Guerrero AV et al. 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. ClinPain 2018
- Numerous systematic reviews support use of a multidisciplinary biopsychosocial approach to rehab which includes psychological interventions
- There is potential advantages when more than one treatment type is delivered by a single provider including better integration, accessibility, and reduced health cost.
- Purpose of this systematic review was to compare the effectiveness of physiotherapist delivered psychological interventions on pain, disability, and psychological outcomes compared to physiotherapy alone or usual care. Outcomes were measured as short term (4-16 wk) and long term (26-52 wk)
- Eligible studies included diagnoses of acute or chronic LBP, neck pain, WAD, and TMD. Fibromyalgia, headache, RA, and migraines were excluded.A total of 34 studies of 4,936 pts were included. All studies had a high risk of performance bias due to difficulty of blinding physiotherapists and participants to these types of interventions
- For pain outcomes, there was a statistically significant difference at both short and long term between physiotherapist delivered psychological interventions compared with physiotherapy alone or usual care
- For disability, there was a statistically significant difference at short term between physiotherapist delivered psychological interventions compared with physiotherapy alone or usual care but no statistically significant difference was found at long-term follow-up
- For psychological outcomes there was a statistically significant difference at both short and long term between physiotherapist delivered psychological interventions compared with physiotherapy alone or usual care
- For fear of movement outcomes there was a statistically significant difference at short term between physiotherapist delivered psychological interventions compared with physiotherapy alone or usual care but no statistically significant improvement at long-term.
- For pain catastrophizing, there was a statistically significant difference at both short and long term between physiotherapist delivered psychological interventions compared with physiotherapy alone or usual care
- Overall, the effect sizes were mostly small. However, for the studies that showed a large effect size, they used individually tailored interventions addressing patients’ maladaptive beliefs and increasing levels of activity through various strategies including breathing and relaxation techniques and graded activity.