Functional Rehabilitation Class for South Asian Females (SAF) in Hindi/Urdu: A Service Evaluation Project

Purpose

The Dynamic Health Musculoskeletal (MSK) services, Peterborough serves an ethnically diverse population. The South Asian population is the second-largest ethnic group in Peterborough and it was identified that this group of service users often have low follow up rates, increased non-attendance for appointments and achieve poorer outcomes from physiotherapy. Reasons for this are proposed as cultural barriers, preference to be seen by a female therapist, limitation to participate in existing classes due to language and cultural barriers and hesitancy of expression when interacting with health care professionals from different backgrounds through translation services. The aim of developing SAF Rehabilitation Classes in Hindi/Urdu, delivered by Hindi/Urdu speaking Physiotherapists, was to establish whether negotiating language and cultural barriers and delivering a culturally appropriate exercise programme improved patient clinical outcomes.

85% of south asian female participants
reported clinically significant improvement on the MSK-HQ score (Mean 12.6, SD 6.92)

Approach

SAF patients referred to MSK Physiotherapy services, who spoke and understood Urdu/Hindi languages and required an interpreter were triaged by clinicians for a 45 minute appointment with Hindi/Urdu speaking female therapists to assess their suitability for the intervention. Musculoskeletal Health Questionnaire (MSK-HQ), Visual Analogue Score (VAS) and Patient's functional goal scores were used as outcomes pre and post-class. Moreover, subjective feedback was sought post session. The pilot comprised of 5 cohorts, with a maximum of 6 patients per group. Each group was offered five sessions of 90 minutes, one session per week, delivered by two Hindi/Urdu speaking physiotherapists and included: 1. Active discussion and education on Pain neuroscience, recommended physical activity guidelines, pacing and multi-factorial nature of pain. 2. Exercise session including group warm-up, functional exercises and relaxation. 3. Home exercise program. Due to literacy barriers, customized home exercise sheets were designed with utilization of images and minimal words. The fifth session was run in collaboration with local community lifestyle services to offer the opportunity to continue the attained lifestyle changes in their local community settings.

Outcomes

Results: 25 patients attended the programme from September 2019- March 2020. 76 % of the patients completed the classes. 24 % dropped out due to other health issues, high pain sensitivity or for other unknown reasons. Of the 20 patients completing the programme, 65% had clinically significant > 1 improvement in VAS (Mean 1.68, SD 1.9) with overall improvement (95% CI, 0.78 to 2.56 p < 0.005). 85% had > 5.5 clinically significant improvement on the MSK-HQ score (Mean 12.6, SD 6.92) with overall improvement (95% CI, -15.84 to -9.36 p < 0.005). Patient functional score improved 3 points on average per goal.

Conclusion(s): The intervention improved MSK-HQ and VAS scores significantly and improved functional goals while maintaining high patient attendance. Future work could explore rolling this project out with relevant modifications in other communities.

Cost and savings

No costs incurred.

Implications

The implementation of this program to meet the needs of a hard to reach group with chronic pain was shown to have low dropout rate and significant improvements in all clinical measures. Further research with a control group for this kind of functional rehabilitation program could provide impactful insight in costs versus benefits and feasibility of implementation of this project at a larger scale.

Top three learning points

No further information. 

Funding acknowledgements

Nil funding