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Health problems and treatment effects in patients with non-specific musculoskeletal disorders

Abstract

Thesis 2002

Eva-Britt Malmgren-Olsson, RPT, MSc, Department of Community Medicine and Rehabilitation Physiotherapy, Umeå University.

Persistent non-specific musculoskeletal pain disorders is an increasing health problem in primary care causing suffering for the individual and a burden for the society. Appropriate and effective treatments for these patients have been hard to find. The general aim of this thesis was to get an extensive description of patients with non-specific musculoskeletal disorders and to evaluate the effects of different physiotherapeutic treatment modalities in primary care. The design was a clinical, controlled study with measurements at three time-points, before the interventions, and two follow-ups at six months and at one year. A total of 78 patients, 64 women and 14 men, were consecutively recruited to the three modalities; Body Awareness Therapy (BAT), Feldenkrais

(FK) and individual physiotherapy (TAU). The outcome variables were aimed at evaluating different pain dimensions, as well as physical psychosocial and health-related factors.

The results showed that the patients were a very heterogeneous group, associated with different problem profiles. Nearly half of the patients reported severe psychological problems due to both present time but also to negative life-events during lifetime. In comparison to two reference groups of healthy individuals these patients were more psychological distressed and had a more negative self-image. Both the patient group with non-specific musculoskeletal disorders and a patient group with whiplash associated disorders, also showed significant poorer balance than a healthy control group on clinical balance tests.

An overall result was that all treatment groups (BAT, FK and TAU) showed significant improvements over time on several outcome variables and there were few significant differences between the groups. When outcomes were calculated in effect-size values a general pattern was that the group treatments achieved larger effects than the individual treatment group.

The identifying of three distinct subgroups revealed more obvious differences of outcome patterns and amplitude of effect-size values. Two of these subgroups achieved a positive treatment outcome, and one subgroup was associated with a negative outcome. A logistic multivariate regression analysis showed that the only explanatory factor for treatment outcome was which treatment modality the patients had been involved in. This meant that the chance to achieve a positive treatment outcome for patients with non-specific musculoskeletal disorders, increased 6.6 times with Body Awareness Therapy and 4.1 times with Feldenkrais compared to individual physiotherapy.

Keywords: Non-specific musculoskeletal disorders, Body Awareness Therapy, Feldenkrais, individual physiotherapy, treatment effects, effect-size, primary care