistency, and more detailed reporting regarding who delivered the intervention, the training provided, and the specific content of CBT-I components would add clarity, and may enhance CBT-I efficacy and allow better replication.
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Affiliation(s)
- Abigail Browne
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
| | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Centre, University of Limerick, Limerick, Ireland
| | - Kieran O’ Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Sports and Human Performance Centre, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
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Veillon J, Preuilh A, Wormser J. Cognitive behavioural interventions led by a physiotherapist in chronic non-specific low back pain: A systematic review and meta-analysis. J Bodyw Mov Ther 2024; 39:635-644. [PMID: 38876697 DOI: 10.1016/j.jbmt.2024.03.057] [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: 06/06/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The effectiveness of physiotherapist-led Cognitive Behavioural Interventions (CBI) with or without physiotherapy is still unclear. OBJECTIVE This systematic review (PROSPERO registration number CRD42022321073) aims to determine the effectiveness of physiotherapist-led CBI with or without physiotherapy in comparison to physiotherapy alone on quality of life, disabilities and catastrophization. METHODS MEDLINE, Web of Science, Science Direct, and PEDro were searched for randomized controlled trials that investigate the use of CBI versus conventional physiotherapy in chronic NSLBP. To be included CBI had to be performed by a physiotherapist. The primary and secondary outcomes were respectively quality of life and disability. RESULTS Fourteen studies were included in qualitative analysis, in which 4 did not meet the PEDro score of 6 or higher. Pooled standardized mean differences from 3 studies showed no difference in quality of life between groups for mental and physical sub-scores at 3 months (SMD 0.02, 95% CI -0.17 to 0.21 and SMD 0.07, 95% CI -0.12 to 0.26 respectively). Pooled standardized mean differences from 9 studies showed no difference in disability between groups at 3, 6 and 12 months (SMD = - 0.40, CI 95% -0.80 to 0.01; SMD -0.18, CI 95% = -0.41 to 0.05; and SMD -0.24, CI 95% = -0.48 to 0.00 respectively). CONCLUSION Results of CBI, especially cognitive functional therapy, seem promising in disability management despite a substantial heterogeneity. Furthermore, we found no difference in quality of life.
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Affiliation(s)
- Juliane Veillon
- School of Physiotherapy and Rehabilitation, IFMK CEERRF, France.
| | - Arnaud Preuilh
- Sorbonne University, INSERM, U 1146, CNRS UMR 7371, Laboratoire d'imagerie biomédicale, France.
| | - Johan Wormser
- Department of Rehabilitation and Department of Intensive Care, Paris Saint Joseph Hospital Group, France.
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Newton C, Singh G, Nolan D, Booth V, Diver C, O'Neill S, Purtill H, Logan P, O'Sullivan K, O'Sullivan P. Cognitive Functional Therapy compared with usual physiotherapy care in people with persistent low back pain: a mixed methods feasibility randomised controlled trial in the United Kingdom National Health Service. Physiotherapy 2024; 123:118-132. [PMID: 38479068 DOI: 10.1016/j.physio.2024.02.003] [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: 12/15/2022] [Revised: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To determine the feasibility of completing a definitive randomised controlled trial (RCT), evaluating the clinical and cost-effectiveness of Cognitive Functional Therapy (CFT) in comparison to usual physiotherapy care (UPC), for people with persistent low back pain (LBP). DESIGN AND SETTING A two-arm parallel feasibility RCT completed in a United Kingdom (UK) Secondary Care National Health Service (NHS) physiotherapy service. PARTICIPANTS Sixty adult participants who reported LBP lasting for more than three months, that was not attributable to a serious (e.g. cancer) or specific (e.g. radiculopathy) underlying cause, were invited to participate. Participants were allocated at random to receive CFT or UPC. INTERVENTIONS Cognitive Functional Therapy and Usual Physiotherapy Care for persistent LBP. MAIN OUTCOME MEASURES The primary outcome was the feasibility of completing a definitive RCT, defined by recruitment of at least 5 participants per month, delivery of CFT per protocol and securing relevant and acceptable outcome measures. Data concerning study processes, resources, management and participant reported outcome measures were collected at baseline, 3, 6 and 12-month follow-up. RESULTS Sixty participants (n = 30 CFT and n = 30 UPC) were recruited with 80% (n = 48), 72% (n = 43) and 53% (n = 32) retained at 3, 6 and 12-month follow-up respectively. NHS physiotherapists were trained to competence and delivered CFT with fidelity. CFT was tolerated by participants with no adverse events. Relevant and clinically important outcome data were collected at all time points (0.4%, 3%, 1% and 0.8% of data was missing from the returned outcome measure booklets at baseline and 3, 6 and 12-month follow-up respectively). The Roland-Morris disability questionnaire was considered the most suitable primary outcome measure with a proposed sample size of 540 participants for a definitive cluster RCT. CONCLUSION It is feasible to conduct a randomised study of CFT in comparison to UPC for NHS patients. A future study should incorporate an internal pilot to address aspects of feasibility further, including participant retention strategies. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN12965286 CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Christopher Newton
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK; Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Gurpreet Singh
- Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Nolan
- Physiotherapy Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Vicky Booth
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Claire Diver
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Seth O'Neill
- School of Allied Health Professions, College of Life Sciences, University of Leicester, Leicester, UK
| | - Helen Purtill
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Pip Logan
- Centre of Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, UK
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland; Sports and Human Performance Research Centre, University of Limerick, Limerick, Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Simpson P, Holopainen R, Schütze R, O'Sullivan P, Smith A, Kent P. Becoming confidently competent: a qualitative investigation of training in cognitive functional therapy for persistent low back pain. Physiother Theory Pract 2024; 40:804-816. [PMID: 36420994 DOI: 10.1080/09593985.2022.2151333] [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: 03/22/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physiotherapists trained to deliver biopsychosocial interventions for complex musculoskeletal pain problems often report difficulties in confidence and competency at the end of training. Cognitive Functional Therapy (CFT) is an individualized biopsychosocial intervention and understanding the facilitators and barriers to training in CFT will help inform future training programs. This study aimed to explore physiotherapists' and trainers' perceptions of the process of developing competency in CFT. METHODS A cross-sectional qualitative design using interviews of 18 physiotherapists and two trainers investigated training in CFT for persistent LBP via reflexive thematic analysis. RESULTS Physiotherapists reported undergoing a complex behavior change process during training. Four themes emerged: 1) Pre-training factors; 2) Behavior change process; 3) Physiotherapy culture and context; and 4) Confident competence and beyond. Key components included graduated practice exposure linked to experiential learning with feedback and clear competency guidelines. Pre-training and contextual factors were facilitators or barriers depending on the individual. Physiotherapists supported ongoing learning, even after competency was achieved. CONCLUSIONS This study provides insight into the processes of change during progress toward competency in CFT. It highlights facilitators and barriers to competency including physiotherapy culture and the clinical environment. The study also describes important educational components, including experiential learning and clinical integration, which may be used to inform future post-graduate training.
