Combining a psychological intervention with physiotherapy: A systematic review to determine the effect on physical function and quality of life for adults with chronic pain

Abstract

Combining a psychological intervention with physiotherapy. A systematic review to determine the effect on physical function and quality of life for adults with chronic pain. Background Chronic pain affects approximately 28 million people in the UK. It does not always respond to conventional curative treatments and can have a devastating impact on an individual's ability to function and perform life roles in the way they would like. Psychological approaches to pain management have been advocated for over 40 years, but it is unclear whether the addition of such approaches to physiotherapy increases treatment effectiveness. Objectives To systematically review the literature to determine whether the addition of psychological approaches to physiotherapy is more effective in improving physical functioning and quality of life than physiotherapy alone. Methods An electronic database search focused on randomised controlled trials comparing a physiotherapy intervention for chronic pain with a matched intervention with an additional psychological therapy component. All eligible studies were independently reviewed by two researchers and the strength of evidence and results evaluated. A meta-analysis was conducted on post-test mean data for physical functioning. Results Eight studies were identified for inclusion. Meta-analysis of the data showed combined treatments to be superior in modifying functional outcomes (standardised mean difference-1.12 95% confidence intervals-1.94 to-0.31). This was echoed in the narrative review of the quality of life evidence. Study quality was variable and thus the findings should be interpreted with caution. Conclusions There is evidence that combining physiotherapy and psychological approaches improves physical function in chronic pain in comparison to physiotherapy alone. Further examination of this field is required to inform changes in practice and to develop treatment methods.

Musculoskeletal conditions and pain management

“…Dr Sarah Wilson and Professor Fiona Cramp from the Bath Centre for Pain Services, Royal United Hospitals Bath, and the University of the West of England, have reviewed the evidence to support psychological interventions combined with physiotherapy to improve pain and function in people with chronic pain [4]. Their findings highlight the benefit in terms of improved function of such combined approaches over physiotherapy alone, and underscore the importance of further work in this area.…”

Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials

“…To date, there have been several systematic reviews around the topic of PIPT. 1 , 17 , 33 , 75 , 90 These prior reviews have summarized studies focused on different pain conditions (ie, postoperative pain, general musculoskeletal pain, and low back pain) and using a range of PIPT delivery modes (ie, in-person, group-based, and remotely delivered) and control groups (ie, no/minimal treatment, attention control, education, and usual care). Most of the prior studies reviewed have included a PIPT intervention based on cognitive-behavioral approaches.…”

“…Two meta-analyses by Silva Guerrero et al 75 and Wilson and Cramp 90 demonstrate that PIPT has a small, but significant, effect on improving physical function, disability, and pain compared to standard physical therapy. In the meta-analysis by Wilson and Cramp, 90 the authors included interventions where the psychological component could be delivered by either a psychologist or physical therapist. This may limit applicability of the review findings to PIPT if adhering to the description by Main and George.…”

An exploration of physiotherapists' perceived benefits and barriers towards using psychosocial strategies in their practice

“…The benefits of psychosocial approaches have been recognized in physiotherapy literature, with regard to patient outcomes. From a patient perspective, reported benefits include: reduced pain and disability (Coronado, Patel, McKernan, Wegener, & Archer, 2019; Guerrero, Maujean, Campbell, & Sterling, 2018; Richmond et al, 2015; van Erp, Huijnen, Jakobs, Kleijnen, & Smeets, 2019), improved functional outcomes and quality of life (Coronado, Patel, McKernan, Wegener, & Archer, ; Richmond et al, 2015; Wilson & Cramp, ), increased adherence to rehabilitation programmes (Skolasky, Maggard, Li, Riley, & Wegener, 2015), enhanced psychosocial wellbeing (Guerrero, Maujean, Campbell, & Sterling, ; Sullivan & Adams, ), reduced use of health care system and improved return to work outcomes (Sullivan & Adams, ), less reliance on pain medication (Sullivan & Adams, ) and greater therapeutic alliance (Wilson, Chaloner, Osborn, & Gauntlett‐Gilbert, 2017). Likewise, from a physiotherapist perspective, the use of psychosocial approaches is perceived to be extremely beneficial for patients' rehabilitation outcomes and adherence (Cowell et al, ; Driver, Lovell, et al, 2019).…”