Pain catastrophizing mediates rapid benefits of accessing in‐person chiropractic care during the COVID‐19 lockdown

Abstract

Background In March 2020, the COVID‐19 pandemic forced the Spanish government to declare a state of emergency. A stringent lockdown was enforced, restricting access to healthcare services, including chiropractic. Reduced access to care provision in combination with psychological stress, social isolation and physical inactivity during the lockdown were shown to negatively influence pain conditions. However, data on strategies to mitigate the impact of the pandemic on these conditions are lacking. Methods Upon easing of restrictions in May 2020, 51 chiropractic clinics throughout Spain pseudo‐randomly invited patients, recruiting a total of 385 participants. During a 14‐day period, participants were exposed to in‐person chiropractic care in either one ( n = 177) or multiple encounters ( n = 109) or to no care ( n = 99). The effects of access to chiropractic care on patients’ pain‐related and psychological outcomes were assessed online through validated self‐reported questionnaires before and after the period of care. Coprimary outcomes included pain intensity, pain interference and pain cognitions. Results When comparing to participants without access to care, pain intensity and interference were significantly decreased at follow‐up, irrespective of the number of encounters. Kinesiophobia was also significantly reduced at follow‐up, though only after multiple encounters. The relationship between fear of movement, changes in pain intensity and interference was mediated by catastrophizing. Conclusion Access to in‐person chiropractic care may provide pain relief, associated with reductions in interference and pain cognitions. Prioritizing in‐person care for patients with maladaptive pain cognitions may help dampen the detrimental consequences of the pandemic on physical and psychological well‐being.

From hands‐on to remote: Moderators of response to a novel self‐management telehealth programme during the COVID‐19 pandemic

“…Patients participating in the telehealth programme reported high levels of satisfaction (4.9/5 ± 0.4) 2 weeks after initiating the programme. These are comparable to the levels reported with in‐person care during the pandemic in Spain (Gevers‐Montoro et al, 2022) but largely exceed satisfaction amongst patients receiving other telehealth programmes (Carrillo‐de‐la‐Pena et al, 2021). Decreases in pain intensity with a large effect size ( η 2 p = 0.43) were also reported.…”

“…For these patients, high scores in this subscale were associated with increased pain on day 14, whereas for those with low harm scores and the same motivation, pain decreased (see Figure 3a). This factor, which reflects the belief in the presence of a serious underlying pathology (Goubert et al, 2004), was also found to reduce the likelihood of benefitting from hands‐on care during the pandemic (Gevers‐Montoro et al, 2022). The present study expands on these findings by providing evidence that these beliefs, when combined with low motivation to actively engage in exercise whilst in home confinement, could lead to worsening of pain symptoms.…”

“…COVID‐19 lockdowns limited access to healthcare services, carrying detrimental consequences for patients’ outcomes (Gevers‐Montoro et al, 2022; Nieto et al, 2020). In Spain, severe restrictions were imposed on in‐person services (Carrillo‐de‐la‐Pena et al, 2021), including the closure of chiropractic clinics (@QuiropracticAEQ, 2020).…”