Brady B1,2, Veljanova I3, Boland R4, Chipchase L2
1Liverpool Hospital, Department of Pain Medicine, Liverpool BC NSW, Australia, 2Western Sydney University, School of Science and Health, Campbelltown, Australia, 3Western Sydney University, School of Social Science and Psychology, Liverpool, Australia, 4Fairfield Hospital, Physiotherapy Department, Fairfield, Australia
Background: Culturally adapted approaches have been suggested as an effective strategy to enhance patient engagement and reduce health disparities in culturally and linguistically diverse (CALD) communities. However, the effectiveness of culturally adapted approaches for improving outcomes for CALD patients who attend for physiotherapy interventions is yet to be established.
Purpose: The purpose of this review was two-fold. First, it aimed to identify and critically appraise research that has evaluated culturally adapted physiotherapy for CALD patient populations. Second, it aimed to synthesise and appraise systematic reviews that investigated culturally adapted health promotion interventions relevant to physiotherapy practice (physical activity, overweight/obesity, chronic disease risk and patient self-management).
Methods:
1) A systematic literature search was conducted to identify peer-reviewed articles that investigated cultural adaptations of physiotherapy interventions for CALD communities. Multiple search strategies were undertaken to identify prospective investigations published between 1993 and 2018 that explored a culturally adapted physiotherapy intervention. Sixty-seven articles were retrieved and analysed. Only one study satisfied the inclusion criteria, which was critically appraised using the PEDro scale.
2) A systematic search of systematic reviews published between1993 and 2018 was conducted. The search strategy yielded 52 potentially relevant articles, of which 17 reviews met the inclusion criteria. Included reviews were appraised using the AMSTAR-2 criteria.
Results:
1) One original research article, a pilot study, was extracted that investigated a culturally adapted physiotherapy intervention in comparison to usual care for 48 patients with chronic neuromusculoskeletal pain. The study scored 9/10 on the PEDro scale. It provided preliminary evidence that culturally adapted physiotherapy approaches enhance patient engagement with physiotherapy.
2) In total, 17 systematic reviews that investigated culturally adapted health promotion interventions were extracted. Twelve focused on lifestyle interventions (5 physical activity, 4 weight management and 5 chronic disease risk) and three focused on self-management programmes (n=3). The majority of the reviews (16/17) reported a benefit from culturally adapted interventions on participant knowledge and behaviour change outcomes; however, the methodological quality of included studies varied. Ten reviews were rated as moderate, four as low, and three as critically low according to the AMSTAR-2 criteria. Factors associated with successful outcomes included a package of adaptations (inclusive of surface and deep structure adaptations), and engagement with multicultural community healthcare workers to deliver interventions.
Conclusion(s): There is limited evidence to support the efficacy of cultural adaptation of physiotherapy interventions. However, the synthesis of cultural adaptation in the context of health promotion supports the use of cultural adaptation for improving physical activity, weight, chronic disease risk, and enhancing patient self-management.
Implications: There is little evidence to define the effectiveness of culturally adapted physiotherapy approaches for CALD patient populations. Thus, Physiotherapists can only be guided by evidence from multiple systematic reviews in the field of health promotion that support the use of cultural adaptation for improving patient knowledge and suboptimal lifestyle behaviours. Consequently, there is a pressing need for research in physiotherapy to investigate cultural adaptation using methods known to be effective. In the absence of such research, it is possible the effectiveness of physiotherapy for CALD patient populations is being constrained.
Keywords: Cultural diversity, Cultural adaptation, Physiotherapy
Funding acknowledgements: The primary author was supported by a PhD Scholarship from the Menzies Foundation.
Purpose: The purpose of this review was two-fold. First, it aimed to identify and critically appraise research that has evaluated culturally adapted physiotherapy for CALD patient populations. Second, it aimed to synthesise and appraise systematic reviews that investigated culturally adapted health promotion interventions relevant to physiotherapy practice (physical activity, overweight/obesity, chronic disease risk and patient self-management).
Methods:
1) A systematic literature search was conducted to identify peer-reviewed articles that investigated cultural adaptations of physiotherapy interventions for CALD communities. Multiple search strategies were undertaken to identify prospective investigations published between 1993 and 2018 that explored a culturally adapted physiotherapy intervention. Sixty-seven articles were retrieved and analysed. Only one study satisfied the inclusion criteria, which was critically appraised using the PEDro scale.
2) A systematic search of systematic reviews published between1993 and 2018 was conducted. The search strategy yielded 52 potentially relevant articles, of which 17 reviews met the inclusion criteria. Included reviews were appraised using the AMSTAR-2 criteria.
Results:
1) One original research article, a pilot study, was extracted that investigated a culturally adapted physiotherapy intervention in comparison to usual care for 48 patients with chronic neuromusculoskeletal pain. The study scored 9/10 on the PEDro scale. It provided preliminary evidence that culturally adapted physiotherapy approaches enhance patient engagement with physiotherapy.
2) In total, 17 systematic reviews that investigated culturally adapted health promotion interventions were extracted. Twelve focused on lifestyle interventions (5 physical activity, 4 weight management and 5 chronic disease risk) and three focused on self-management programmes (n=3). The majority of the reviews (16/17) reported a benefit from culturally adapted interventions on participant knowledge and behaviour change outcomes; however, the methodological quality of included studies varied. Ten reviews were rated as moderate, four as low, and three as critically low according to the AMSTAR-2 criteria. Factors associated with successful outcomes included a package of adaptations (inclusive of surface and deep structure adaptations), and engagement with multicultural community healthcare workers to deliver interventions.
Conclusion(s): There is limited evidence to support the efficacy of cultural adaptation of physiotherapy interventions. However, the synthesis of cultural adaptation in the context of health promotion supports the use of cultural adaptation for improving physical activity, weight, chronic disease risk, and enhancing patient self-management.
Implications: There is little evidence to define the effectiveness of culturally adapted physiotherapy approaches for CALD patient populations. Thus, Physiotherapists can only be guided by evidence from multiple systematic reviews in the field of health promotion that support the use of cultural adaptation for improving patient knowledge and suboptimal lifestyle behaviours. Consequently, there is a pressing need for research in physiotherapy to investigate cultural adaptation using methods known to be effective. In the absence of such research, it is possible the effectiveness of physiotherapy for CALD patient populations is being constrained.
Keywords: Cultural diversity, Cultural adaptation, Physiotherapy
Funding acknowledgements: The primary author was supported by a PhD Scholarship from the Menzies Foundation.
Topic: Professional issues; Professional issues
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: A systematic review
All authors, affiliations and abstracts have been published as submitted.
