Physio findings: mind and body unite to combat pain

Janet Wright looks at the latest research news and Michele Harms reports on Physiotherapy Journal findings.

Long-term pain is a complex problem, often involving psychological factors. Cognitive behavioural therapy (CBT) has become a popular treatment, as it may reduce the patient’s perception of pain.
However, research at a Dutch rehabilitation clinic emphasises that physical exercises are still essential in actually reducing pain. 
Physiotherapist Jan-Paul van Wingerden of the spine and joint centre in Rotterdam recruited 245 patients to take part in a multidisciplinary programme. 
The patients had had severe back pain lasting an average of nine years, but with no specific cause. A control group of 78 patients on the waiting list were given no treatment.
‘In contrast to traditional cognitive behavioural programmes,’ says Mr van Wingerden, ‘the goal of this rehabilitation programme is restore function and to actually diminish pain.’
The eight-week programme integrated CBT principles with specific exercises aimed at functional recovery.
By the end of the trial, more than half the patients had experienced significant pain relief, and most of the group had cut down their use of painkillers.
‘Therapy outcome may improve when more attention is paid to the physical aspects within a multidisciplinary programme,’ says the author.van Wingerden JP. Behavioural therapy combined with physical training improves function and diminishes pain in chronic back pain, Archives of Physical Medicine and Rehabilitation 2014.

Physiotherapy journal editor Michele Harms looks at recent papers

How can we increase motivation to exercise?
The predicted escalation in chronic lifestyle-related diseases led this group of researchers to look at behaviour change and how to motivate people to increase their short and long-term adherence to physical activity.  McGrane, Galvin, Cusack and Stokes undertook a systematic review and meta-analysis which included 14 studies, comprising 1,504 participants. 
Although they reported common problems with study quality, they found that motivational interventions could increase adherence to exercise, have a positive effect on long-term exercise behaviour, improve self-efficacy and reduce levels of activity limitation. 
While this concept should be a key component of the physiotherapist’s role, the authors identify a need to explore how this is implemented currently and to develop the use of motivational interventions in clinical practice.  McGrane N et al. Addition of motivational interventions to exercise and traditional Physiotherapy: a review and meta-analysis
What are the risks that acute whiplash will become chronic?
Collaborating authors from the universities of Oxford and Warwick report the results of a prospective cohort study of 420 participants.They included patients with whiplash symptoms three weeks after injury who had self-referred to physiotherapy. 
The authors identified risk factors for chronic disability, measured using the neck disability index, in people with acute whiplash associated disorders and estimated the impact of the numbers of risk factors present. They collected data approximately 4.5 weeks after injury and at follow-up 12 months later. Thirty per cent of their participants developed chronic disability. 
Their results suggest that initial disability, longer predicted recovery time, psychological distress, passive coping and a greater number of symptoms were associated with chronic disability. 
They also found that the greater the number of risk factors present, the greater the risk (up to 16 times greater) when four or five risk factors were present.  Williamson E et al. Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms
Pulmonary rehabilitation: length of programme
Researchers from the university of Essex and the COPD team at Broomfield hospital set out to investigate the benefits and differences between a six, seven and eight-week pulmonary rehabilitation programme. A total of 363 patients with chronic respiratory conditions participated in their study. 
The exercise programme included 10 minutes’ warm-up and 60 minutes of interval training and a cool down period. There were 10 upper and lower limb exercises and the participants exercised for two minutes (increasing to a maximum of four minutes) and rested for two minutes. The programme also included an education component.
Of the four main outcome measures used (St George’s respiratory questionnaire, clinical COPD questionnaire, hospital anxiety and depression scale and incremental shuttle walk test, the last was the only one to show consistent improvement, with the eight-week programme showing the greatest change. Andrews L et al.  Differences in patient outcomes between a 6, 7 and 8-week pulmonary rehabilitation programme: A service evaluation
More information
These reports are from papers in the latest issue of the CSP journal, Physiotherapy (Physiotherapy March 2015; 101(1). CSP members can access these free of charge online, via the CSP website.

Comments and conclusions

Inactivity can be even more harmful than obesity, say researchers at the university of Cambridge who recorded the weight and exercise levels of 334,161 people. Increasing activity reduced death rates among the least active people, whatever their weight. Eliminating inactivity could save twice as many lives as eliminating obesity, they say. Ekelund U et al. American Journal of Clinical Nutrition 2015
Type 1 diabetes raises women’s risk of cardiovascular disease and death more than men’s, shows a meta-analysis of more than 200,000 patients. Huxley RR et al. Lancet Diabetes & Endocrinology 2015
Janet Wright and Michele Harms

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