Background & Aims
Torture can result in impaired function, reduced quality of life, and persistent pain. Physical therapy (PT) is recommended for holistic care of survivors of torture (SOT), however there are limited evidenced-based guidelines. We conducted a scoping review to identify and describe the approach and gaps in knowledge around the PT treatment of SOT.
Methods
We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Nine databases were searched from inception to 2023. Eligible sources were those that included PT recommendations for treatment of pain or disability for SOT. Variables of interest included specific models or approaches (example: biopsychosocial, trauma-informed, inter-professional), specific interventions, mode of intervention (individual or group), and dosage in terms of frequency and duration. Additionally, we sought to identify potential evidence gaps, and the generalizability of source information; variables included method of study, population, sample size, outcomes, country of authorship, and country of origin of the SOT. Data were categorized into PT themes based on recommendations from the Physiotherapy and Refugees Education Project: 1) trauma-informed care, 2) body-awareness & empowerment, and 3) pain management.
Results
The final analysis included 15 sources with a combined total of 19 different PT interventions. Of these 15 sources, five were randomized controlled trials. The remaining sources consisted of observational studies, a survey, a case series, and expert opinion (review or perspective) papers recommending physical therapy for treatment of chronic pain in SOT. Thematically, two sources described interventions targeting one theme (body-awareness & empowerment), while five sources targeted two themes (body-awareness & empowerment and pain management). Eight sources included all three themes; three of these eight sources were research studies examining outcomes following the PT intervention. Findings were significant favoring the PT groups, but results must be taken cautiously due to methodological limitations of the trials. Studies assessing treatment that included only one theme resulted in no differences between the control and intervention groups.
Conclusions
We describe the scope of the literature regarding PT for SOT. There is variability in PT approach and choice of intervention. A trauma-informed PT approach, coordinated with pain management, and body-awareness & empowerment interventions may address the complex needs of survivors. However, rigorous studies of this three-themed approach are lacking. As the number of displaced persons continues to rise globally, and human rights violations persist, we must be prepared to care for these vulnerable people. Physical therapists are encouraged to utilize a holistic approach, and to examine outcomes of this approach for SOT.
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Presenting Author
Justine Dee
Poster Authors
Topics
- and War
- Organized Violence
- Pain in Special Populations: Torture