Physiotherapy as empowerment : Treating women with chronic pelvic pain

Mattsson, M., Wilkman, M., Dahlberg, L. & Mattson, B. (2000). Advances in Physiotherapy, 2(3), 125-143.
reviewed by Aaron O’Donnell, University of Minnesota doctoral physical therapy student, 2014
This article is available free of charge from Dignity-Danish Institute Against Torture. Please email them at library@dignityinstitute.dk and include a list of desired articles and your mailing address.
 
Background: A large group of CPP (chronic pelvic pain) patients are “inexplicable” from a medical point of view. This causes a lot of discomfort due to the lack of agreement between the patient’s presentation and the diagnostic model used by the doctor. Due to this discomfort, it is important for physiotherapists to become more aware of the interaction between pain, behavior, psychological factors and lifestyle when addressing the rehabilitation process. In many chronic pain syndromes the pain itself is the the main problem but the behavioral consequences generated by the pain is the problem. Physiotherapy can be extremely beneficial for CPP and subjects in this study showed improvements with decreased symptoms and increased function. 
 
Purpose of this study: Focusing on women with CPP
  • Evaluate patients taking part in a new treatment model where the physiotherapist had a key position together with a gynaecologist and an active patient
  • Scrutinize all documents with particular emphasis on the physiotherapist’s actions
Methods: 5 women participated in this study. These women were CPP patients who have had extensive conventional medical treatment and now there is no more to offer. Each woman had an individual treatment. The treatment lasted 20 sessions with each session around 60-90 minutes. The physiotherapists did most of the treating and the gynaecologists completed medical examinations at sessions 1 ,6, 12 and 20. The physiotherapy treatment consisted of many parts.  The first part was to perform interventions that were explicitly aimed at relieving the pain and something that was perceived as comforting and pleasant.  This could consist of Exercises, massage, pain-relieving positioning, and hot packs. The next part of the treatment was to improve the global movement pattern by introducing basic body awareness practice. The third and final component consisted of a home exercise program in which the patients were instructed to not focus as much on their pain and emotions but rather time and quota.
Outcome measures included the body awareness scale (BAS), the doctor’s data, and the patients own self appraisal
 
Results:
  • BAS - All women had reduced scores by the end of the treatment indicating an improvement in the movement systems as well as a reduction in symptoms
  • Doctor’s data -  The examinations did not reveal any pathology that needed further medical or surgical treatment.  However, most patients were anxious while completing the examination.
  • Self appraisal - Two of the patients had fulfilled their desired goals by the end of the treatment while the other three had succeeded to a varying degree.
Conclusion: This study demonstrates that this physiotherapeutic treatment was well applicable in patients with CPP.  Furthermore, this approach seemed to have an empowering effect on the women.

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