Does deprivation influence treatment outcome in physiotherapy?

Lowe, Anna; Campbell, Laura; Ramaswamy, Bhanu; Horobin, Hazel; McLean, Sionnadh

doi:10.1179/1743288x13y.0000000132

Cited by 4 publications

(12 citation statements)

References 56 publications

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“…Mean class completer and non-completer TDS was 2.89 (SD 4.50) and 4.97 (SD 4.04) respectively. A wealth of research shows those from more deprived areas are less likely to adhere to exercise based treatment approaches (Jack et al, 2010) [39,[65][66][67]. The comparably higher deprivation status of the non-completer patients in this study may account for the attendance issues shown.…”

Section: Key Fi Ndingsmentioning

confidence: 66%

“…Multiple high quality studies concerning deprivation and its negative impact on MSK conditions exist [65][66][67] with individual physiotherapy using TDS they found notable deprivation trends. They argue socially deprived patients may suffer sustained stress responses from the effects of poor personal and environmental events [39].…”

Section: Localitymentioning

confidence: 99%

“…A cognitive behavioural intervention including a motivational programme was shown to have moderate evidence for increasing clinic attendance appointments in the mid-term only [126]. These fi ndings are further borne out in the later systematic review by McLean et al [44,66,123] showing there are no robust methods to date of measuring adherence. McLean et al [125], argue identifying new strategies to enhance adherence needs to be improved through a greater understanding of the patient and professional and organisational factors responsible for poor adherence.…”

Section: Key Fi Ndingsmentioning

confidence: 99%

“…Lowe et al [66], found strong evidence that low socioeconomic status (SES) has negative effects on physiotherapy outcomes using three high quality studies on lower back and neck pain. They describe the negative health impacts on those in lower socioeconomic groups more exposed to stressful situations, negative emotions and environments not conducive to health [66]. McLean [68], describes the high attrition rate facing socially deprived patients exposed to MSK interventions for non-specifi c neck pain.…”

Section: Localitymentioning

confidence: 99%

“…The second aim is to identify patient groups at potential risk of poor treatment outcomes. Those with lower socioeconomic status being more socially and materially deprived have been shown to have poorer health outcomes and reduced response to physiotherapy [66]. Research also indicates both age and gender impacting on common MSK conditions [50].…”

Section: Aimsmentioning

confidence: 99%

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Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

Abramson¹

2018

J Nov Physiother Phys Rehabil

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Background: Patients with shoulder impingement syndrome (SIS) suffer pain and disability and present enormous health and fi nancial challenges to the NHS. There is limited evidence for many of the commonly used physiotherapy treatment interventions. Research suggests deprivation, age, gender and attendance are possible predictors of poor treatment outcome in common MSK conditions. The present author set up and ran a physiotherapy led group based SIS class to improve generic health outcomes and reduce shoulder pain and disability.Method: 236 SIS patients were referred over a 22 month period. 154 completed the once weekly six week course. 82 failed to complete the class. Generic health outcomes were measured with the Euroqol EQ-5D-5L with condition specifi c outcome measured using the Shoulder Pain and Disability Index (SPADI). Covariates possibly predictive of poor treatment outcome were analysed using linear regression and included Townsend Deprivation Score (TDS), age and gender. Class completers and non-completers were compared to determine any association with TDS, age and gender.Results: Statistically signifi cant improvements in generic health (t -7.77, df 153, p < 0.001) and shoulder pain and disability (t -9.36, df 153, p < 0.001) were found post intervention. No association for the predictive utility of TDS, age and gender on EQ-5D-5L and SPADI outcome was found. Statistically signifi cant differences between class completers and non-completers for TDS t (181.17)=-3.62, p < 0.001) and age (t (134.72)=2.41, p = 0.017) were found. Younger patients and those from more deprived areas attended fewer classes. No association was found between gender and non-attendance. TDS, age and gender have no association with class non-completion type be it never attended or attended then did not attend (DNA). Conclusion:Physiotherapists play a key role in managing the third most common MSK pathology. This evaluation suggests positive outcomes for those completing a group based SIS class on both health and shoulder pain and disability. SIS patients meeting inclusion criteria should be routinely fed into group based classes. Younger patients and those from more deprived areas may benefi t from a more individualised management approach.

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Section: Key Fi Ndingsmentioning

confidence: 66%

Section: Localitymentioning

confidence: 99%

Section: Key Fi Ndingsmentioning

confidence: 99%

Section: Localitymentioning

confidence: 99%

Section: Aimsmentioning

confidence: 99%

See 3 more Smart Citations

Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

Abramson¹

2018

J Nov Physiother Phys Rehabil

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Allied health professionals: A promising ally in the work against health inequalities- A rapid review

Gkiouleka

Aquino

Ojo-Aromokudu

et al. 2022

Public Health in Practice

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The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management

Areias,

Molinos,

Moulder

et al. 2023

npj Digit. Med.

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Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from −2.0 95%CI −2.1, −1.9 to −2.1 95%CI −2.3, −1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.

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Does deprivation influence treatment outcome in physiotherapy?

Cited by 4 publications

References 56 publications

Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

Allied health professionals: A promising ally in the work against health inequalities- A rapid review

The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management

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