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Affiliation(s)
- Phoebe Simpson
- School of Allied Health, Curtin University, Perth, Australia
| | - Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland
| | - Robert Schütze
- School of Allied Health, Curtin University, Perth, Australia
- Multidisciplinary Pain Management Centre, Royal Perth Hospital, Victoria Square, Perth, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, Australia
- Bodylogic Physiotherapy, Perth, Australia
| | - Anne Smith
- School of Allied Health, Curtin University, Perth, Australia
| | - Peter Kent
- School of Allied Health, Curtin University, Perth, Australia
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Tehrany R, Maki D, Teixeira MJC, Chumak T, Hoerz C. Allied health professionals' experiences and views towards improving musculoskeletal services in the UK for patients with musculoskeletal and co-existing mental health conditions: a qualitative study. BMC Musculoskelet Disord 2024; 25:207. [PMID: 38454371 PMCID: PMC10918939 DOI: 10.1186/s12891-023-06878-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 09/12/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Interplay between physical and mental health (MH) is widely recognised amongst patients with Musculoskeletal and co-existing MH conditions. Evidence suggests that psychological interventions improve outcomes and satisfaction in patients with physical conditions, however current healthcare models continue to separate physical and mental health care, as health services are fragmented. If the delivery of MH support could be facilitated by Allied Health Professionals (AHPs), such as physiotherapists and occupational therapists (OTs), this could be an effective, low-cost way to achieve routine integration. This study aimed to explore the experiences of UK physiotherapists and OTs working with patients with MSK and co-existing MH conditions and to understand views on improving MSK services. METHODS This was an exploratory-descriptive qualitative study using semi-structured interviews. Participants were recruited via social media and professional organisations using convenience sampling. Participants included registered UK physiotherapists or OTs within MSK settings who managed patients with MH conditions. Inductive thematic analysis was used, where single and double-level coding, single counting and inclusion of divergent cases were conducted to enhance methodological rigour. RESULTS Three overarching themes were identified. Overarching theme one referred to openness to provide MH support, with scope of practice and lack of confidence as themes. Overarching theme two described challenges, incorporating mental health stigma, the clinical environment, and limited experience. The overarching theme referring to training, identified the need for further training and strategies to implement as themes. CONCLUSION Many challenges to achieving optimal integration of physical and mental health care exist within MSK services. These challenges go beyond the need for additional training and knowledge acquisition and include departmental readiness such as funding, diary management, and supervision by senior colleagues/or psychologists. These need consideration in parallel to match the evolving needs of the MSK population.
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Affiliation(s)
- Rokhsaneh Tehrany
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, London, UK.
- Department of Orthopaedic and Musculoskeletal Science, University College London, London, UK.
| | - Dana Maki
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, UK
- Alanzoor Physiotherapy & Rehabilitation Complex, Manama, Kingdom of Bahrain
| | - Maria J C Teixeira
- Nursing Research Department, Royal National Orthopaedic Hospital NHS Trust, London, UK
- London South Bank University, London, UK
- Nuffield Health Oxford, The Manor Hospital, Oxford, UK
| | - Tanya Chumak
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Christine Hoerz
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, UK
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Swink LA, Mealer ML, Miller MJ, Anderson CB, Cook PF, Stevens-Lapsley JE, Christiansen CL. Telehealth Walking Self-Management for Individuals With Amputation: A Qualitative Study of Therapist Perspectives on Adoption. Phys Ther 2024; 104:pzad155. [PMID: 37944092 PMCID: PMC10902556 DOI: 10.1093/ptj/pzad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to understand therapist-identified factors influencing clinical adoption of a telehealth walking self-management intervention for individuals with lower limb amputation. METHODS Semi-structured focus groups were completed with actively practicing physical and occupational therapists treating populations that are medically complex. A qualitative explorative design was employed with conventional content analysis and iterative independent parallel coding using 2 analysts. Themes and subthemes were generated with a consensus building process identifying patterns and collapsing codes to represent participant perspectives. RESULTS Thematic saturation was met after 5 focus groups (24 therapists). Therapists were on average 34 years old and predominantly female (n = 19; 79%) physical therapists (n = 17; 71%). Three primary facilitator and barrier themes were identified for intervention adoption: system, therapist, and person. System considerations included telehealth support and interprofessional care coordination. Therapist facilitators included self-management programming that overlapped with standard of care and personalization methods. However, limited behavioral theory training was a therapist level barrier. Finally, person factors such as patient activation could influence both positively and negatively. Person facilitators included social support and barriers included the complex health condition. CONCLUSION System, therapist, and person facilitators and barriers must be considered to maximize the adoption of similar telehealth walking self-management interventions and prior to larger scale implementation of the current intervention for individuals with lower limb amputation. IMPACT A telehealth walking self-management intervention has potential impact for individuals with lower limb amputation and must be considered in terms of optimizing system, therapist, and person level facilitators and barriers to implementation.
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Affiliation(s)
- Laura A Swink
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Meredith L Mealer
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Matthew J Miller
- School of Medicine, University of California, San Francisco, California, USA
| | - Chelsey B Anderson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Cory L Christiansen
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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Munneke W, Demoulin C, Roussel N, Leysen M, Van Wilgen CP, Pitance L, Reezigt RR, Voogt LP, Dankaerts W, Danneels L, Köke AJA, Cools W, De Kooning M, Nijs J. Comparing physical therapy students' attitudes and beliefs regarding chronic low back pain and knee osteoarthritis: an international multi-institutional comparison between 2013 and 2020 academic years. Braz J Phys Ther 2024; 28:100592. [PMID: 38368840 PMCID: PMC10883834 DOI: 10.1016/j.bjpt.2024.100592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. OBJECTIVES To assess the differences in physical therapy students' attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. METHODS In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work. RESULTS In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. CONCLUSIONS Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low.
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Affiliation(s)
- Wouter Munneke
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Nathalie Roussel
- Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Antwerp, Belgium
| | - Marijke Leysen
- Pain in Motion International Research Group (PiM), Belgium; Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - C Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Transcare, Transdisciplinary Pain Management Center, the Netherlands
| | - Laurent Pitance
- Neuro-musculoskeletal Lab (NMSK), UCLouvain, Brussels, Belgium; Oral and Maxillofacial Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Roland R Reezigt
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Lennard P Voogt
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Department of Physical Therapy, University of Applied Sciences Rotterdam, Rotterdam, the Netherlands
| | - Wim Dankaerts
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physical Therapy, Universiteit Gent, Ghent, Belgium
| | - Albère J A Köke
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, CAPHRI, Maastricht University, Maastricht, the Netherland; Department of Physical Therapy Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Wilfried Cools
- Core facility - Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel, Brussels, Belgium
| | - Margot De Kooning
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group (PiM), Belgium; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Sweden.
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Haber T, Hinman RS, Dobson F, Vicenzino B, Darlow B, Kayll S, Hall M. Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross-sectional survey. Musculoskeletal Care 2023; 21:763-775. [PMID: 36864703 PMCID: PMC10947065 DOI: 10.1002/msc.1751] [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] [Received: 02/08/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Using a case vignette of an adult (George) presenting with hip pain consistent with hip OA, this study aimed to describe: (a) whether physiotherapists make diagnoses and identify bodily structures using either patient history and/or physical examination findings; (b) which diagnoses and bodily structures physiotherapists attribute to the hip pain; (c) how confident physiotherapists were in their clinical reasoning using patient history and physical examination findings; (d) what treatments physiotherapists would offer to George. METHODS We conducted a cross-sectional online survey of physiotherapists in Australia and New Zealand. We used descriptive statistics to analyse closed questions and content analysis for open-text responses. RESULTS Two hundred and twenty physiotherapists completed the survey (39% response-rate). After receiving the patient history, 64% diagnosed George's pain and 49% of these as hip OA; 95% attributed George's pain to a bodily structure(s). After receiving the physical examination, 81% diagnosed George's hip pain and 52% of these as hip OA; 96% attributed George's hip pain to a bodily structure(s). Ninety-six percent of respondents were at least somewhat confident in their diagnosis after the patient history, and 95% were similarly confident after the physical examination. Most respondents offered advice (98%) and exercise (99%), but fewer offered treatments for weight loss (31%), medication (11%), and psychosocial factors (<15%). DISCUSSION About half of the physiotherapists that diagnosed George's hip pain made a diagnosis of hip OA, despite the case vignette including clinical criteria for a diagnosis of OA. Physiotherapists offered exercise and education, but many physiotherapists did not offer other clinically indicated and recommended treatments, such as weight loss and sleep advice.
