Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain: A pilot randomised controlled trial

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 Î • 2 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. Trial registration number ACTRN12616000857404; Pre-results.