Current Practices of Physiotherapists in Implementing Psychologically Informed Physical Therapy in Chronic Pain Management: A Scoping Review

Abstract

Introduction: This study is a scoping review of the current practices in implementing Psychologically Informed Physical Therapy (PIPT) in chronic pain management. A fundamental shift of physiotherapy practice from the traditional approach of biomedical to a biopsychosocial approach has acquired recognition indicating a more comprehensive approach to addressing the complexity of the physiotherapy profession. Thus, the primary objective of this scoping review is to identify and map current data on physiotherapists’ current practices in implementing PIPT in chronic pain management, and its secondary objective is to map the evidence and describe the effectiveness/efficacy, clinical utility, cost-effectiveness, and barriers of PIPT as a physiotherapy intervention. Methods. In accordance with the set of Selection Criteria, a scoping review was undertaken to search for papers in seven databases: (1) PubMed/MEDLINE, (2) PEDro, (3) ClinicalKey, (4) Cochrane, (5) ProQuest, (6) Philippine Journal of Physical Therapy, and (7) HERDIN. A triangulation method to the search was conducted and applied for title screening, abstract screening, and full-text review to validate the articles retrieved in the databases. Thematic analysis was used to gather information and identify all themes related to PIPT as a physiotherapy intervention to make sense of the retrieved data. In addition, results were presented using descriptive synthesis to give various information and diverse integrated evidence. Results and Discussion. 38 studies out of 78,860 fulfilled the inclusion and exclusion criteria and passed the abstract and title review. After satisfying the inclusion criteria and conducting a full-text review, 15 of these articles were discarded, leaving a total of 23 studies. The data extracted from the recent studies highlight a few key findings: (1) Cognitive-behavioral therapy (CBT) is more commonly used and applied to wide variety of situations than the other PIPT intervention identified; (2) there appears to be a difference in perceived effectiveness/efficacy between PIPT interventions and conventional PT approaches; (3) despite their apparent usability and viability, internet-based psychological programs used in conjunction with physical therapy do not show to improve outcomes beyond physical therapy alone; (4) the cost-effectiveness of PIPT interventions has not received much attention; (5) a variety of implementation obstacles have been explored; and, (6) PIPT publications are far more common in North America, particularly in the United States. Conclusion. Depending on the type of intervention utilized, current approaches for implementing PIPT may be more successful than conventional physical therapy in lowering or eradicating chronic pain. When PIPT is used in an outpatient context, it improves chronic pain management more than when it is used in an internet-based setting. Moreover, while PIPT remains a promising treatment model, more evidence is needed to justify its widespread adoption, especially given the high demand for training and barriers to implementing it.