What effects does a physiotherapy-led group intervention using interactive behavioural modification therapy (IBMT) have for people with chronic musculoskeletal pain?

Knott, Lucy (2015) What effects does a physiotherapy-led group intervention using interactive behavioural modification therapy (IBMT) have for people with chronic musculoskeletal pain? Masters by Research thesis (MSc), Manchester Metropolitan University.

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Abstract

Background Chronic pain can be disabling. It is a major cause of morbidity and increased usage of healthcare services. The effects of a physiotherapy led-programme using Interactive Behavioural modification therapy (IBMT) with a 3-month follow-up for patients with musculoskeletal pain is unknown. Aims To examine pre to post and medium term (3 months) effects of a physiotherapy-led programme, the Functional Rehabilitation programme (FRP), for patients with chronic musculoskeletal pain, in terms of fear of movement, disability, self-efficacy, depression and physical function. Design The study included two phases. Phase one was a preliminary retrospective study using data from 278 patients. Phase two used a prospective pre-experimental medium-term follow-up study design with 53 participants. The FRP programme was delivered over a 5- week period, each group had between 8 and 10 participants. Both phases were undertaken at Fairfield General Hospital outpatient physiotherapy department, Pennine Acute NHS Hospitals Trust. Outcome measures Primary outcome was Tampa scale of Kinesiophobia (TSK), secondary measures included; Roland Morris Disability Questionnaire (RMDQ), Pain disability questionnaire (PDQ), pain self-efficacy questionnaire (PSEQ) and the Hospital anxiety and depression scale (HADS). In addition physical function tests included speed and distance of walking and step up repetition. Results Improvements were observed in all outcome measures. Minimal clinical important difference (MCID) was reached in those measures with recognised levels (TSK and RMDQ) and were sustained at 3-month follow-up. In addition, depression scores reduced to within normal level (0-7). There was no statistically significant difference in outcomes between condition types. Conclusions A physiotherapy-led group intervention using a psychologically informed approach produced positive changes in reducing fear relating to movement, pain-related disability, depression and anxiety in a mixed chronic pain aetiology group. There was no statistically significant difference in outcomes between low back pain and multi-site pain. Future studies should look at a longer term follow-up with an RCT design of the impact of physiotherapist’s management. In relation to the growing problem of managing increasing numbers of people with chronic pain, this study adds to the growing body of evidence of how physiotherapist’s could take a lead role in chronic pain management. This would help to address the current shortage of skilled professionals to deliver pain management and expand the professions repertoire. Further, it adds weight on previous research carried out by physiotherapists which has focussed on chronic low back pain to this study’s mixed chronic pain cohort.