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

Guerrero, Alma Viviana Silva; Maujean, Annick; Campbell, Letitia; Sterling, Michele

doi:10.1097/ajp.0000000000000601

Cited by 98 publications

(98 citation statements)

References 77 publications

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“…A recent systematic review and metaanalysis indicated moreover that psychological interventions delivered by physiotherapists were promising to improve psychological factors in musculoskeletal pain conditions. 63 This review results also highlight potential future research paths. factor, the influence of the psychological factor on the relation between a predictor and an outcome should be analyzed.…”

Section: Discussionmentioning

confidence: 90%

“…60 Multidimensional biopsychosocial treatment that addresses physical and psychological factors related to perceived pain and disability is an effective treatment approach in chronic pain patients. [61][62][63] Patient education to expand patients' understanding regarding pathology, pain and influencers of pain and disability (e.g. psychological factors such expectation of recovery, self-efficacy, fear avoidance, pain catastrophizing by means of cognitive behavioral approach) 64,65 seems essential as it is shown in recent qualitative studies that persons with shoulder pain believed that their pain was caused by structures local to the shoulder region.…”

Section: Discussionmentioning

confidence: 99%

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The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

et al. 2019

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Objective: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. Data Sources: Electronic databases (Pubmed, Web of Science, Embase, PsycINFO) were searched until the 14 th of January 2019. Study selection: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. Results: Twenty-three articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatisation or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. Conclusion: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

et al. 2019

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“…Certainly, the authors suggested that different testing paradigms may be affected differently by psychological factors . Nevertheless, psychological treatments might be effective for reducing pain, even when delivered combined with physiotherapy for pain and disability by physiotherapists …”

Section: Discussionmentioning

confidence: 99%

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Krüger

Hilberg

2020

Haemophilia

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Introduction Haemophilic arthropathy is associated with pain that often becomes chronic, likely caused by peripheral and central mechanisms. In the field of haemophilia, to our knowledge, the role of the descending pain pathway, which can also be involved in these pain processes, has not been examined to date. Aim In light of the dearth of existing literature, we sought to evaluate the function of endogenous descending pain modulation in patients with haemophilia. Methods Thirty adult patients with moderate to severe haemophilia A or B (median [interquartile range] age 51.0 [42.0‐54.0]) and 23 healthy adult controls (age 46.5 [36.8‐54.3]) underwent conditioned pain modulation (CPM) in order to examine the function of endogenous pain modulation. The CPM response was determined by scoring a test stimulus (heat) alone as well as under the influence of a conditioning stimulus (cold) on the basis of a numeric rating scale (NRS) (0 = ‘no pain’ to 100 = ‘worst possible pain’). Results Patients with haemophilia demonstrated a statistically significant reduced CPM response when compared with the age‐matched healthy controls (median (interquartile range) NRS score: patients: −10 (−17.5‐[−7.5]) vs controls: −20 (−30.0‐[−13.75]); P = .002). The determined difference in the CPM response between both cohorts showed a medium effect size of r = .433. Conclusion The results of this study indicate that an impaired degree of endogenous pain modulation could be present in patients with haemophilia. Therefore, the function of the descending pain pathway should be considered regarding an individual and comprehensive pain management.

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“…For musculoskeletal disorders, the predominant contemporary model consists of an integrative and multidimensional biopsychosocial theoretical framework (Gatchel et al 2007). The increasing understanding of key psychological factors in the perpetuation of pain and pain-related disability has resulted in multiple treatment modalities for musculoskeletal disorders, and the effectiveness of psychological approaches in the management of these disorders has been evaluated in numerous meta-analyses (see e.g., Ehde et al 2014; Guerrero Silva et al 2018; Markozannes et al 2017; Williams et al 2012). Nonetheless, the effectiveness of psychological interventions is still inconsistent according to outcome research on return to work (RTW).…”

Section: Introductionmentioning

confidence: 99%

Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders: a systematic review and meta-analysis of randomized-controlled trials

Finnes

Enebrink

Ghaderi

et al. 2018

Int Arch Occup Environ Health

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PurposeCommon mental disorders (CMDs) and musculoskeletal disorders are highly prevalent in the population and cause significant distress and disability, and high costs to society. The main objective of this systematic review and meta-analysis was to examine the outcome and comparative effectiveness of psychological interventions in reducing sickness absence (SA) due to CMDs or musculoskeletal disorders, compared to a waitlist control group, usual care or another clinical intervention.MethodsWe reviewed 3515 abstracts of randomized controlled trials published from 1998 to 2017. Of these, 30 studies were included in the analysis.ResultsThe psychological interventions were overall more effective than treatment as usual in reducing SA (small effect sizes), but not compared to other clinical interventions. Results were similar for studies on CMDs and musculoskeletal pain. A few significant moderating effects were found for treatment-specific variables. However, these were difficult to interpret as they pointed in different directions.ConclusionThere was a small but significant effect of psychological treatments in reducing SA. We identified areas of improvement such as methodological problems among the included studies and failure to specifically address RTW in the interventions that were evaluated. Clinical implications of the findings, and ways of improving methodological rigour of future studies are discussed.Electronic supplementary materialThe online version of this article (10.1007/s00420-018-1380-x) contains supplementary material, which is available to authorized users.

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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

Abstract: The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions.

Cited by 98 publications

References 77 publications

The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders: a systematic review and meta-analysis of randomized-controlled trials

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