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Affiliation(s)
- Travis Haber
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Fiona Dobson
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Bill Vicenzino
- School of Health and Rehabilitation SciencesUniversity of QueenslandSaint LuciaAustralia
| | - Ben Darlow
- Department of Primary Health Care and General PracticeUniversity of Otago WellingtonWellingtonNew Zealand
| | - Sam Kayll
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Michelle Hall
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
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Chalmers S, Hill J, Connell L, Ackerley S, Kulkarni A, Roddam H. The value of allied health professional research engagement on healthcare performance: a systematic review. BMC Health Serv Res 2023; 23:766. [PMID: 37464444 PMCID: PMC10355072 DOI: 10.1186/s12913-023-09555-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/16/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Existing evidence suggests that clinician and organisation engagement in research can improve healthcare performance. With the increase in allied health professional (AHP) research activity, it is imperative for healthcare organisations, clinicians, managers, and leaders to understand research engagement specifically within allied health fields. This systematic review aims to examine the value of research engagement by allied health professionals and organisations on healthcare performance. METHODS This systematic review had a two-stage search strategy. Firstly, the papers from a previous systematic review examining the effect of research engagement in healthcare were screened to identify papers published pre-2012. Secondly, a multi-database search was used to conduct a re-focused update of the previous review, focusing specifically on allied health to identify publications from 2012-2021. Studies which examined the value of allied health research engagement on healthcare performance were included. All stages of the review were conducted by two reviewers independently. Each study was assessed using the appropriate Joanna Briggs Institute critical appraisal tool. A narrative synthesis was completed to analyse the similarities and differences between and within the different study types. RESULTS Twenty-two studies were included, comprising of mixed research designs, of which six were ranked as high importance. The findings indicated that AHP research engagement appears related to positive findings in improvements to processes of care. The review also identified the most common mechanisms which may link research engagement with these improvements. DISCUSSION This landmark systematic review and narrative synthesis suggests value in AHP research engagement in terms of both processes of care and more tentatively, of healthcare outcomes. While caution is required because of the lack of robust research studies, overall the findings support the agenda for growing AHP research. Recommendations are made to improve transparent reporting of AHP research engagement and to contribute essential evidence of the value of AHP research engagement. TRIAL REGISTRATION This systematic review protocol was registered with the international prospective register of systematic reviews, PROSPERO (registration number CRD42021253461 ).
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Affiliation(s)
- S Chalmers
- University of Central Lancashire; Allied Health Research Unit, School of Health Sciences, University of Central Lancashire, Fylde Rd, Preston, PR1 2HE, UK.
- Bolton NHS Foundation Trust, Minerva Road, Farnworth, Bolton, Greater Manchester, BL4 0JR, UK.
| | - J Hill
- University of Central Lancashire; Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Fylde Rd, Preston, PR1 2HE, UK
| | - L Connell
- University of Central Lancashire; Allied Health Research Unit, School of Health Sciences, University of Central Lancashire, Fylde Rd, Preston, PR1 2HE, UK
- East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, UK
| | - S Ackerley
- University of Central Lancashire; Allied Health Research Unit, School of Health Sciences, University of Central Lancashire, Fylde Rd, Preston, PR1 2HE, UK
| | - A Kulkarni
- Royal College of Speech & Language Therapists, 2-3 White Hart Yard, London, SE1 1NX, UK
| | - H Roddam
- Subject Matter Expert for AHP Research, Health Education England, Manchester, UK
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10
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Phang SKA, Betzler BK, Dan YR, Bin Abd Razak HR. Current evidence does not support the routine use of cognitive behavioural therapy in total knee arthroplasty: A systematic review. J Clin Orthop Trauma 2023; 42:102204. [PMID: 37449056 PMCID: PMC10336691 DOI: 10.1016/j.jcot.2023.102204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/09/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023] Open
Abstract
Background There is a significant dissatisfaction rate in patients undergoing total knee arthroplasty (TKA), and poor mental health in patients is increasingly recognized as a major contributor to dissatisfaction. The aim was to review the effectiveness of cognitive behavioural therapy (CBT) in improving pain and functional outcomes of patients undergoing TKA and highlight important aspects that may be crucial for improvement. Methods A systematic search was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were included if they were randomized control trials that included patients undergoing unilateral or bilateral TKA, with CBT as an intervention compared against usual care, and reported outcomes in pain, knee function and any psychological outcomes as measured. Results Eight RCTs were selected which included 683 participants. The timings of CBT delivery, profiles of therapists, and outcome measures reported varied across the studies. Overall, 3 studies reported significant improvement in pain outcomes, 3 studies reported significant improvement in functional outcomes and 5 studies reported significant improvements in psychological outcomes. Conclusion Current evidence does not support the efficacy of CBT as current literature is too heterogenous. Further studies with homogenous CBT methods are required to further ascertain the true relationship between CBT and postoperative outcomes of TKA. Future studies should consider the points set out in this review, such as the importance of revisiting CBTskills, providing individualized therapy, having a supervisory team to support the fidelity of interventions, and identifying which group of patients would best benefit from CBT.
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Affiliation(s)
- Sean Kia-Ann Phang
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Brjan Kaiji Betzler
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Yuet-Ruh Dan
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
- Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, 169857, Singapore
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11
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van Dijk H, Köke AJA, Elbers S, Mollema J, Smeets RJEM, Wittink H. Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1634. [PMID: 36674387 PMCID: PMC9861865 DOI: 10.3390/ijerph20021634] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.
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Affiliation(s)
- Han van Dijk
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CH Utrecht, The Netherlands
| | - Albère J. A. Köke
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, 6211 LK Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands
- Department Physiotherapy, Zuyd University for Applied Sciences, 6419 DJ Heerlen, The Netherlands
- Pain in Motion International Research Group (PiM), 1050 Brussels, Belgium
| | - Stefan Elbers
- Kantar Public, Behavioural Insights & Communications, 1079 LH Amsterdam, The Netherlands
| | - Jurgen Mollema
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CH Utrecht, The Netherlands
| | - Rob J. E. M. Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, 6211 LK Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), 1050 Brussels, Belgium
- CIR Rehabilitation, 5628 WB Eindhoven, The Netherlands
| | - Harriët Wittink
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CH Utrecht, The Netherlands
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12
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Nagasawa Y, Shibata A, Fukamachi H, Ishii K, Oka K. Physical therapist-delivered acceptance and commitment therapy and exercise for older outpatients with knee osteoarthritis: a pilot randomized controlled trial. J Phys Ther Sci 2022; 34:784-790. [PMID: 36507082 PMCID: PMC9711971 DOI: 10.1589/jpts.34.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
[Purpose] In this pilot study, we investigated the effectiveness of physical therapist-delivered acceptance and commitment therapy in older outpatients with knee osteoarthritis and chronic pain. [Participants and Methods] This single-center, open-label, parallel-group pilot randomized controlled trial included 30 patients assigned to the physical therapist-delivered acceptance and commitment therapy group (n=15) and the usual care physical therapy-only group (n=15). Both treatments were administered once a week for 8 weeks. Evaluation was performed 4 weeks before intervention, pre-intervention, post-intervention, and 4 weeks after intervention. The primary outcome was diagnosis of a physical disability, and secondary outcomes included psychological inflexibility, pain intensity, anxiety, depression, physical function, and objectively measured physical activity. [Results] Physical therapist-delivered acceptance and commitment therapy had a limited effect on physical disability, although we observed a favorable tendency. With regard to secondary outcomes, physical therapist-delivered acceptance and commitment therapy did not show significant effects. Notably, 15 patients withdrew from this study and 6 were diagnosed with coronavirus disease. [Conclusion] Physical therapist-delivered acceptance and commitment therapy did not appear to show significant effects in the present study. It is necessary to correct these issues in this study, and future studies are warranted to investigate the effects of this therapy.
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Affiliation(s)
- Yasuhiro Nagasawa
- Department of Rehabilitation, Hasegawa Hospital: 85
Yachimatani, Yachimata, Chiba 289-1103, Japan, Graduate School of Sport Sciences, Waseda University,
Japan,Corresponding author. Yasuhiro Nagasawa (E-mail: ) (Supplementary
materials: refer to PMC https://www.ncbi.nlm.nih.gov/pmc/journals/2193/)
| | - Ai Shibata
- Faculty of Health and Sports Sciences, University of
Tsukuba, Japan
| | | | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Japan
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13
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Bamonti PM, Moye J, Harris R, Kallmi S, Kelly CA, Middleton A, Bean JF. Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy. Arch Rehabil Res Clin Transl 2022; 4:100198. [PMID: 35756988 PMCID: PMC9214325 DOI: 10.1016/j.arrct.2022.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the development of the Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) Coaching Protocol to increase exercise self-efficacy in middle-aged and older adults participating in Live Long Walk Strong (LLWS) Rehabilitation Program. LLWS Rehabilitation Program is an innovative physical therapist (PT) delivered outpatient intervention for middle- and older-aged adults with slow gait speed. Design Phase II randomized controlled trial (RCT) with masked outcome assessment. We applied the Knowledge to Action Framework to develop and implement the LLWS SMART Coaching Protocol within an RCT for the LLWS Rehabilitation Program. Data will be collected at baseline and post intervention at 2, 8 and 16 weeks. Setting Outpatient; VA Boston Healthcare System. Participants Community-dwelling veterans (N=198) (older than 50 years) with slow gait speed (<1.0 m/s). Interventions Participants will be randomized to the LLWS Rehabilitation Program, an 8-week (10-session) PT-delivered intervention, or wait-list control group. Each study visit will introduce a new SMART Coaching module focused on goal setting, exercise adherence, and addressing internal and external barriers to meeting exercise goals. Main Outcome Measures Primary outcome is gait speed and secondary outcome is the Self-Efficacy for Exercise Scale. Conclusions Incorporating cognitive behavioral tools in physical therapy intervention research is critical for targeting motivational processes needed for exercise behavior change.
