Amanda Lundvik Gyllensten

International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia

Purpose: The excess cardiovascular morbidity associated with schizophrenia is attributed to an interplay between behavioural (physical inactivity, unhealthy diet, substance abuse), genetic and illness related factors, as well as the effects of antipsychotic treatment. Patients have limited access to physical healthcare with less opportunity for cardiovascular risk prevention and treatment programmes than the non-psychiatric population. The aim of this paper is to improve physical activity (PA) within rehabilitation programmes for people with schizophrenia. Method: The development process consisted of: a) systematic literature review on PA in schizophrenia in eight databases up to May 2010; b) review on existing national and international guidelines; c) consensus meetings, and d) formulation of the final consensus document. Results: There is insufficient evidence for the relative contribution of PA reducing cardio-metabolic risks in people with schizophrenia. Demographical, biological, psychological, cognitive-behavioural, emotional, social and environmental barriers for PA could be identified. Conclusions: Although PA outcomes on cardio-metabolic parameters are still unknown, the benefits of physical activity as part of a larger lifestyle programme are sufficient for the recommendation that persons with schizophrenia follow the 2008 U.S. Department of Health and Human Services PA Guidelines with specific adaptations based on disease and treatment-related adverse effects. Implications for Rehabilitation For substantial health benefits, patients with schizophrenia should do at least 150 min a week of moderate-intensity, or 75 min of moderate- to vigorous-intensity aerobic activity. The promotion of a healthy lifestyle should be the shared responsibility of all health care providers under supervision of general practitioners and psychiatrists. Each patient with schizophrenia should have access to high quality physical health services with a high quality physical assessment and follow-up. The choice between the two equally effective training alternatives should be based on the patients’ preference, and availability of equipment and resources. Health care providers should consider illness symptoms, side-effects of antipsychotic medication, low self-efficacy and the lack of social support when motivating patients to a healthy lifestyle.

Embodied identity—A deeper understanding of body awareness

The aims of this study were to explore and generate an understanding of the meaning of body awareness through explanations of the experience of body awareness given by professionals and patients in psychiatric rehabilitation. A total of 20 strategically selected healthy informants were interviewed individually and in groups. Thirteen previous interviews with physiotherapists and 11 previous interviews with patients in psychiatric rehabilitation, describing their experiences of body awareness therapy and its effects were reanalyzed and included in the data for this study; in all 44 informants were included. Grounded theory methods guided the data construction and analysis. A theoretical understanding was conceptualised from which a core category of body awareness emerged: the embodied identity. This core category was related to two categories: living in the body and living in relation to others and in society. The subcategory “living in the body” was conceived as an important aspect to become more aware of the body and to experience oneself fromwithin in order to recognize ones needs. A key point was the fact that bodily experiences always exists in the present moment. The experience of the body, the balance, and stability of the physical self were basic experiences that were connected to the conception of well-being and control. To understand ones emotions and needs through the awareness of the body were understood as the base for self-confidence, trust in one-self, and the ability to take care of oneself and ones needs physically and mentally. The subcategory “living in relation to others and in society” was conceived as an important aspect for the embodied self to interact with others and for societal participation. Working with the body in physiotherapy practice should include an understanding that body awareness is inseparable from the identity and may have an impact on the health of the individual. This implies that interventions to address problems in body awareness should be integrated into physiotherapy practice.

Outcome of Basic body awareness therapy. A randomized controlled study of patients in psychiatric outpatient care

The aim was to study the outcome of Basic Body Awareness Therapy (Basic BAT) added to treatment as usual (TAU) compared to TAU only, for patients with mood, somatoform or personality disorders in psychiatric outpatient services. Seventy-seven patients were randomized to Basic BAT and TAU (n=38) or TAU only (n=39). Patients were assessed at baseline and after 12 sessions of Basic BAT, 3 months after baseline. At the termination of Basic BAT sessions, patients receiving Basic BAT in addition to TAU showed significant improvements concerning the quality of movements using the Body Awareness Scale–Health (BAS-H), and psychiatric symptoms and attitudes towards body and movement using the Body Awareness Scale interview, compared to the TAU-only patients. A significant improvement in favour of the patients receiving Basic BAT was also shown with regard to self-efficacy, physical coping resources and sleep. Age and sex showed no significant influence on outcome. The results indicate that Basic BAT in addition to TAU, in a relatively short intervention period improves the body awareness and attitude towards the body as well as self-efficacy, sleep and physical coping resources compared to TAU only. This study indicates a positive short-term outcome of the Basic BAT treatment. However, studies of the long-term outcome remain to be undertaken.

