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Silva Guerrero AV1, Maujean A2,3, Setchell J1,4, Sterling M2,3
1The University of Queensland, School of Health and Rehabilitation Sciences/ Recovery Injury Research Centre, Brisbane, Australia, 2The University of Queensland, Recovery Injury Research Centre, Brisbane, Australia, 3The University of Queensland, Centre of Research Excellence in Recovery Following Road Traffic Injuries, Brisbane, Australia, 4The University of Toronto, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital. Department of Physical Therapy, Toronto, Canada
Background: Neck pain remains highly prevalent and costly worldwide. Clinical practice guidelines for non-traumatic neck pain (NTNP) and specifically for Whiplash Associated Disorders (WAD), recommend the provision of reassurance as the first line of treatment. However, there is little evidence available to determine what reassurance should comprise of, and how it should be delivered. Individuals with WAD report higher levels of pain and disability, show features of nociplastic pain and higher levels of psychological distress that are not as apparent in people with non-traumatic neck pain. There is also evidence to suggest that physiotherapy treatments are more effective for people with NTNP than they are for people with WAD. In view of these findings, it is likely that the two neck pain groups may have different needs with respect to the content and approach of reassurance provided to them by physiotherapists. A first step in understanding the nature of reassurance required is to determine approaches used by physiotherapists.
Purpose: This study aimed to identify and compare what physiotherapists perceive to be the main concerns, fears and worries that patients with WAD and NTNP have as a result of their condition. Additionally, we aimed to identify and compare the strategies used by physiotherapists to address the fears and concerns of patients with NTNP and WAD.
Methods: A comparative cross-sectional qualitative study using two online surveys. Using purposive samples, the perceptions of 50 physiotherapists were obtained. The answers to the open-ended questions were analysed using a thematic approach and then themes were examined for areas of convergence and divergence/mismatch.
Results: Four similar themes for both neck pain groups emerged from the physiotherapists' responses to the survey.
1) Concerns related to pain,
2) Interference with daily life,
3) Psychological distress, and
4) When I will recover? Some subthemes differed for each theme. For example, in the theme 'psychological distress' the WAD group had subthemes of anger and thoughts about no resolution, whereas, for the NTNP group, subthemes were anxiety and uncertainty. The only theme of divergence/mismatch was
(5) Fear-avoidance, which was nominated by the physiotherapists for the non-traumatic neck pain group only.
Three similar themes emerged from the physiotherapists' responses to the question about what they do to address the worries/fears/concerns of patients with neck pain:
1) Provide reassurance
2) Education
3) Psychological Strategies.
Two notable areas of divergence reported by the physiotherapists as strategies used exclusively for patients with WAD:
4) Pain relief and
5) Encourage to move/empowerment. There were three divergent themes for the NTNP group:
6) Creating an action plan for recovery
7) Communication skills
8) Biologically focused strategies.
Conclusion(s): Physiotherapists described a wealth of reassuring strategies for patients with NTNP and WAD. There were several shared themes but also some discordant ones.
Implications: This detailed comparison may provide information to physiotherapists about potential approaches (i.e. provide reassurance, education, psychological and biologically focused strategies, pain relief, encourage to move/ empowerment, communication skills and creating an action plan) to reassurance provision to patients with neck pain. The next step is to explore patients' requirements and needs.
Keywords: Reassurance, non-traumatic neck pain, WAD
Funding acknowledgements: No specific funding was obtained for this study
Purpose: This study aimed to identify and compare what physiotherapists perceive to be the main concerns, fears and worries that patients with WAD and NTNP have as a result of their condition. Additionally, we aimed to identify and compare the strategies used by physiotherapists to address the fears and concerns of patients with NTNP and WAD.
Methods: A comparative cross-sectional qualitative study using two online surveys. Using purposive samples, the perceptions of 50 physiotherapists were obtained. The answers to the open-ended questions were analysed using a thematic approach and then themes were examined for areas of convergence and divergence/mismatch.
Results: Four similar themes for both neck pain groups emerged from the physiotherapists' responses to the survey.
1) Concerns related to pain,
2) Interference with daily life,
3) Psychological distress, and
4) When I will recover? Some subthemes differed for each theme. For example, in the theme 'psychological distress' the WAD group had subthemes of anger and thoughts about no resolution, whereas, for the NTNP group, subthemes were anxiety and uncertainty. The only theme of divergence/mismatch was
(5) Fear-avoidance, which was nominated by the physiotherapists for the non-traumatic neck pain group only.
Three similar themes emerged from the physiotherapists' responses to the question about what they do to address the worries/fears/concerns of patients with neck pain:
1) Provide reassurance
2) Education
3) Psychological Strategies.
Two notable areas of divergence reported by the physiotherapists as strategies used exclusively for patients with WAD:
4) Pain relief and
5) Encourage to move/empowerment. There were three divergent themes for the NTNP group:
6) Creating an action plan for recovery
7) Communication skills
8) Biologically focused strategies.
Conclusion(s): Physiotherapists described a wealth of reassuring strategies for patients with NTNP and WAD. There were several shared themes but also some discordant ones.
Implications: This detailed comparison may provide information to physiotherapists about potential approaches (i.e. provide reassurance, education, psychological and biologically focused strategies, pain relief, encourage to move/ empowerment, communication skills and creating an action plan) to reassurance provision to patients with neck pain. The next step is to explore patients' requirements and needs.
Keywords: Reassurance, non-traumatic neck pain, WAD
Funding acknowledgements: No specific funding was obtained for this study
Topic: Musculoskeletal: spine; Pain & pain management; Musculoskeletal
Ethics approval required: Yes
Institution: Griffith University
Ethics committee: Ethical Review Board of Griffith University
Ethics number: 2017/050
All authors, affiliations and abstracts have been published as submitted.