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Key Words
- Exercise
- LLWS, Live Long Walk Strong
- PT, physical therapist
- Physical therapy modalities
- RCT, randomized controlled trial
- Rehabilitation
- SCT, social cognitive theory
- SMART, Specific, Measurable, Action-Oriented, Realistic, and Timed
- SPPB, Short Physical Performance Battery
- VA, Veterans Affairs
- Walking speed.
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Affiliation(s)
- Patricia M. Bamonti
- VA Boston Healthcare System, Research Service, Boston, MA
- Harvard Medical School, Department of Psychiatry, Boston, MA
| | - Jennifer Moye
- Harvard Medical School, Department of Psychiatry, Boston, MA
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Rebekah Harris
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Selmi Kallmi
- VA Boston Healthcare System, Mental Health Division, Brockton, MA
| | - Catherine A. Kelly
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Addie Middleton
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Jonathan F. Bean
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
- Harvard Medical School, Department of Physical Medicine & Rehabilitation, Boston MA
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14
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Feldman R, Haleva-Amir S, Pincus T, Ben Ami N. Physiotherapists' perceptions of implementing evidence-based practice for patients with low back pain through the Enhanced Transtheoretical Model Intervention: a qualitative study. Physiother Theory Pract 2022:1-12. [PMID: 35384785 DOI: 10.1080/09593985.2022.2062690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physiotherapists have been urged to implement evidence-based practice for the management of low back pain (LBP). However, recent evidence suggests that many fail to do so, specifically in accordance with eliciting and addressing psychosocial factors that impact pain. The Enhanced Transtheoretical Model Intervention (ETMI) for the Treatment of patients with LBP was developed in Israel according to the clinical guidelines and demonstrated clinically and cost-effectiveness. OBJECTIVES This study's purpose is to explore physiotherapists' perceptions of implementing evidence-based practice through the ETMI approach. DESIGN Qualitative study. METHODS Qualitative semi-structured interviews were conducted with 26 physiotherapists. The interviews were audio-recorded, transcribed, coded, and analyzed thematically to identify prevalent themes. RESULTS Three main themes were identified from the transcripts, consisting of barriers and facilitators of implementing the intervention, and a meta-theme referring to shifts in the perceptions of professional role and identity. CONCLUSION The findings suggest that physiotherapists believed that implementing ETMI and adopting a psychosocial approach to LBP can be achieved by overcoming issues around communication skills, patient reassurance, and inter-professional collaboration. Therapists also highlighted the need for physiotherapy training to gain skills in combined physical and psychological approaches.
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Affiliation(s)
- Ron Feldman
- Department of Physiotherapy, Ariel University, Ariel, Israel.,Department of Physiotherapy, "Maccabi" Healthcare Services, Tel-Aviv, Israel
| | | | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Noa Ben Ami
- Department of Physiotherapy, Ariel University, Ariel, Israel
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15
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Ho EKY, Chen L, Simic M, Ashton-James CE, Comachio J, Wang DXM, Hayden JA, Ferreira ML, Ferreira PH. Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis. BMJ 2022; 376:e067718. [PMID: 35354560 PMCID: PMC8965745 DOI: 10.1136/bmj-2021-067718] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN Systematic review with network meta-analysis. DATA SOURCES Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. RESULTS 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). CONCLUSIONS For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138074.
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Affiliation(s)
- Emma Kwan-Yee Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Lingxiao Chen
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Milena Simic
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire Elizabeth Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Josielli Comachio
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Daniel Xin Mo Wang
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jill Alison Hayden
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manuela Loureiro Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Paulo Henrique Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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16
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Bouma SE, van Beek JFE, Diercks RL, van der Woude LHV, Stevens M, van den Akker-Scheek I. Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review. BMJ Open 2022; 12:e056831. [PMID: 35105598 PMCID: PMC8808449 DOI: 10.1136/bmjopen-2021-056831] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA). DESIGN Scoping review. DATA SOURCES The databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception up to January 2021. ELIGIBILITY CRITERIA Primary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs (population); (2) on implementing LIs with physical activity and/or weight management as key components (concept) and (3) on conservative management of hip and/or knee OA (context). Articles not published in English, German or Dutch were excluded. DATA EXTRACTION AND SYNTHESIS Barriers and facilitators were extracted by two researchers independently. Subsequently, the extracted factors were linked to a framework based on the Tailored Implementation for Chronic Diseases checklist. RESULTS Thirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. The extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients' negative attitude towards LIs, patients' low health literacy and HCPs' lack of knowledge and skills around LIs or promoting behavioural change. The extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs' own role in implementing LIs, the content or structure of LIs and HCPs' positive attitude towards LIs. CONCLUSIONS Multiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs. PROSPERO REGISTRATION NUMBER CRD42019129348.
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Affiliation(s)
- Sjoukje E Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Juliette F E van Beek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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17
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Lucas L, Parker J. Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study. Arch Physiother 2022; 12:2. [PMID: 35012683 PMCID: PMC8750848 DOI: 10.1186/s40945-021-00124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.
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Affiliation(s)
- Lauren Lucas
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffiled, UK. .,Present address: Salford Royal NHS Foundation Trust; Community Stroke and Neuro Rehab Team, Sandringham House, Salford, M5 4DG, UK. .,Present address: School of Human Sciences, University of Derby, Derby, UK.
| | - Jack Parker
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffiled, UK.,Present address: School of Human Sciences, University of Derby, Derby, UK
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18
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Ballengee LA, Zullig LL, George SZ. Implementation of Psychologically Informed Physical Therapy for Low Back Pain: Where Do We Stand, Where Do We Go? J Pain Res 2021; 14:3747-3757. [PMID: 34908873 PMCID: PMC8665872 DOI: 10.2147/jpr.s311973] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022] Open
Abstract
Low back pain continues to be a leading cause of disability and cost throughout the world. Evidence-based guidelines recommend use of non-pharmacological interventions to address decreases in physical function due to low back pain. Psychologically informed physical therapy (PIPT) is one way to effectively and efficiently address the need for non-pharmacological approaches. However, adoption of psychologically informed practice (PiP) by physical therapists has shown mixed results due to implementation challenges. In this perspective, we discuss the current state of PIPT training and implementation. We also propose a conceptual roadmap for future implementation needs related to increasing delivery of PIPT-informed approaches.
