Denne vitenskapelige artikkelen er fagfellevurdert etter Fysioterapeutens retningslinjer, og ble akseptert 5.desember 2022. Ingen interessekonflikter oppgitt.
Abstract
Background: Norwegian Psychomotor Physiotherapy (NPMP) is an established treatment approach mainly applied to patients with long-lasting musculoskeletal pain. The research in the field of NPMP is gradually expanding. The aim of this study was therefore to conduct a systematic search of the published literature for empirical studies in the field, to chart the characteristics and methodologies used and uncover gaps in the research field.
Methods: A scoping review methodology was chosen.
Results: A total of 93 full text research articles were analysed. The analysis identified primarily articles with a quantitative approach concerning development and standardisation of the NPMP body examination into scales. The qualitative studies concerned different experiences from the body examination and the treatment approach from the patients' and/or the physiotherapists' perspectives.
Conclusion: The literature in the field is limited but has slowly expanded during the last 20 years. More research is generally needed to further develop and expand the treatment approach.
Keywords: Norwegian Psychomotor Physiotherapy, Scoping review, Quantitative methods, Qualitative methods
Norsk psykomotorisk fysioterapi. En scoping review studie
Sammendrag
Hensikt: Norsk psykomotorisk fysioterapi (NPMF) er en etablert behandling tilnærming primært for pasienter med langvarige muskel- og skjelett smerter og sammensatte lidelser. Forskning innen fagfeltet er i utvikling. Hensikten med denne studien var derfor å gjennomføre et systematisk søk av den publiserte litteraturen i fagfeltet for å kartlegge omfang, metodisk tilnærming og å bidra til å avdekke kunnskapshull.
Metode: Scoping review ble valgt som metode.
Resultater: I alt ble 93 artikler analysert. Analysen avdekket primært artikler med en kvantitativ tilnærming som omhandlet utvikling og standardisering av kroppsundersøkelsen i NPMF. De kvalitative studiene omhandlet ulike erfaringer fra kroppsundersøkelsen og behandlingstilnærmingen fra pasientenes og eller fysioterapeutenes perspektiv.
Konklusjon: Litteraturen i fagfeltet er begrenset, men har gradvis ekspandert de siste 20 årene. Mer forskning er generelt nødvendig for å videreutvikle behandlingstilnærmingen.
Nøkkelord: Norsk psykomotorisk fysioterapi, Scoping review, Kvantitative metoder, Kvalitative metoder.
Introduction
Long-lasting musculoskeletal pain is characterized by reduced physical function, often linked with anxiety and depression, and with increased risk of developing other health conditions, early retirement, reduced wealth, and social participation, and increased all-cause mortality (1).
Norwegian Psychomotor Physiotherapy (NPMP) is a physiotherapeutic approach applied to patients with long-lasting musculoskeletal pain and complex health complaints (2, 3). The approach emerged from the collaboration between the physiotherapist Aadel Bülow-Hansen and the psychiatrist Trygve Braatøy (1946-1951) (2, 3). Bülow-Hansen and Braatøy collaborated by treating the same patients and discussing experiences and theories. One major interest during their collaboration was how muscular tension, breathing and emotions interdepended and mutually influenced each other(2, 3). As such their approach conceptualized the reciprocal relationship between restrictions and regulations of muscular tension, breathing, movements and emotions (2,3).
Since 1952, the treatment approach has furthered developed being a specialization in physiotherapy. From 1994 the education was a post graduate education at Oslo University College of Applied Sciences, and from 2000 at the Artic University of Norway, Tromsø (UiT) (2). Further, the education was at a level of master's degree at UiT since 2010, at the Western Norway University of Applied Sciences and the Oslo Metropolitan University since 2018 and 2021, respectively.
The research in the field of NPMP is gradually expanding. Hence a review might provide an overview and bring together the research in the field (6). The aim was therefore to 1) conduct a systematic search of the published literature of empirical studies in the field of NPMP, 2) chart the characteristics and methodologies used in the identified studies, 3) and uncover gaps in the research field.
