Silva Guerrero A.V.1, Maujean A.1, Letitia C.1, Michele S.1
1Griffith University, Allied Health School, Gold Coast, Australia
Background: Evidence suggests that the inclusion of psychological components in any intervention (e.g. physical rehabilitation) significantly improves health outcomes. Whilst psychological interventions may be required for some patients with musculoskeletal pain, there can be difficulties associated with attending psychological treatment. Individuals may face stigma when seeking and engaging in psychological treatments and mental health care due to lack of understanding of psychological factors associated with musculoskeletal. Secondly, additional cost may be incurred when patients are treated in an interdisciplinary team where payments are charged separately by each provider. Finally, the availability of group pain management and pain clinic services is generally low, and these services often have long waiting lists. Evidence suggests that there are potential advantages when more than one treatment type is delivered by a single practitioner such as better integration of component treatments, greater accessibility, and reduced health cost minimising the need for secondary level care.
Purpose: This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy compared to physiotherapy alone 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 (MEDLINE®, CINAHL, PsycINFO, Cochrane central and SPORTDiscus) were systematically searched for randomised controlled trials from inception to May 2016. Two independent reviewers screened titles, abstracts and full text of potential studies against eligibility criteria. Study quality was assessed using the Cochrane risk of bias tool. Overall quality of the evidence for the main analyses was assessed using the GRADE approach. All analyses were conducted using random effects models.
Results: 35 articles met the eligibility criteria, 29 of them were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological treatment decreased pain in the short (25 studies, MD= -0.45; 95% [CI], -0.72 to -0.18) and long term (19 studies, MD= -0.44; 95% [CI], -0.70 to -0.17) and decreased disability in the short term (27 studies, SMD= -0.14; 95% [CI], -0.27 to -0.01). None of the effects were clinically important. Moderate to high quality evidence demonstrated small to medium effects for most psychological outcomes at short and long term follow-up. Effects for pain catastrophizing, anxiety and depression were clinically important.
Conclusion(s): The results indicate that physiotherapists delivered psychological interventions show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions and may provide a low-cost addition to current primary care.
Implications: The finding of this study indicates that using physiotherapists to deliver a combination of treatments (i.e. psychological intervention and physiotherapy) may be cost-effective and a less intensive way to manage musculoskeletal pain conditions.
Funding acknowledgements: No specific funding was obtained for this review.
Topic: Musculoskeletal
Ethics approval: NA
All authors, affiliations and abstracts have been published as submitted.