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Affiliation(s)
- Lindsay A Ballengee
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Division of Physical Therapy, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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19
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Razmjou H, Savona A, Szafirowicz A, Deel L, Richards R. Psychosocial risk factors and physical and mental well-being following a compensable knee injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1995896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Helen Razmjou
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
| | - Alicia Savona
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Analia Szafirowicz
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lauren Deel
- Working Condition Program, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robin Richards
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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20
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Depression Moderates Physical Functioning Over Time in Survivors of Cancer. REHABILITATION ONCOLOGY 2021; 39:E98-E105. [DOI: 10.1097/01.reo.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Gopal A, Sydow R, Block V, Allen DD. Effectiveness of Physical Therapy in Addressing Sexual Dysfunction in Individuals with Multiple Sclerosis: A Systematic Review and Meta-analysis. Int J MS Care 2021; 23:213-222. [PMID: 34720761 PMCID: PMC8550487 DOI: 10.7224/1537-2073.2020-039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) frequently report sexual dysfunction, a condition that may result in low sexual satisfaction and decreased quality of life. Although sexual dysfunction is usually treated pharmacologically, physical therapists, especially those trained in pelvic floor physical therapy (PT), are well-equipped to address a variety of impairments that contribute to poor sexual function. The current evidence for effectiveness of PT interventions in improving sexual dysfunction, sexual satisfaction, and the emotional well-being aspect of quality of life was analyzed. METHODS The PubMed, CINAHL, and PEDro databases were searched through December 2019. Articles were included if participants had a clinical diagnosis of MS, reported sexual dysfunction or pain with intercourse, and had an intervention within the PT scope that addressed sexual dysfunction. Means and SDs were extracted from each study independently by two authors. Effect sizes (d) and 95% CIs were calculated within and across studies. RESULTS Eight studies met the inclusion criteria. Combined effects were significant and large across six studies for sexual function (d = 0.82, 95% CI, 0.57-1.06), moderate across seven studies for sexual satisfaction (d = 0.65, 95% CI, 0.43-0.87), and moderately large across two studies for emotional well-being (d = 0.78, 95% CI, 0.17-1.40). Between-group differences reached significance for sexual satisfaction (d = 0.29, 95% CI, 0.03-0.55). CONCLUSIONS Sexual function, sexual satisfaction, and emotional well-being can all be effectively addressed with various PT interventions. Highly effective interventions included pelvic floor muscle training and mindfulness. Future research should compare PT interventions with non-PT controls to determine best practice in this population.
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Affiliation(s)
- Arpita Gopal
- From the Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA
| | - Rebecca Sydow
- From the Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA
| | - Valerie Block
- Weill Institute for Neurosciences, Department of Neurology (VB), University of California, San Francisco, CA, USA
| | - Diane D. Allen
- From the Department of Physical Therapy and Rehabilitation Science (AG, RS, DDA), University of California, San Francisco, CA, USA
- Department of Physical Therapy, San Francisco State University, San Francisco, CA, USA (DDA)
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Salik Sengul Y, Kahraman T, Ozcan Kahraman B. Problematic Facebook use behavior and locus of control in physiotherapy students. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [PMCID: PMC8354783 DOI: 10.1186/s43161-021-00031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Problematic Facebook use is a broader umbrella for term addictive-like symptoms, and scarce self-regulation related to Facebook use reflecting social and personal problems, and many studies have suggested that it is associated with many psychosocial problems. Locus of control (LOC) is described as a personality trait developed through social learning theory. Recently, LOC has got attention from both the patient’s and clinician’s perspectives. In addition, higher external LOC is associated with problematic Internet use. The aim was to investigate whether problematic Facebook use is associated with LOC. Four hundred twenty-one university students were enrolled in this cross-sectional study. Problematic Facebook use was determined by the Bergen Facebook Addiction Scale, and the participants were divided into two groups as neutral users and problematic users. Locus of control was assessed using the Locus of Control Scale, including subscales of personal control, belief in chance, the meaninglessness of the effortfulness, belief in fate, and belief in an unjust world. Results In total, 333 students were eligible for the study. There were 66 students with neutral Facebook use (19.8%), and the remaining (n=267) had problematic Facebook use (80.2%). No significant difference was observed in the demographic characteristic of neutral and problematic Facebook users (p>0.05). Problematic Facebook users had significantly higher scores on the meaninglessness of the effortfulness (p<0.001), belief in fate (p=0.019), and belief in an unjust world (p=0.004) compared to the neutral Facebook users. Conclusions The results showed that the physiotherapy students having a problematic Facebook had significantly higher scores on the meaninglessness of the effortfulness, belief in fate, and belief in an unjust world compared to neutral Facebook users. All these negative thoughts might be a problem both for students themselves and their future patients.
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Bunzli S, Taylor N, O'Brien P, Dowsey M, Wallis J, Choong P, Shields N. How Do People Communicate About Knee Osteoarthritis? A Discourse Analysis. PAIN MEDICINE 2021; 22:1127-1148. [PMID: 33502513 DOI: 10.1093/pm/pnab012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. DESIGN A qualitative synthesis using discourse analysis methods. METHODS Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers, and/or clinicians. Methodological quality was evaluated through the use of the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analyzed with inductive discourse analysis. RESULTS A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1,673 direct quotes) from people with knee osteoarthritis, carers, and clinicians in 16 countries. Two overarching discourses were identified-impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore down over time and required a doctor to repair. The overarching participatory discourse almost always coexisted alongside an impairment discourse. According to this discourse, a "busy body" was perceived as "healthy," and people could remain active despite knee osteoarthritis. CONCLUSION The prevailing impairment discourse may potentially discourage people from using knees that have passed their "use-by date" and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating that may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.
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Affiliation(s)
- Samantha Bunzli
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Nicholas Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia
| | - Penny O'Brien
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Michelle Dowsey
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Jason Wallis
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Choong
- University of Melbourne, Department of Surgery, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Nora Shields
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Victoria, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Australia
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Semrau J, Hentschke C, Peters S, Pfeifer K. Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:500. [PMID: 34051780 PMCID: PMC8164753 DOI: 10.1186/s12891-021-04353-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). Methods A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an ‘urn randomisation’ algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop self-management strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. Results There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI − 2.82 to 2.99; p = 0.955), at 6 months (mean difference, − 1.80; 95% CI; − 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, − 1.33; 95% CI − 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. Conclusion BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. Trial registration Current controlled trials NCT01666639, 16/08/2012. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04353-y.
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Affiliation(s)
- Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany.
| | | | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie (DVGS) e.V, Vogelsanger Weg 48, 50354, Hürth-Efferen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Gebbertstraße 123 b, 91056, Erlangen, Germany
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Exploring the Physical Therapy Experience Among People Living With Lymphedema: A Biopsychosocial Perspective. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, van Balen R, Kempen GIJM, Achterberg WP, van Haastregt JCM. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr 2021; 21:224. [PMID: 33794804 PMCID: PMC8017759 DOI: 10.1186/s12877-021-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION Netherlands Trial Register: NTR5695 (7 March 2016).
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Affiliation(s)
- Maaike N Scheffers-Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Galea Holmes MN, Wileman V, McCracken LM, Critchley D, March MK, Norton S, Moss-Morris R, Noonan S, Barcellona M, Godfrey E. Experiences of training and delivery of Physical therapy informed by Acceptance and Commitment Therapy (PACT): a longitudinal qualitative study. Physiotherapy 2020; 112:41-48. [PMID: 34020201 DOI: 10.1016/j.physio.2020.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Physiotherapy informed by Acceptance and Commitment Therapy (PACT) is a novel intervention that is related to improved disability and functioning in people with chronic lowback pain. This study explored physiotherapists experiences over time of the PACT training programme and intervention delivery. DESIGN A longitudinal qualitative study using semi-structured, in-depth, individual interviews at three time points was conducted. METHODS A phenomenological approach underpinned the methods. Interviews followed topic-guides developed a priori. Transcribed interviews were coded inductively to generate themes. Data were member checked by participants and validated by two researchers. PARTICIPANTS Eight clinical physiotherapists from three secondary care centres in the United Kingdom (n = 5 female; age, 24 to 44 years; duration of practice, 3 to 14 years) were included. RESULTS Five themes emerged from the data. Experiential learning techniques were challenging but valued because they bridged theoretical principles and concepts with practice. Ongoing individual and group supervision was beneficial, but required tailoring and tapering. PACT delivery extended physiotherapy skills and practice, including techniques that acknowledged and addressed patient treatment expectations. With experience, participants desired greater flexibility and autonomy to tailor PACT delivery. CONCLUSIONS PACT training and delivery were acceptable to physiotherapists. Existing skills were developed and additional, applicable approaches were provided that addressed psychosocial and behavioural aspects of chronic low back pain.
