Behavioural typologies of experienced benefit of psychomotor therapy in patients with chronic shoulder pain: A grounded theory approach

Barriers and facilitators related to self-management of shoulder pain: a systematic review and qualitative synthesis

OBJECTIVE

The objective of this review was to identify barriers and facilitators related to self-management from the perspectives of people with shoulder pain and clinicians involved in their care.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, SPORTDiscus, Embase, ProQuest Health, Web of Science, and Scopus were searched from inception to March 2022.

REVIEW METHODS

A meta-aggregative approach to the synthesis of qualitative evidence was used. Two independent reviewers identified eligible articles, extracted the data, and conducted a critical appraisal. Two reviewers independently identified and developed categories, with validation by two further researchers. Categories were discussed among the wider research team and a comprehensive set of synthesized findings was derived.

RESULTS

Twenty studies were included. From the perspective of patients, three synthesized findings were identified that influenced self-management: (1) support for self-management, including subthemes related to patient-centred support, knowledge, time, access to equipment, and patient digital literacy; (2) personal factors, including patient beliefs, patient expectations, patient motivation, pain, and therapeutic response; and (3) external factors, including influence of the clinician and therapeutic approach. From the perspective of clinicians, two synthesized findings were identified that influenced self-management: (1) support for self-management, including education, patient-centred support, patient empowerment, time, and clinician digital literacy; and (2) preferred management approach, including clinician beliefs, expectations, motivation, therapeutic approach, and therapeutic response.

CONCLUSION

The key barriers and facilitators were patient-centred support, patient beliefs, clinician beliefs, pain, and therapeutic response. Most of the included studies focused on exercise-based rehabilitation, and therefore might not fully represent barriers and facilitators to broader self-management.

Understanding Shoulder Pain: A Qualitative Evidence Synthesis Exploring the Patient Experience

OBJECTIVE

The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments.

METHODS

A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme appraisal tool.

RESULTS

Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact ("It has been a big upheaval"); (2) developing an understanding ("Why is it hurting so much?"); and (3) exercise ("Am I going to go through a lot of pain in moving it…?"). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a "permanent" solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations.

CONCLUSION

These findings deepen our understanding of the impact of shoulder pain on peoples' lives and provide novel insight into the experience of treatment. Enhanced awareness of people's experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation.

IMPACT

To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms.

LAY SUMMARY

Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People's understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.

Psychomotor therapy as a treatment of chronic spinal pain: A qualitative study

OBJECTIVE

Psychomotor therapy is an innovative complementary approach that enhances the mind-body connection. It could have a positive effect on chronic pain syndromes but has not yet been specifically studied for spinal pain. We thus aimed to explore the experiences of chronic spinal pain patients with psychomotor therapy.

DESIGN

We conducted a qualitative study using semi-structured interviews. 17 patients with chronic spinal pain were recruited from a multidisciplinary spinal pain program in a rehabilitation hospital in Switzerland. Participants received psychomotor therapy as part of this care. All interviews were transcribed and thematic analysis was performed.

SETTING

Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.

RESULTS

Four themes emerged from thematic analysis: 1) Connecting body and mind; 2) Passive individualized care; 3) Effect on mobility and well-being versus pain; and 4) Need for further care. Participants particularly appreciated the person-centered approach, relaxation and link between body and mind in the psychomotor therapy sessions. They shared positive effects of psychomotor therapy on mobility, kinesiophobia and overall well-being, rather than on pain. Finally, they would have liked more follow-up care at the end of the program.

CONCLUSIONS

Experiences reported by patients in this study suggest that psychomotor therapy could be a promising complementary therapy for chronic spinal pain within a biopsychosocial approach. To better understand the benefits of psychomotor therapy for chronic spinal pain, further research is needed and should consider patient-reported outcome measures such as well-being, fear-avoidance belief and disability.

Effect of Psychomotricity in Combination With 3 Months of Active Shoulder Exercises in Individuals With Chronic Shoulder Pain: Primary Results From an Investigator-Blinded, Randomized, Controlled Trial

OBJECTIVE

To evaluate whether psychomotor therapy (PMT) in combination with usual care active exercise (AE) rehabilitation for the shoulder is superior to merely AE.

DESIGN

The trial was a single-center, stratified (by corticosteroid injection [yes or no]), randomized, and controlled superiority trial.

SETTING

Shoulder unit of the orthopedic department at Hospital Lillebaelt, Vejle Hospital.

PARTICIPANTS

Eligible participants (N=87) were adults aged 18-75 years with shoulder complaints lasting for at least 3 months, in addition to a score equal to or below 3 on the Multidimensional Assessment of Interoceptive Awareness score. Furthermore, patients had at least a visual analog scale pain score of 2 at rest, 3 at night, and 5 in activity (range: 0-10).

INTERVENTIONS

Patients were randomized to 12 weeks of AE (control group) or in combination with 5 PMT sessions (intervention group).

MAIN OUTCOME MEASURE

The primary outcome was the patient-reported outcome score Disability of the Arm, Shoulder and Hand questionnaire. The primary endpoint was 12 weeks after baseline.

RESULTS

There was no between-group difference in function between the intervention group and control group.

CONCLUSIONS

Our results showed no additional benefit on patient-reported function and pain from PMT over usual care in patients with long-lasting shoulder pain and low body awareness. This finding suggests that PMT adds no additional benefit to patients' recovery in relation to pain and active function in comparison to standard care.