PHYSIOTHERAPY INTERVENTIONS IN THE MANAGEMENT OF PHYSICAL AND/OR PSYCHOLOGICAL OUTCOMES AMONG REFUGEES: A SYSTEMATIC REVIEW

M. Latrous¹, A. Ahmed¹, E. Elrasheid¹, M. Mahmoud¹, A. Mohammed¹, J. Allen¹, L. Morris¹

¹Qatar University, Physical Therapy and Rehabilitation Sciences, College of Health Sciences, QU Health, Doha, Qatar

Background: Refugees face significant challenges due to the trauma they endure and therefore are at a greater risk of developing various psychological and physical impairments. Physiotherapists have a significant role to play in helping traumatized refugees mitigate the mental and physical impairments that affect their overall wellbeing. It is therefore important for physiotherapists around the world to be guided on how to provide the best possible care to this population and to build core competencies in the management of refugees.

Purpose: The following systematic review aimed to explore the effectiveness of various physiotherapy interventions in the management of physical and/or psychological outcomes such as pain, disability, and mental health among traumatized refugees.

Methods: The search strategy was based on the PICO model for systematic review questions. The literature search was conducted during January 2022 by two independent reviewers in the following databases: Embase, Scopus, PubMed, and PEDro,which are accessible through the Qatar University Library website.No limitations on the year of publication were applied. However, language was limited to English only. The search strategy was adapted to each database and based on the key terms. The Oxford Centre for Evidence-Based Medicine (OCEBM) framework was used to determine the level of evidence (Level 1 to 5) of the studies included. An adapted 9-point PEDro scoring system was utilized for methodological appraisal of eligible randomized controlled trials (RCTs) only.

Results: The review included three studies, of which two included RCTs denoting level 2 evidence and one was a pre-test/post-test denoting level 3 evidence on the OCEBM framework. The RCTs scored 6/9 (66.6%) and 8/9 (88.8%) on the adapted PEDro scale, respectively. The three included studies were published recently in English in 2019 and 2020. All the studies evaluated the effects of different types of physical activity and/or exercises on psychological and physical outcomes, including pain, mental health, PTSD symptoms, anxiety and depressive symptoms.

Conclusions: The evidence included in this review was too limited to draw any solid conclusions about the effectiveness of physiotherapy interventions on psychological and physical outcomes among refugees, indicating a research gap in this area. The growing need for physiotherapy treatment within this patient group requires the development and evaluation of more specialized, culturally and sensitively adaptive treatment options to provide the highest quality of care. This review highlights the difficulties in conducting studies in this population, particularly RCTs. Therefore, this review demonstrates the urgent need for future research to thoroughly consider all ethical aspects of the population before undertaking on any study, and it must be strongly justified whether studies should be conducted at all in this group.

Implications: The study provides recommendations that need to be taken into consideration related to conducting RCTs among refugee populations. For example, assigning participants to control or waiting-list groups poses ethical dilemmas as it withholds participants from receiving early interventions or a potentially beneficial intervention. It is therefore recommended to widen the scope of evidence related to physiotherapy management and go beyond effectiveness studies, by investigating the most appropriate study designs for refugee populations.

Funding acknowledgements: No funding received.

Keywords:
Refugees
Physiotherapy
Physical/psychological symptoms

Topics:
Disability & rehabilitation
Disaster management
Community based rehabilitation

Did this work require ethics approval? No

Reason: It was a systematic review.