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Affiliation(s)
- Melissa N Galea Holmes
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Vari Wileman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Lance M McCracken
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK; Department of Psychology, Uppsala University, Uppsala, 751 42, Sweden.
| | - Duncan Critchley
- Department of Physiotherapy, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus London, SE1 1UL, UK.
| | - Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown Rd, Blacktown, NSW 2147, Australia; Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006 Australia.
| | - Sam Norton
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK; Centre for Rheumatic Diseases, School of Immunology & Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Sandra Noonan
- Department of Physiotherapy, Guy's and St Thomas' Hospital NHS Foundation Trust, London, SE1 9RT, UK.
| | | | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK; Department of Physiotherapy, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus London, SE1 1UL, UK.
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Ballengee LA, Covington JK, George SZ. Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting. BMC MEDICAL EDUCATION 2020; 20:382. [PMID: 33097054 PMCID: PMC7583179 DOI: 10.1186/s12909-020-02272-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists. METHODS Thirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected. RESULTS After the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients. CONCLUSION Students had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.
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Affiliation(s)
- Lindsay A. Ballengee
- Department of Orthopaedic Surgery, Duke University School of Medicine and Durham VA Health Care System Center of Innovation to Accelerate Discovery and Practice Transformation, 411 W Chapel Hill Street Ste 600, Durham, NC 27701 USA
| | - J. Kyle Covington
- Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University School of Medicine, 311 Trent Drive, Durham, NC 27710 USA
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27001 USA
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Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials. Pain Rep 2020; 5:e847. [PMID: 33490842 PMCID: PMC7808677 DOI: 10.1097/pr9.0000000000000847] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Randomized trials have examined the efficacy of psychologically informed physical therapy methods including graded activity or graded exposure, cognitive-behavioral-based physical therapy, acceptance and commitment-based physical therapy, and internet-based psychological programs compared to traditional physical therapy approaches for musculoskeletal pain. Summary findings suggest that psychologically informed physical therapy is a promising care model; however, more convincing evidence is needed to support widespread adoption, especially in light of clinician training demands. Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges.
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Perez JE, Schmidt MA, Narvaez A, Welsh LK, Diaz R, Castro M, Ansari K, Cason RW, Bilezikian JA, Hope W, Guerron AD, Yoo J, Levinson H. Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction. Hernia 2020; 25:1-13. [PMID: 32959176 DOI: 10.1007/s10029-020-02304-5] [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: 04/27/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. METHODS The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. CONCLUSIONS There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.
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Affiliation(s)
- J E Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M A Schmidt
- Department of Physical Therapy and Occupational Therapy, Duke University, Durham, NC, 27710, US
| | - A Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - L K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - R Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - M Castro
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - K Ansari
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - R W Cason
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US
| | - J A Bilezikian
- Department of General Surgery, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - W Hope
- General Surgery Specialists, New Hanover Regional Medical Center, Wilmington, NC, 28403, US
| | - A D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - J Yoo
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, NC, 27704, US
| | - H Levinson
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, 27710, US. .,Director of Innovation and Entrepreneurship, Associate Professor of Plastic and Reconstructive Surgery, Pathology, Dermatology and Surgical Sciences, Departments of Dermatology, Pathology, and Surgery, Duke University Medical Center, DUMC 3181, Durham, NC, 27710, US.
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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Leahy E, Chipchase L, Calo M, Blackstock FC. Which Learning Activities Enhance Physical Therapist Practice? Part 2: Systematic Review of Qualitative Studies and Thematic Synthesis. Phys Ther 2020; 100:1484-1501. [PMID: 32529234 DOI: 10.1093/ptj/pzaa108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Post-professional physical therapy expertise requires career-long participation in learning activities. Understanding physical therapists' lived experience of learning activities provides novel insight into how best to enhance physical therapist practice from the perspective of the learner. The purpose of this study was to explore qualified physical therapists' experiences, beliefs, and perspectives with regard to learning activities and professional development. METHODS Eight databases were searched for studies published from inception through December 2018. Study selection included mixed-methods and qualitative studies exploring physical therapists' experiences, perspectives, beliefs, and attitudes. Thematic synthesis was performed, and the GRADE-Confidence in the Evidence from Reviews of Qualitative research was used to assess the level of confidence in the findings. A total 41 studies with 719 participants were included. RESULTS The key findings include physical therapists' perceptions that worthwhile post-professional learning requires more than attendance at professional development courses. Physical therapists perceived that worthwhile learning requires connection with others and being "taken out of one's comfort zone." Sufficient time and accessible, trustworthy resources were also valued. CONCLUSIONS Moderate- to low-level evidence suggests that the choice of professional development activities and education design for qualified physical therapists should consider the inclusion of connected activities, activities that take participants out of comfort zones, time to practice, and trustworthy resources that are easily accessible. Future research should evaluate the effectiveness of learning activities encompassing these factors, prioritizing those that minimize the barriers of time and distance. IMPACT This study adds to the profession's understanding of physical therapists' lived experience of learning activities, providing novel insight into how best to enhance physical therapist practice from the perspective of the learner.
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Affiliation(s)
- Edmund Leahy
- BPhysio, MPhty(Musc),, Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia; Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; and Physiotherapy Department, Northern Health, Epping, Victoria, Australia
| | - Lucy Chipchase
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Marlena Calo
- B.Physiotherapy, PGCErt (PFPhysio), Department of Physiotherapy, School of Science and Health, Western Sydney University; and Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University
| | - Felicity C Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University
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Abstract
Rhabdomyolysis can result in pain, physical limitations and may require hospitalization for medical management; however, little evidence has been reported on the efficacy of physical therapy (PT) interventions for this condition. Additionally, a review of literature on occurrences of rhabdomyolysis associated with cancer treatments yielded limited results. The purpose of this case report was to describe the acute and inpatient rehabilitation (IPR) examination, interventions, and outcomes for a patient with breast cancer and rhabdomyolysis. The patient was a 57-year-old female with a history of recurrent breast cancer who presented to the hospital with a chief complaint of bilateral thigh pain and weakness after the second cycle of chemotherapy and was diagnosed with rhabdomyolysis. After initially declining PT treatment during her first hospitalization, the patient was readmitted after a fall at home. She was hospitalized for 14 days with a transfer to IPR. The patient received a total of 12 days of PT (two acute care visits and 10 IPR visits) that included patient education, neuromuscular re-education, therapeutic exercise, and gait training. The patient was discharged home at a modified independent level with improvements in pain from 8/10 to 0/10 on the Numeric Pain Rating Scale. Functionally, she improved from ambulating 20 feet (6.1 m) to 600 feet (183 m); her Timed Up and Go score improved from 62 seconds to 10 seconds. Finally, her Berg Balance Scale improved from 31/56 to 55/56. Data from this case study suggest that PT management appears to improve functional outcomes for individuals diagnosed with rhabdomyolysis while undergoing chemotherapy, however, a holistic approach was necessary for progress to educate her on the importance of participation in PT with this condition. Further research is required to explore factors that influence rhabdomyolysis in the presence of chemotherapy as well as the recommended rehabilitation program for rhabdomyolysis.
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Affiliation(s)
- Grace Burns
- Rehabilitation Services, Beaumont Health, Troy, USA
| | - Christopher M Wilson
- Physical Therapy, Oakland University, Rochester, USA.,Rehabilitation Services, Beaumont Health, Troy, USA
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Holopainen R, Piirainen A, Karppinen J, Linton SJ, O'Sullivan P. An adventurous learning journey. Physiotherapists' conceptions of learning and integrating cognitive functional therapy into clinical practice. Physiother Theory Pract 2020; 38:309-326. [PMID: 32338113 DOI: 10.1080/09593985.2020.1753271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Recent low back pain guidelines recommend a BPS approach to the management of disabling low back pain. However, the most effective way of teaching physiotherapists to implement these approaches remains unknown. The present qualitative study aimed to explore physiotherapists' conceptions of learning and integrating Cognitive Functional Therapy (CFT) into clinical practice in Finnish primary health care.Methods: We interviewed 22 physiotherapists, who participated in four to six days of CFT workshops. A phenomenographic approach was used to explore the variation in the physiotherapists' conceptions of this process.Results: Four themes emerged from the data: 1) membership of work community; 2) learning journey; 3) transition to new working methods; and 4) professional role as a physiotherapist. These themes varied in four categories of description: recognizing difference of the new approach, toward integrating the new approach, waking up to explore, commitment to new approach and expanding application of new approach. The critical aspects between the categories that enabled the integration of CFT into clinical practice were ability to overcome resistance and to change views, being shaken and ability to critically reflect on one's work, support from the work community and becoming convinced, creativity, multidisciplinary collaboration and continuous learning.Conclusion: The participants' responses to the training varied greatly, suggesting that for some, the training was insufficient to support adequate changes in their practice behavior; whereas for others, the training was a life changing experience.
