Operationalisation of a biopsychosocial approach for the non-pharmacological management of patients with chronic musculoskeletal pain in low- and middle-income countries: A systematic review.

BACKGROUND: Chronic musculoskeletal pain is a major health concern. The biopsychosocial approach is an evidence-based approach recommended for managing chronic musculoskeletal pain. However, the evidence for this approach is largely reported from high-income countries; therefore, it is important to ascertain how biopsychosocial approaches are operationalised in low- and middle-income countries to inform practice. AIM: To examine the evidence for the operationalization of biopsychosocial interventions in managing patients with chronic musculoskeletal pain in low-and middle-income countries. METHODS: The search included studies published in English from 2008 to September 2019 in: Cochrane library, OVID, CINAHL, Scopus, PUBMED, Web of Science, and SportDiscus. Randomised and non-randomised trials using a biopsychosocial intervention were considered. The review team developed a search strategy; two independent reviewers screened and assessed results for quality. RESULTS: Sixteen studies were included (n = 996) with mainly low back pain populations (n = 11 studies). Others were osteoarthritis (n = 1) and other musculoskeletal pain (n = 4). The majority (n = 12) of studies attained fair to poor quality, three had good quality, one scored excellent quality. Interventions applied biopsychosocial principles such as cognitive functional therapy, and graded activity, delivered by healthcare professionals such as physiotherapists and doctors. However, most results provided insufficient information regarding healthcare professionals' capacity to deliver interventions, lack of information regarding intervention delivery and training of healthcare professionals. CONCLUSIONS: The results highlight the potential for delivering biopsychosocial interventions in low- and middle-income countries; however, future research should consider robust methodological approaches with clear details to achieve high-quality trials.

Patients' Satisfaction With Inpatient Orthopedic Physiotherapy Services at a Tertiary Hospital in Ghana.

BACKGROUND: Although assessing patient satisfaction ensures quality assurance, compliance, and better effects of therapy, patient satisfaction studies are lacking within the Ghanaian physiotherapy domain. OBJECTIVE: To ascertain patients' satisfaction with physiotherapy services and evaluate factors that influence satisfaction levels at the trauma and orthopedic directorate of Komfo Anokye Teaching Hospital. METHOD: A cross-sectional survey was done, and systematic random sampling was used to recruit participants. One-hundred twenty (120) patients participated in the study. Data were collected using an adapted structured patient satisfaction questionnaire. Data obtained were analyzed using SPSS version 24. Descriptive statistics and nonparametric tests were performed. RESULTS: The mean age of participants was 39.9 ± 15.8 years. They comprised 48 (40%) females and 72 (60%) males. The most common cause of patient admission was road traffic accident (71.7%). All dimensions of satisfaction assessed were highly rated (>90%). Majority of the participants reported that they were satisfied (95.7%) and compliant (91.6%) with the physiotherapy treatment. Respect shown by therapist (98%) and courtesy and friendliness (97%) were the most rated indices; however, some respondents had uncertainties pertaining to patient involvement in decision-making. The majority of participants also reported that due to their satisfaction, compliance came naturally (75.9%) and reported compliance had a significant association with satisfaction (P = .02). Age was also found to influence satisfaction (P = .04). CONCLUSION: Patient satisfaction with physiotherapy services rendered at the inpatient facility was high, and satisfaction reportedly translated into ease with compliance.

Chronic low back pain beliefs and management practices in Africa: Time for a rethink?

BACKGROUND: Chronic low back pain (CLBP) beliefs are important psychosocial risk factors affecting the occurrence and progression of CLBP. To address pain beliefs and implement recommended biopsychosocial approaches for CLBP management, an understanding of the beliefs of patients and healthcare professionals (HCPs), and also CLBP management practices, is necessary. A narrative review was conducted to explore CLBP beliefs and practices in African countries. METHODS: Two systematic searches were conducted using seven databases (MEDLINE, Embase, PsychInfo, CINAHL Plus, AMED, PubMed and Web of Science) with combined variations of the terms "Management", "Guidelines", "Chronic Low Back Pain", "Beliefs", "Patients", "Healthcare Professionals" and "Africa". RESULTS: Five studies and one standard treatment guideline document were included. No systematically developed African CLBP treatment guideline was found, although CLBP practices were identified in two African countries. CLBP management in African countries appears to be biomedically orientated. Only three research articles investigated the CLBP beliefs of patients in Africa, with none assessing HCP beliefs. Unhelpful CLBP beliefs (catastrophizing and fear avoidance) and biomedical thoughts about the causes of CLBP were identified. Unhelpful CLBP beliefs were associated with increased disability. CONCLUSIONS: Management practices for CLBP in African countries appear to contradict recommended biopsychosocial management guidelines by developed countries and are not sufficiently documented. Research on CLBP beliefs and CLBP management practices in Africa is lacking. To enhance the uptake of biopsychosocial approach in Africa, research around CLBP beliefs in African CLBP patients and HCPs is required.

Knowledge, attitude and practice of physiotherapists towards health promotion in Ghana.

BACKGROUND: Physiotherapists are well equipped to address health promotion issues with their patients and the public. However, no studies have been conducted in Ghana to assess the knowledge, attitude and practice of physiotherapists towards health promotion. OBJECTIVES: This study therefore seeks to determine the knowledge, attitude and practice of physiotherapists towards health promotion in Ghana. METHODS: This cross-sectional study was conducted at some selected physiotherapy departments in health facilities across Ghana. Ninety-one registered physiotherapists living and working in Ghana were recruited for this study. A closed-ended self-administered questionnaire was used to collect data on the demographics, knowledge, attitude and practice of physiotherapists towards health promotion. The scores for each section were calculated individually, and the final knowledge, attitude and practices score was obtained by calculating the total of the three sections. Statistical Package for Social Sciences version 22.0 was employed to analyse all the study variables. RESULTS: Physiotherapists' knowledge was 72%, attitude 84% and practice 87% towards health promotion. The association between the physiotherapists' knowledge of health promotion and practice was significant with Pearson's chi-square test (p = 0.013). But there was no significant association between knowledge and attitude of physiotherapists towards health promotion (p = 0.097). CONCLUSION: Physiotherapists have very good knowledge, attitude and practice towards health promotion in Ghana. This is essential for better integration into the scope of physiotherapy practice, and therefore, the health promotion policy in Ghana should be revised to include physiotherapists, because they are experts in exercise prescription and physical activity. CLINICAL IMPLICATIONS: The outcomes of this study could provide the impetus for physiotherapists to include health promotion in clinical and community services for primary prevention of non-communicable diseases as well as secondary and tertiary prevention of disability to promote functional independence.