Use of Mental Health Interventions by Physiotherapists to Treat Individuals with Chronic Conditions: A Systematic Scoping Review

Abstract

Purpose: Physiotherapists work with people with chronic conditions and can act as catalysts for behavioural change. Physiotherapy has also seen a shift to a bio-psychosocial model of health management and interdisciplinary care, which is important in the context of chronic conditions. This scoping review addressed the research question “How do physiotherapists use mental health–based interventions in their treatment of individuals with chronic conditions?” Method: The Embase, MEDLINE, PsycINFO, and CINAHL databases were searched, and a variety of study designs were included. Data were categorized and descriptively analyzed. Results: Data were extracted from 103 articles. Low back pain (43; 41.7%) and non-specified pain (16; 15.5%) were the most commonly researched chronic conditions, but other chronic conditions were also represented. Outpatient facilities were the most common setting for intervention (68; 66.0%). A total of 73 (70.9%) of the articles involved cognitive­–behavioural therapy, and 41 (40.0%) included graded exercise or graded activity as a mental health intervention. Conclusions: Physiotherapists can use a variety of mental health interventions in the treatment of chronic conditions. More detailed descriptions of treatment and training protocols would be helpful for incorporating these techniques into clinical practice.

Allied health professionals’ experiences and views towards improving musculoskeletal services in the UK for patients with musculoskeletal and co-existing mental health conditions: a qualitative study

“…The evolving needs of the MSK population could therefore benefit from more flexible appointment schedules, particularly in outpatient settings where appointments are notoriously controlled, with limited room for adjustment. This is of particular importance since evidence suggests that outpatient facilities were the most common setting for evaluating mental health interventions in patients with chronic conditions [ 18 ]. These observations suggest there is a need to focus on understanding how the delivery of psychological interventions can be feasibly implemented from the perspective of NHS managers.…”

“…A semi-structured interview guide (see Appendix 1 ) was formulated following a review of the literature [ 16 , 18 , 20 , 30 ] and in-depth discussions between a qualitative researcher (who is a specialist MSK physiotherapist), a senior lecturer in physiotherapy, and a physiotherapy researcher (who is currently supporting a programme of work exploring the efficacy of interventions for optimising the integration of MSK and mental health management). This guide included three semi-structured questions, with a pre-determined list of prompts to ensure consistency between the interviewers.…”

“…There is evidence that a biopsychosocial approach involving psychological interventions, such as Cognitive Behavioural Therapy (CBT) and mindfulness, result in positive health outcomes, improved functioning and reduced healthcare utilisation for patients with MSK conditions and co-existing anxiety and depression [ 16 , 17 ]. Furthermore, there is mounting interest towards evaluating the efficacy of psychological interventions delivered by non-psychologists [ 18 , 19 ]. A systematic review and meta-analysis indicated that physiotherapist delivered psychological interventions in combination with physiotherapy is more effective than physiotherapy alone for improving pain and disability outcomes.…”

The Approach of Physiotherapists in the Management of Patients with Persistent Pain and Comorbid Anxiety/Depression: Are There Any Differences between Male and Female Professionals?

“…Male professionals represent the target of educational events finalized to raise awareness about the importance of patients' psychological well-being in obtaining amelioration of chronic pain. Our data would indicate that male professionals (compared to female ones) are hesitant to abandon a traditional model of physiotherapy in favour of intervention strategies that take into account emotional aspects [30].…”

“…The application of a biopsychosocial model in the management of chronic pain is crucial because increasing evidence indicates that the presence of depressive and anxiety disorders are factors associated with the persistence of physical pathologies [28,29]. A recent article highlighted that physiotherapists could provide mental health interventions autonomously, such as graded exercise or graded activity, but that insufficient knowledge is one the most prominent barriers in applying these types of interventions [30]. Mental health training among physical therapists should therefore be promoted to overcome these barriers.…”