Combining a psychological intervention with physiotherapy: A systematic review to determine the effect on physical function and quality of life for adults with chronic pain

Background: Chronic pain affects approximately 28 million people in the UK. It does not always respond to conventional curative treatments and can have a devastating impact on an individual's ability to function and perform life roles in the way they would like. Psychological approaches to pain management have been advocated for over 40 years, but it is unclear whether the addition of such approaches to physiotherapy increases treatment effectiveness.Objectives: To systematically review the literature to determine whether the addition of psychological approaches to physiotherapy is more effective in improving physical functioning and quality of life than physiotherapy alone.Methods: An electronic database search focused on randomised controlled trials comparing a physiotherapy intervention for chronic pain with a matched intervention with an additional psychological therapy component. All eligible studies were independently reviewed by two researchers and the strength of evidence and results evaluated. A meta-analysis was conducted on post-test mean data for physical functioning.Results: Eight studies were identified for inclusion. Meta-analysis of the data showed combined treatments to be superior in modifying functional outcomes (standardised mean difference -1.12 95% confidence intervals -1.94 to -0.31). This was echoed in the narrative review of the quality of life evidence. Study quality was variable and thus the findings should be interpreted with caution.Conclusions: There is evidence that combining physiotherapy and psychological approaches improves physical function in chronic pain in comparison with physiotherapy alone. Further examination of this field is required to inform changes in practice and to develop treatment methods.