A systematic review on physical therapy interventions for patients with binge eating disorder

Abstract Purpose: Since a distorted body experience and a sedentary lifestyle are central in the course of binge eating disorder (BED), physical therapy might be an interesting add-on treatment. The aim of this study was to systematically review randomised controlled trials (RCTs) evaluating physical therapy on binge eating and physical and mental health in BED patients. Method: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Library were searched from their inception until 15 August 2012 for relevant RCTs comparing physical therapy with a placebo condition, control intervention or standard care. Results: Three RCTs involving 211 female community patients (age range: 25–63 years) met all selection criteria. Review data demonstrate that aerobic and yoga exercises reduce the number of binges and the body mass index (BMI) of BED patients. Aerobic exercise also reduces depressive symptoms. Only combining cognitive behavioural therapy (CBT) with aerobic exercise and not CBT alone reduces BMI. Combining aerobic exercise with CBT is more effective in reducing depressive symptoms than CBT alone. Conclusions: The limited number of available studies and the heterogeneity of the interventions limit overall conclusions and highlight the need for further research. Implications for Rehabilitation Because of severe co-morbid psychiatric and physical conditions, binge eating disorder is one of the most difficult psychiatric conditions to treat. Both yoga and aerobic exercise have shown promise in reducing binge eating pathology and weight. Combining aerobic exercise with cognitive behavioural therapy seems more effective in reducing depressive symptoms than cognitive behavioural therapy alone.

Long-term effectiveness of Basic Body Awareness Therapy in psychiatric outpatient care. A randomized controlled study

The long-term effects of Basic Body Awareness Therapy (BBAT) in addition to treatment as usual (TAU) were studied in a randomized, controlled design in psychiatric outpatient care. Seventy-seven patients with mood, stress-related somatoform, behavioural or personality disorders were studied at baseline, after a 3-month treatment period and at a 6-month follow-up. The use of psychiatric healthcare and social services were studied during 12 months, starting with baseline. The study comprised a control group (n=39) that received TAU and a treatment group (n=38) that in addition to TAU also received 12 sessions of BBAT. The aim was to study the effects of BBAT in addition to TAU compared with TAU only, regarding: body awareness, health-related factors and coping strategies as well as the use of the social services and psychiatric healthcare. Analysis of variance (ANOVA) repeated-measures analysis of the intention-to-treat population (n=77) revealed that the BBAT group had a significantly improved body awareness (p<0.001), attitude to the body fewer symptoms (p<0.001) and improved self-efficacy (p<0.05), from baseline to 6 months after the termination of treatment, compared with the control group. The treatment group also had a significantly less use of psychiatric treatment from healthcare professionals other than the psychiatrist (p<0.05) during 1 year after baseline and a significantly less total use of social services (p<0.05). The evidence of the positive effects as well as the lower costs for psychiatric healthcare and social services for the group that had received BBAT in addition to TAU is discussed, and it is concluded that BBAT seem an effective intervention in psychiatric outpatient care also in the long term for patients who in addition to psychiatric disorders also present somatic symptoms.

A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa.

Abstract Purpose: The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. Method: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. Results: Eight randomised controlled trials involving 213 patients (age range: 16–36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. Conclusions: The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.

The importance of emotions in physiotherapeutic practice

Abstract Emotions are a topic of great relevance, but are not frequently studied within physiotherapy. To identify and express emotions can be seen as a prerequisite for having emotional intelligence, an ability highly needed in treatment situations in physiotherapy. Within psychology, there is a tradition as well as a recognized fact that the identification and expression of emotions are important for good clinical outcomes. The aim of this paper is to review the literature within physiotherapy and psychology about the importance of emotions in treatment situations. Research has shown that physiotherapists have an awareness of underlying emotions in treatment situations, but often respond mostly on an intellectual level. Skills and awareness in identifying and expressing emotions in combination with cognitive and self-monitoring skills can be an effective way of improving the clinical reasoning process and treatment outcomes in physiotherapy. Identifying and expressing emotions in treatment situations may also increase positive treatment outcomes thanks to an increased adherence to transference and countertransference processes in treatment situations. More emphasis can be put on identifying and promoting verbal expression of emotions in treatment situations in physiotherapy practice.

Patient experiences of basic body awareness therapy and the relationship with the physiotherapist

Background and Purpose: To explore the experiences of patients undergoing basic body awareness therapy in psychiatric physiotherapy. In addition, the therapeutic relationship and the concept of the working alliance were examined. Subjects: Two groups of patients participated: patients with schizophrenia (n=6) and general psychiatric outpatients (n=5). Method: A qualitative technique, video taping and interviewing the patients during treatment was used. Results: The most common experience from the treatment was ‘balance and posture’. Other experiences were ‘body movement control’ and ‘awareness and handling of body signals’. Themes central to establishing a good working alliance were identified. Discussion and Conclusions: The impact of balance and posture was discussed and some new hypotheses were generated.

Attitudes towards mental illness among health care students at Swedish universities – A follow-up study after completed clinical placement

The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.

Are emotions important for good interaction in treatment situations

Emotional aspects in interaction have been an area of growing interest in recent decades. The aims of this study were to investigate the role of emotions in interactions between individuals receiving physiotherapy and their therapists providing PT services to them in psychiatric care. The study was a qualitative case study with cross-case analysis according to Shephard et al () and . Eleven informants participated, all of them “experts in interaction” with patients. All informants perceived that emotional aspects were important for good interaction between physical therapist and patient. It was considered important to identify and express emotions as a PT but also to identify emotions in patients and help patients to express emotions. The following themes were identified: emotions as a basis for interaction; identifying and using ones own emotions as a PT; separating ones own emotions from the patients emotions; motivating forces and emotion, body language and emotion and emotional awareness in patients. The results are also discussed in the light of existing theories about the importance of emotions.