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Affiliation(s)
- Riikka Holopainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Steven James Linton
- Center for Health and Medical Psychology, School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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35
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Physical Therapy Evaluation and Management of Cancer-Related Low Back Pain: A Perspective. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions: a systematic review and metasynthesis of qualitative studies. Pain 2020; 161:1150-1168. [DOI: 10.1097/j.pain.0000000000001809] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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The Effectiveness of Group-Based Physiotherapy-Led Behavioral Psychological Interventions on Adults With Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 98:215-225. [PMID: 30277912 DOI: 10.1097/phm.0000000000001053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Group-based physiotherapy-led behavioral psychological interventions (GPBPIs) are an emerging treatment for chronic low back pain, but the efficacy of these interventions is uncertain. A review of relevant randomized controlled trials and a meta-analysis was conducted to evaluate the effectiveness of GPBPIs on pain relief in adults with chronic low back pain. Literature databases, Google Scholar, bibliographies, and other relevant sources were searched. Thirteen intervention studies (13) published from 1998 to 2013 were included. The meta-analysis was conducted using RevMan software in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. In reviewing the short- (<6 mos), intermediate- (≥6 and <12 mos), and longer-term (≥12 mos) effects of GPBPIs, long-term follow-up evaluations showed large and significant effect sizes (standardized mean difference = -0.25, 95% confidence interval = -0.39 to -0.11, I2 = 38%, P < 0.01). Subgroup analysis indicated that patients from GPBPIs group had the greater short-, intermediate-, and long-term pain reduction than patients on waiting listing or usual care group. Compared with other active treatments, GPBPIs showed a small but significant long-term pain reduction in patients with chronic low back pain (standardized mean difference = -0.18, 95% confidence interval = -0.35 to -0.01, I2 = 32%, P = 0.04). In general, GPBPIs may be an acceptable intervention to relieve pain intensity.
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A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions. Clin J Pain 2019; 34:838-857. [PMID: 29554030 DOI: 10.1097/ajp.0000000000000601] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy on pain, disability, and psychological outcomes for patients with musculoskeletal pain conditions. METHODS The review was conducted in accordance with the (PRISMA) guidelines. Five databases were systematically searched for randomized controlled trials from inception to May 2016. Studies were required to compare a psychological intervention delivered by physiotherapists combined with physiotherapy to physiotherapy alone or usual care. Physiotherapists delivering the interventions must have undergone training by a psychologist or a health professional trained in the delivery of psychological interventions. RESULTS A total of 34 articles met the eligibility criteria, of those, 30 were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological intervention combined with physiotherapy decreased pain in the short (26 studies, mean difference=-0.37; 95% confidence interval [CI], -0.65 to -0.09) and long term (22 studies, mean difference=-0.38; 95% CI, -0.67 to -0.10) and decreased disability in the short term (29 studies, standardized mean difference =-0.14; 95% CI, -0.26 to -0.01). Effect sizes were small. Low to high quality evidence demonstrated small to medium effects for some psychological outcomes at short-term and long-term follow-ups. DISCUSSION The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions.
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Driver C, Oprescu F, Lovell GP. Exploring physiotherapists' considerations regarding the use of psychosocial strategies in practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1783. [DOI: 10.1002/pri.1783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Christina Driver
- School of Social SciencesUniversity of the Sunshine Coast Maroochydore Queensland Australia
| | - Florin Oprescu
- School of Health and Sport ScienceUniversity of the Sunshine Coast Maroochydore Queensland Australia
| | - Geoff P. Lovell
- School of Social SciencesUniversity of the Sunshine Coast Maroochydore Queensland Australia
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40
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Driver C, Lovell GP, Oprescu F. Physiotherapists' views, perceived knowledge, and reported use of psychosocial strategies in practice. Physiother Theory Pract 2019; 37:135-148. [PMID: 30870078 DOI: 10.1080/09593985.2019.1587798] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Research has addressed the usefulness of psychosocial strategies within physiotherapy, as part of a biopsychosocial model. A lack of current research in Australia concerning the views of physiotherapists, from a range of practice areas, regarding a variety of strategies, suggests the need for broader exploration. Methods: This research employed a cross-sectional survey asking Australian physiotherapists (n = 251) to rate their perceived importance and perceived benefits of psychosocial strategies; perceived positive effects on rehabilitation outcomes and adherence; confidence in applying strategies, and perceived benefits of further training. Data were analyzed using descriptive statistics, Crosstabs with Chi-Squared Tests of Contingencies and Spearman's Rank-Order Correlations. Results: Physiotherapists reported that having knowledge of such strategies was important and considered them beneficial for practice. Respondents rated highly their perceived knowledge about goal setting and positive reinforcement, both of which were reported as most used in practice. Approximately one quarter of physiotherapists reported using cognitive behavioral therapy and motivational interviewing. Physiotherapists communicated a lack of confidence to apply psychosocial strategies in their practice, and desired further training. Conclusion: Physiotherapists could benefit from tailored instruction regarding psychosocial strategies at a level appropriate to, and within their scope of practice. This could enhance their practice from a biopsychosocial perspective, subsequently improving outcomes for their patients.
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Affiliation(s)
- Christina Driver
- School of Social Sciences, University of the Sunshine Coast , Maroochydore, Queensland, Australia
| | - Geoff P Lovell
- School of Social Sciences, University of the Sunshine Coast , Maroochydore, Queensland, Australia
| | - Florin Oprescu
- School of Health and Sport Science, University of the Sunshine Coast , Maroochydore, Queensland, Australia
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Coronado RA, Patel AM, McKernan LC, Wegener ST, Archer KR. Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rogelio A. Coronado
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Akshita M. Patel
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Lindsey C. McKernan
- Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Physical Medicine and Rehabilitation; Vanderbilt University Medical Center; Nashville Tennessee
| | - Stephen T. Wegener
- Department of Physical Medicine and Rehabilitation; Johns Hopkins University; Baltimore Maryland
| | - Kristin R. Archer
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Physical Medicine and Rehabilitation; Vanderbilt University Medical Center; Nashville Tennessee
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Nordström K, Ekhammar A, Larsson MEH. Physiotherapist-guided Free Movement Dance for patients with persistent pain is empowering in everyday living. A qualitative study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1536893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Annika Ekhammar
- Rehabilitation Clinic, Primary Health Care, Närhälsan Eriksberg Rehabilitation Clinic, Gothenburg, Sweden
| | - Maria EH Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
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Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: A qualitative study. Musculoskelet Sci Pract 2018; 38:113-119. [PMID: 30423526 DOI: 10.1016/j.msksp.2018.10.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Physiotherapists have been urged to embrace a patient-oriented biopsychosocial (BPS) framework for the management of non-specific chronic low back pain (NSCLBP). However, recent evidence suggests that providing broader BPS interventions demonstrates small differences in pain or disability compared to usual care. Little is known about how to integrate a BPS model into physiotherapy practice and the challenges it presents. OBJECTIVE To explore the perceptions of physiotherapists' in primary care in England adopting a BPS approach to managing NSCLBP patients. METHOD Qualitative semi-structured interviews were conducted with ten physiotherapists working in primary care. A purposive sampling method was employed to seek the broadest perspectives. Thematic analysis was used to analyse the interview transcripts and capture the emergent themes. RESULTS Three main themes emerged: (1) physiotherapists recognised the multi-dimensional nature of NSCLBP and the need to manage the condition from a BPS perspective, (2) addressing psychological factors was viewed as challenging due to a lack of training and guidance, (3) engaging patients to self-manage their NSCLBP was seen as a key objective. CONCLUSION Although employing a BPS approach is recognised by physiotherapists in the management of NSCLBP, this study highlights the problems of implementing evidence based guidelines recommending that psychological factors be addressed but providing limited support for this. It also supports the need to allocate more time to explore these domains in distressed individuals. Engaging patients to self-manage was seen as a key objective, which was not a straightforward process, requiring careful negotiation.
