Liv Helvik Skjaerven

Systematic Review of the Benefits of Physical Therapy Within a Multidisciplinary Care Approach for People With Schizophrenia

Background Although schizophrenia is the fifth leading cause of disability-adjusted life years worldwide in people aged 15 to 44 years, the clinical evidence of physical therapy as a complementary treatment remains largely unknown. Purpose The purpose of this study was to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of physical therapy for people with schizophrenia. Data Sources EMBASE, PsycINFO, PubMed, ISI Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were searched from their inception until July 1, 2011, for relevant RCTs. In addition, manual search strategies were used. Study Selection Two reviewers independently determined study eligibility on the basis of inclusion criteria. Data Extraction Reviewers rated study quality and extracted information about study methods, design, intervention, and results. Data Synthesis Ten RCTs met all selection criteria; 6 of these studies addressed the use of aerobic and strength exercises. In 2 of these studies, yoga techniques also were investigated. Four studies addressed the use of progressive muscle relaxation. There is evidence that aerobic and strength exercises and yoga reduce psychiatric symptoms, state anxiety, and psychological distress and improve health-related quality of life, that aerobic exercise improves short-term memory, and that progressive muscle relaxation reduces state anxiety and psychological distress. Limitations The heterogeneity of the interventions and the small sample sizes of the included studies limit overall conclusions and highlight the need for further research. Conclusions Physical therapy offers added value in the multidisciplinary care of people with schizophrenia.

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.

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.

Basic elements and dimensions to the phenomenon of quality of movement - a case study

Abstract Quality of movement is frequently referred to as a phenomenon in the European movement tradition, underlining the close connection between outer expression and inner, lived experience. Within physical therapy little is clarified about the phenomenon from the point of view of lived experience. A case study has been undertaken focusing on the lived experience of the phenomenon, searching for basic elements and dimensions. An interpretive phenomenological approach was the method chosen for research. A qualitative interview was conducted involving one movement expert with an understanding and knowledge of the phenomenon. Analysis of the data revealed three levels of views on the quality of movement: basic elements and dimensions, functional use and personal integration. The phenomenon could be understood by the relation between three key elements, postural stability, free breathing and awareness; all contributing to a refinement in movement as well as a greater experience of well-being. The key elements were considered prerequisites to a four-dimensional therapeutic approach involving personal integration of bodily and mental aspects in movement. The basic element and dimensions of the phenomenon of quality of movement can be regarded as a starting point for research in this area.

Reliability and validity of the Body Awareness Rating Scale (BARS), an observational assessment tool of movement quality

Abstract Movement quality assessed by the Body Awareness Rating Scale (BARS) is used as an indicator of health and self-efficacy in patients with long-lasting musculoskeletal and mental health problems. The objective of the study was to examine reliability and construct validity of the movement quality scale. 25 patients and 25 healthy persons were included. Internal consistency was examined by Cronbachs α, reliability by intraclass correlation coefficient (ICCagreement) and measurement error reported by standard error of measurement (SEM) and smallest detectable change (SDC). Construct validity was examined by testing hypotheses of moderate association between the observational scale and the self-report Short-Form Health Survey (SF-36) subscales and the General Perceived Self-Efficacy Scale (GPSES). A hypothesis about the difference in scores between groups being expected to differ in health states was tested. Internal consistency (α) was 0.92. Inter-tester reliability was ICC = 0.99 and SEM = 0.8. The test–retest reliability was ICC = 0.96 and SEM = 1.4, implying that improvement should be above 3.3 (SDC) to claim a treatment effect. BARS was moderately correlated (0.30 ≤ rs < 0.60) with most SF-36 subscales and GPSES. The patients demonstrated less movement quality than healthy persons. Evidence was provided of high internal consistency and reliability in qualified testers. Construct validity was indicated, as BARS reflected various aspects of health and self-efficacy.

Greek sculpture as a tool in understanding the phenomenon of movement quality

Abstract Previous research has shown that movement quality may be described as offering a general impression of a whole unified person, understood as a relation between postural stability, free breathing and awareness, which combined produce a refinement of movement as well as enhancing well-being. The phenomenon could further be structured in terms of four movement dimensions: structural, physiological, psychological/relational and a purely human dimension. So far we have little knowledge about these dimensions. The aim of this study is to deepen the understanding of the phenomenon of movement quality through close observation of Greek sculpture, reflection and literature studies relating to Greek sculpture. The aim was to see if these methods could be a tool for achievement of a deeper understanding of movement quality, in clinical observation and reasoning. A phenomenological method was used to study the essence of the phenomenon of movement quality. A study of Greek sculpture was chosen because of the way ancient Greek sculptors sought to express several dimensions of human existence. The results show that close observation, reflection and literature studies of Greek sculptures deepened the knowledge of the four dimensions of movement quality and provided a way in which this knowledge could be expressed in words. These methods may represent a tool for achieving a deeper understanding of movement quality in clinical observation and reasoning.

