None listed
Conditions
Brief summary
Primary aim: The aim of this project is to pilot a culturally adapted physiotherapy assessment and treatment approach for use with three CALD communities living in Australia and contrast it with ‘usual’ evidence based physiotherapy care. This project will seek to identify aspects of trial design that may need to be modified in a larger RCT. This includes establishing community acceptance and satisfaction with the novel treatment approaches and determining community willingness to participate in randomised research. It will also generate outcome data that will be used for sample size estimates and predicting the magnitude of treatment effects for a future clinical trial. Hypothesis It is hypothesised that the culturally adapted approaches will be well accepted by participants and significantly more effective at improving function, burden of suffering and patient adherence, when compared to usual care. Proposed research design Pilot Randomised Controlled Trial. Two group pre-test, post-test design. Methods: Potential participants will be identified from physiotherapy wait-lists and assessed to ascertain eligibility for trial inclusion. Those who meet the inclusion criteria and consent to participate will be randomly assigned to either the culturally adapted physiotherapy treatment or evidence based usual physiotherapy care. The culturally adapted physiotherapy treatment approach will be a combination of group physiotherapy education and exercise, and individual treatment. Participants allocated to this treatment arm will attend a group session for two hours a week, for six weeks and up to four individual sessions over three months with a qualified physiotherapist. The control group is evidence based usual care and will include treatment by a qualified physiotherapist who has not been trained in cultural adaptation methods. Participants randomised to this treatment arm will attend up to ten physiotherapy sessions that incorporate evidenced based physiotherapy management, over three months. Data that will help determine the feasibility of future trials will be collected including recruitment rates, drop-out rates, adherence and patient satisfaction will be collected at three months. Physical performance outcomes (six minute walk distance and the number of sit to stand’s performed in 1 minute) and pain related questionnaires (Brief Pain Inventory, Pictorial Representation of Illness and Self-Measure, Depression Anxiety and Stress Scale) will collected at pre and post treatment to inform treatment efficacy.
Interventions
The intervention to be evaluated is 'culturally adapted physiotherapy assessment and treatment'. This intervention arm will be delivered by the physiotherapist who developed the culturally adapted pain management physiotherapy protocols from extensive qualitative enquiry, clinical expertise and review of the literature. This treating physiotherapist has a Bachelor of Physiotherapy, a Masters of Manual Therapy and ten years of clinical practice. Participants randomised to this intervention arm wi
The intervention to be evaluated is 'culturally adapted physiotherapy assessment and treatment'. This intervention arm will be delivered by the physiotherapist who developed the culturally adapted pain management physiotherapy protocols from extensive qualitative enquiry, clinical expertise and review of the literature. This treating physiotherapist has a Bachelor of Physiotherapy, a Masters of Manual Therapy and ten years of clinical practice. Participants randomised to this intervention arm will attend a combination of group therapy sessions (approximately two hours’ duration, once a week, for 6 weeks) and up to 4 individualised physiotherapy sessions of 30 minute duration, until treatment conclusion at 3 months. The group sessions will be facilitated by a bilingual health educator and conducted at a local community venue that is accessible by patients from culturally and linguistically diverse backgrounds. The individual physiotherapy sessions will be delivered by the same physiotherapist and with the assistance of an interpreter as required. The program content is based on current evidence based guidelines for the management of chronic pain that aim to improve patients physical and socio-occupational functioning using CBT principles. In our trial, evidence based pain management content has been adapted to reflect the beliefs, values and behaviours of the three communities of interest. This has included the following components: - Locating educational material within the unique explanatory model of disease held by each community - Modifying the educational materials to suit the language and reflect the health literacy of each community - Using culturally appropriate examples and metaphors for problem solving and activity pacing - Delivering exercise interventions using culturally specific examples such as traditional dance components - Locating interventions in familiar and accessible settings - Emphasising traditional and ethnoculturally relevant coping strategies such as the use of prayer, natural remedies and spiritual relaxation strategies - Involving family or community members in goal setting and skill implementation Patients will be given a log book to complete to evaluate compliance with the program content. The individual sessions will be tailored by the physiotherapist to suit the specific needs of the patient, following a culturally informed assessment protocol. The assessment will explore cultural beliefs and values, degree of alignment with ethnocultural community, spiritual domains and extracting the patient's explanatory model of illness.
Sponsors
Liverpool Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1) Referred to physiotherapy for treatment of their chronic pain condition 2) Self-identifying as Vietnamese, Mandaean or Assyrian 3) 18 years of age or older 4) Diagnosis of non-specific musculoskeletal pain 5) Pain that has lasted more than 3 months 6) Agree to participate in physiotherapy treatment and able to attend a pain management program if randomised to this treatment arm.
Exclusion criteria
1) Specific diagnoses necessitating other treatment such as complex regional pain syndrome, radiculopathy, wait listed for surgery for their pain condition or complex psychological disorders, 2) Surgery within the last 3 months 3) Patients requiring assistance for mobility including the use of an aid other than a walking stick.
Outcome results
None listed