Patient-therapist interactions in musculoskeletal physiotherapy: A qualitative systematic review and meta-synthesis

Abstract

Studies were not eligible if all interventions were from the same group (group or individual), if interventions contained a mix of both group and individual physiotherapy or if any differences between the intervention groups were deemed to be negligible. Studies were excluded if only one of the interventions had multidisciplinary team (MDT) involvement (e.g. psychology, occupational therapy, and dietician). Studies deemed to compare a group or individual intervention to a minimalist control group only (e.g. home exercise programme only or educational/advice booklet only) were excluded. Studies had to report results from one or more outcome measures in the domains of pain intensity and/or level of functional disability. Study quality was assessed used the PEDRO scale. The treatment effects of group physiotherapy were compared to individual physiotherapy using meta-analyses. Results: 14 RCT’s were included. Seven studies were on low back pain, three on neck pain, two on knee pain and one on shoulder pain. No statistically significant differences were found for pain and disability between group and individual physiotherapy in the short-, mediumand long-term. Conclusion(s): Across a range of musculoskeletal conditions, therewas no significant difference in pain and disability between group and individual physiotherapy. Based on this review, it is hard to justify individual therapy. Future research needs to show that individualised care can better demonstrate improved outcomes for the additional treatments costs to be justified. Implications: The results of this study will guide future research which could discover more effective physiotherapy interventions for musculoskeletal conditions. This would benefit clinical practice and lead to improvements in patients’ pain and disability levels.