Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain

A pilot randomised controlled trial

Bernadette Brady, Irena Veljanova, Siobhan Schabrun, Lucinda Chipchase

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. Design: A participant-blinded and assessor-blinded pilot randomised controlled trial. Setting: Outpatient physiotherapy departments at two public hospitals and one district pain clinic. Participants: Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. Interventions: 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. Outcome Measures: Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. Results: 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. Conclusions: Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes.

Original languageEnglish
Article numbere021999
Pages (from-to)1-10
Number of pages10
JournalBMJ Open
Volume8
Issue number7
DOIs
Publication statusPublished - 2018
Externally publishedYes

Fingerprint

Chronic Pain
Patient Participation
Randomized Controlled Trials
Pain
Therapeutics
Pain Clinics
Musculoskeletal Pain
Public Hospitals
Pain Management
Psychological Stress
Outpatients
Outcome Assessment (Health Care)

Cite this

Brady, Bernadette ; Veljanova, Irena ; Schabrun, Siobhan ; Chipchase, Lucinda. / Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain : A pilot randomised controlled trial. In: BMJ Open. 2018 ; Vol. 8, No. 7. pp. 1-10.
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abstract = "Objective: To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. Design: A participant-blinded and assessor-blinded pilot randomised controlled trial. Setting: Outpatient physiotherapy departments at two public hospitals and one district pain clinic. Participants: Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. Interventions: 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. Outcome Measures: Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. Results: 96{\%} of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58{\%} of the usual physiotherapy group. For the culturally adapted group attendance (87{\%}±18{\%}) and adherence (68{\%}±32{\%}) were higher relative to usual care (68{\%}±32{\%} and 55{\%}±43{\%}). Satisfaction was similar for the culturally adapted (82.7{\%}±13.4{\%}) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95{\%} CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. Conclusions: Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes.",
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Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain : A pilot randomised controlled trial. / Brady, Bernadette; Veljanova, Irena; Schabrun, Siobhan; Chipchase, Lucinda.

In: BMJ Open, Vol. 8, No. 7, e021999, 2018, p. 1-10.

Research output: Contribution to journalArticle

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T1 - Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain

T2 - A pilot randomised controlled trial

AU - Brady, Bernadette

AU - Veljanova, Irena

AU - Schabrun, Siobhan

AU - Chipchase, Lucinda

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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N2 - Objective: To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. Design: A participant-blinded and assessor-blinded pilot randomised controlled trial. Setting: Outpatient physiotherapy departments at two public hospitals and one district pain clinic. Participants: Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. Interventions: 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. Outcome Measures: Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. Results: 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. Conclusions: Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes.

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KW - Cultural diversity

KW - chronic pain

KW - cultural competency

KW - physical therapy speciality

KW - cultural diversity

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