Physical therapy for survivors of torture: A scoping review

Abstract

Background: Torture can result in impaired functional mobility, reduced quality of life, and persistent pain. Physical therapy (PT) is recommended for holistic care of survivors of torture (SOT), however there are limited evidenced-based guidelines. We conducted a scoping review to identify and describe the approach and gaps in knowledge around the PT treatment of SOT. Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Nine databases were searched. Eligible sources involved PT treatment for SOT. Interventions were categorized into themes based on recommendations from the Physiotherapy and Refugees Education Project: 1) trauma-informed care, 2) body-awareness & empowerment, 3) pain management. Results: The final analysis included 15 sources. Eight sources included all three themes; three of these eight sources were research studies examining outcomes following the PT intervention. While outcomes of these studies were significant for improvement among the PT groups, results must be taken cautiously due to methodological limitations of the trials. Studies assessing treatment that included only one theme resulted in no differences between the control and intervention groups. Conclusions: We describe the scope of the literature regarding PT for SOT. A trauma-informed PT approach, coordinated with pain management, and body-awareness & empowerment interventions may address the complex needs of survivors. However, rigorous studies of this three-themed approach are lacking. As SOT seek medical services, healthcare providers must be prepared to care for these vulnerable people. Physical therapists are encouraged to utilize a holistic approach, and to examine outcomes of this approach for SOT.