Methods
A scoping review methodology is well suited for mapping the size and scope of research on a topic, synthesizing findings, and identifying gaps in the literature (4). The approach is further appropriated given the expectation of finding papers with diverse methodology (4). We followed the framework for scoping reviews originally described by Arksey and O'Malley (5) and later advanced by Levac et al. (6) and Khalil et al. (7).
Identifying relevant studies
Relevant peer-reviewed articles were identified in the databases: The Cochrane Library, Epistemonikos, PEDro (The Physiotherapy Evidence Database), AMED, Cinahl, Scopus, Medline, Embase, Forskningsdatabasen.dk, Norart, Oria, Web of Science, SveMed+, Idunn, Google Scholar. The searches were conducted in March 2020 and in June 2021. The search terms used to identify the relevant studies were psychomotor physiotherapy, psychomotor physical therapy, Psykomotorisk fysioterapi [psychomotor] AND [physiotherapy] (appendix).
No restrictions were placed on the study search to ensure inclusion of the full breadth of the literature.
Study selection
To capture the breadth of the literature, articles were included if it: 1) was peer-reviewed, 2) contained NPMP treatment and or elements from the treatment approach, 3) contained the body-examination in NPMP or elements of the examination. No limitation was set for year of publication. Articles were excluded if they: 1) were not peer-reviewed, 2) not written in English or Scandinavian languages.
After the identification of the citations in the electronic database search, the first screening focused on the title and abstract (n=1066). Following this, the authors independently screened the possible articles to be included in the further analysis. A total of 106 articles were chosen to be studied further (Figure 1). The authors then considered these articles and excluded 13 articles because they were not peer-reviewed. Finally, this process ended in including 93 articles (Figure 1).
Charting extraction
Information about the studies is described in table 1.
Data synthesis and analysis
The studies were further analysed to gain insight into the results presented in the studies. During this process, the identified studies were re-read to further extract the results. The methodology and perspectives in the studies varied. Consequently, we divided the studies in three groups: quantitative studies, qualitative studies, and studies including both qualitative and quantitative methods. The quantitative studies were thematic divided in, patients receiving NPMP, examination and outcome of the treatment. The qualitative studies were divided in empirical studies from the patients' and the physiotherapists' perspectives, and theoretical articles.
Results
Distribution of publications and methodology
The included 93 full text articles were from 1975 to 2021 and most of them were conducted in Norway (n=87) (Figure. 1, Table 1). Eighteen of the years had no publications, twenty-one of the years had either one, two or three publications and the years 2001, 2003, 2006, 2007, 2008, 2010, 2012, 2014, 2018, 2019, 2020 and 2021 had 4 or more publications (Figure 2).
A total of 68 studies were written in English and published in international journals. Most of the studies used quantitative approaches (n=51). Among these studies, 21 concerned development and evaluation of psychometric properties of different test scales emerged from the NPMP body examination (8-28). Three studies included development and evaluation of a body awareness questionnaire (29-31). There were five outcome studies of NPMP treatment, including three randomized controlled studies (RCT)(32-36). Among the other quantitative studies, 20 included the use of one of the scales, emerged from the NPMP body examination or elements from the NPMP treatment approach (36,39-57).
One study included both a quantitative and a qualitative approach (58).
Among the qualitative studies, 15 studies (59-73) explored experiences from the physiotherapist's perspective, 10 studies (74-83) from the patients' perspectives and three studies (84-86) from both the physiotherapist and the patients' perspectives. There were two case studies (87, 88) and seven theoretical studies (89-95). The theoretical perspectives in the qualitative studies were, in addition to NPMP, primarily Merleau-Ponty's phenomenology of perception. However, different perspectives for example from social science, psychology and communication theories were also used.
The sample size in the studies varied from 1-416 participants, mainly being patients with musculoskeletal pain or mental health problems. The physiotherapists were specialized in NPMP. Most of the studies were conducted in primary health care or mental health clinics.
Quantitative studies
Patients receiving NPMF