Patient education and basic body awareness therapy in hip osteoarthritis – a qualitative study of patients’ movement learning experiences

Abstract Background: Osteoarthritis (OA) is associated with pain, dysfunction and reduced quality of life. Patient education (PE) followed by 12 weekly sessions of Basic Body Awareness Therapy (BBAT) was offered to patients with hip OA, aiming to strengthen their ability to move and act functionally in daily life. Aim: To explore how patients described their experiences and outcome from participating in PE and BBAT. Method: Individual, semi-structured interviews with five patients, aged 52-78 years, were performed after PE and BBAT at four and ten months. Interview data were analyzed by systematic text condensation. Results: Three main themes emerged. “Becoming motivated and involved” reflected experiences of encouragement and support from information given and communication with group members. In “Movement awareness learning” patients described becoming aware of and improving functional movement, alleviating symptoms and increasing daily functioning. “Movement and disease in a long-term perspective” reflected patientś experience of increased self-awareness and taking better care of themselves at 10 months after baseline. Practicing basic movement principles, they felt empowered to handle daily life challenges in more functional and energy-economical ways. Conclusion: PE followed by BBAT in groups may be beneficial to patients with hip OA, and provide lasting benefits regarding daily life function. Implications for Rehabilitation Insight into disease process and relationship to functional movement gained through patient education may empower patients with hip osteoarthritis in management of daily life Movement awareness and exploration of movement quality using principles from Basic Body Awareness Therapy was found to support patients in finding resources for functional movement, implemented in daily actions Movement strategies characterized by adjustment rather than force was experienced by the patients to support their general functioning, despite of prevailing hip pain Implementing group therapeutic factors (Yalom) in physiotherapy was found to strengthen patients’ motivation and belief in functional improvement

Patients suffering from rheumatic disease describing own experiences from participating in Basic Body Awareness Group Therapy: A qualitative pilot study

ABSTRACT Background: Rheumatic diseases have physical and psychological impact on patients’ movement and function. Basic Body Awareness Therapy focuses on promoting more functional movement quality in daily life. The purpose of this study was to describe patient experiences from participating in Basic Body Awareness Group Therapy for inpatients with rheumatic disease. Methods: A phenomenological design included data collection in two focus group interviews with seven patients. Giorgi’s four-step phenomenological method was used for data analysis. Results: Four main themes emerged: (1) “Movement exploration—being guided in movement” described informants’ exploration of bodily signals and movement habits; (2) “Movement awareness training in a relational perspective” informants described experiences from being in a group setting; (3) “Movement awareness—integration and insight” described informants’ reflections on movement experiences; and (4) “Integrating and practicing new movement habits” informants described how they used their movement experiences in daily life. Conclusions: The study described perspectives in movement learning experienced by patients. The results support the view that contact with the body can help patients exploring and cultivating their own resources for a more functional movement quality. Descriptions of relational movement learning aspects can contribute to our understanding of physiotherapy group design.

The phenomenon of movement quality: a phenomenographic study of physiotherapy students’ movement experiences

Abstract Background: This study aimed to explore how students in a physiotherapy bachelor program acquire awareness of their own movement quality and form conceptions of movement quality. Methods: The study was designed as an elective course, implementing Basic Body Awareness Therapy principles. The participants were six PT students. Two data sets – students’ diaries and reflective group interviews – were collected, one a week before the course ended, and one on its completion. Phenomenographic research methodology was used to transcribe and analyze the data. Results: Three descriptive categories emerged reflecting the PT students’ conceptions of movement quality phenomenon as a widening process: I: Coming into contact with movement experiences, II: Variety of movement qualities, and III: Movement quality as professional development. Within these, two critical aspects, Acceptance of own movement quality and Reflective reasoning based on own experiences of being in movement to gain quality, were identified, indicating aspects of pedagogical importance in deepening PT students’ understanding of the movement quality phenomenon. Conclusion: The three categories reflect the PT students’ variety, widening views on movement quality. The findings elucidate movement awareness learning, by being in movement, indicating a direction for future research on students’ learning of movement quality conceptions within physiotherapy education.

Basic Body Awareness Therapy and patient education in hip osteoarthritis: a multiple case study

Abstract International guidelines recommend exercise and patient education (PE) in hip osteoarthritis. However, we need more in-depth evidence regarding the effect of different exercise modalities. The aim of this study was to examine short- and long-term outcomes of PE and Basic Body Awareness Therapy (BBAT). Seven patients (five men, two women) with moderate to severe osteoarthritis were recruited. Pain, function and quality of life were assessed at baseline and after 4 and 10 months, pain during walking being the main outcome. PE, aiming for patients’ empowerment through information and counselling, was given in a 2 h group setting. BBAT, focusing on promoting movement quality and awareness in a variety of daily movements, was given weekly in groups over 12 weeks. Five patients participated in PE and BBAT, two in PE only. After 4 months all reported improvement. Less pain during walking was found in four patients, and after 10 months in three patients (one PE, two PE and BBAT, two missing). One patient (PE) reported being unchanged and one (PE and BBAT) worse and motivated for surgery, both with 0 mm joint space. BBAT and PE may be beneficial in hip osteoarthritis, but the supplementary effect of BBAT must be further examined.