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44
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Kelly JM, Bunzli S, Ritchie C, Kenardy J, Smeets R, Sterling M. Physiotherapist-delivered Stress Inoculation Training for acute whiplash-associated disorders: A qualitative study of perceptions and experiences. Musculoskelet Sci Pract 2018; 38:30-36. [PMID: 30218882 DOI: 10.1016/j.msksp.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/10/2018] [Accepted: 09/04/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Formally trained and accredited physiotherapists delivered Stress Inoculation Training (SIT) integrated with guideline-based physiotherapy management to individuals with acute whiplash associated disorders (WAD) as part of a randomised controlled trial. The delivery of SIT by physiotherapists is new. OBJECTIVES To investigate physiotherapists' perspectives on delivering SIT as part of the trial and in routine practice. DESIGN Qualitative descriptive. METHOD Physiotherapists (n = 11) participated in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings were triangulated against an audit of physiotherapists' adherence to the SIT protocol. RESULTS Three themes were identified: perceived value; capacity to deliver; and adaptation and implementation. Physiotherapists' saw value in SIT in that they perceived the program to have improved patient outcomes, enhanced their therapeutic alliance, and provided new skills to manage psychological contributors to WAD. Physiotherapists' capacity to deliver the program was facilitated through the development of confidence in their ability to deliver sessions, viewing SIT as falling within their current professional identity, and having confidence in their ability to manage mismatches in patients' expectations of care. All physiotherapists reported having used SIT to some extent in routine practice, by selectively delivering sessions and/or integrating the content with other management. Physiotherapists were able to deliver SIT as was intended (94.6% adherence). CONCLUSIONS Physiotherapists' supported adding SIT to usual management of individuals with acute WAD. Education on SIT principles is recommended during pre-professional training to facilitate future implementation.
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Affiliation(s)
- Joan M Kelly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Australia.
| | - Samantha Bunzli
- Department of Surgery, The University of Melbourne, Melbourne, Victoria Australia.
| | - Carrie Ritchie
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland Australia.
| | - Justin Kenardy
- School of Psychology, The University of Queensland, Brisbane, Queensland Australia.
| | - Rob Smeets
- Department of Rehabilitation Medicine, Maastricht University, and Libra Rehabilitation and Audiology, Eindhoven/Weert, The Netherlands.
| | - Michele Sterling
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland Australia.
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Chui A, Mazzitti D, Nalder E, Cameron D, Polatajko HJ, Dawson DR. Therapists' experience of the cognitive orientation to daily occupational performance (CO-OP) approach: Shifting from conventional practice. Scand J Occup Ther 2018; 27:133-141. [PMID: 29983084 DOI: 10.1080/11038128.2018.1483424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The CO-OP ApproachTM has been increasingly used in research and practice, yet its critical elements and implementation challenges are largely undescribed. Obtaining therapists' perspectives on CO-OP may reveal insights into potential critical and mediating factors.Aim/Objective: To explore the experiences of CO-OP therapists by understanding their perceptions on the approach compared with conventional practice, and by identifying mediating factors in its implementation.Material and Method: This exploratory study utilized a qualitative descriptive design. A purposive sample of occupational therapists (n = 3) was interviewed. Data were analyzed using thematic analysis and themes were validated within a focus group.Results/Findings: Three themes were identified: 'CO-OP works,' 'CO-OP delivery is mediated by contextual factors,' and 'CO-OP shifts the therapeutic approach.' Therapists perceived CO-OP to be efficacious for client-centred goal attainment. Guided discovery and the problem-solving strategy were identified as unique and challenging CO-OP elements. Mediating factors such as level of cognitive impairment and quality of family member involvement may affect CO-OP efficacy.Conclusions: Therapists found CO-OP to be efficacious and adopted unique elements into their professional approaches.Significance: This is the first study to investigate CO-OP therapists' experiences. Future research is recommended to enhance training of therapists in key CO-OP features.
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Affiliation(s)
- Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - Daniela Mazzitti
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,March of Dimes Canada, Toronto, Canada
| | - Debra Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Helene J Polatajko
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Deirdre R Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Peters S, Wilkinson A, Mulligan H. Views of healthcare professionals on training for and delivery of a fatigue self-management program for persons with multiple sclerosis. Disabil Rehabil 2018; 41:2792-2798. [PMID: 29911446 DOI: 10.1080/09638288.2018.1478993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To explore the experiences and perspectives of the healthcare professionals who were trained to and delivered "Minimise Fatigue, Maximise Life" (MFML), a patient-centered group-based fatigue self-management program for persons with multiple sclerosis.Methods: A qualitative descriptive study with semi-structured individual interviews at two time points. Data were analyzed for themes. Six healthcare professional facilitators who were trained to and delivered "Minimise Fatigue, Maximise Life" participated in a first interview, and five in a second. Participants were all female, aged between 23 and 66 years old and either occupational therapists or physiotherapists.Results: Two themes were evident in the data. The first, "Reciprocity," showed how the healthcare professionals were trained to deliver MFML, then reciprocated in the program delivery as active participants, which then provided feelings of personal reward and expansion of their usual practice. The second, "Enhancements," encompassed suggested directions for future training and deliveries of the program.Conclusion: This study suggests that multidimensional patient centered interventions also benefit the healthcare professionals who provide them because it expands their practice. Healthcare professionals who recognize the benefits of innovative and patient-centered interventions, supports both the patients with whom they work, and adds value to the health services they provide.Implications for rehabilitationHealthcare professionals who undergo training to facilitate delivery of self-management programs, which are based in an empowerment model, report an enhancement or expansion of their traditional practice.An empowerment-based program delivered in a group situation encourages and facilitates people to draw on their own and peers' knowledge and expertise to problem solve for self-management.Healthcare professional education should facilitate the healthcare professional's learning, and ability and willingness to acknowledge the richness in knowledge and expertise held by their patients.
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Affiliation(s)
- Stefan Peters
- Department of Medical Psychology and Psychotherapy Medical Sociology and Rehabilitation Sciences, Julius-Maximillian University of Wurzburg, Würzburg, Germany
| | - Amanda Wilkinson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hilda Mulligan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Amorim CS, Espirito Santo AS, Sommer M, Marques AP. Effect of Physical Therapy in Bruxism Treatment: A Systematic Review. J Manipulative Physiol Ther 2018; 41:389-404. [DOI: 10.1016/j.jmpt.2017.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
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48
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Hartley SE. Re-imagining the role of the physiotherapist when managing people with long-term conditions. Physiother Theory Pract 2018; 35:1005-1014. [DOI: 10.1080/09593985.2018.1467989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sandra Elaine Hartley
- Department of Health Professions, Brooks Building, Birley Fields Campus, Manchester, England
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Keefe FJ, Main CJ, George SZ. Advancing Psychologically Informed Practice for Patients With Persistent Musculoskeletal Pain: Promise, Pitfalls, and Solutions. Phys Ther 2018; 98:398-407. [PMID: 29669084 PMCID: PMC7207297 DOI: 10.1093/ptj/pzy024] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 02/08/2018] [Indexed: 12/28/2022]
Abstract
There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.
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Affiliation(s)
- Francis J Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27708-0187 (USA)
| | - Chris J Main
- Research Institute for Primary Care & Health Sciences, Keele University, North Staffordshire, United Kingdom
| | - Steven Z George
- Duke Clinical Research Institute, Durham, North Carolina, and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina. Dr George is a Catherine Worthingham Fellow of the American Physical Therapy Association
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50
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Toye F, Seers K, Barker K. A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundPeople with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.Objectives(1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs.DesignWe used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument.Data sourcesWe searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings.ResultsWe screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (seeReport Supplementary Material 1; URL:www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy.LimitationsThere are no agreed methods for determining confidence in QESs.ConclusionsWe highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain.Future workFuture work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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