Physical therapy for survivors of torture: A scoping review
DOI:
https://doi.org/10.7146/torture.v34i1.138985Keywords:
torture, trauma, physical therapy, physiotherapy, painAbstract
Background: Torture can result in impaired function, reduced quality of life, and chronic pain. Physical therapy (PT) is recommended for wholistic 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 involving PT treatment for SOT. Extracted data included the source of evidence, PT description, mode of delivery, and research study outcomes. Interventions were categorized into themes based on recommendations from the Physiotherapy and Refugees Education Project: trauma-informed care, body-awareness & empowerment, and pain management. Source-reported treatment approach and expected effect of the interventions informed the thematic categorization.
Results: The final analysis included thirteen sources with a combined total of 18 different interventions. Thematically, two sources described interventions targeting body-awareness & empowerment, while five sources targeted body-awareness & empowerment and pain management. Six sources included all three themes. Two of these six sources were research studies examining PT outcomes. Findings were significant favoring the PT, but results must be taken cautiously due to methodological limitations. Studies assessing treatment related to only one theme resulted in no between group differences.
Conclusions: We describe the scope of the literature regarding PT for SOT. 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 approach are lacking. As the number of displaced persons continues to rise globally, we must be prepared to care for these vulnerable people. Physical therapists are encouraged to utilize a wholistic approach, and to examine outcomes of this approach for survivors of torture.
References
Alme, M. N., Jalovcic, D., Fricker, I., Peters, S., Vårdal, R., Rocca, P., Hale, W., Alagöz, E., Leskovsek, N., Benyaich, A., McGowan, E., Pettersson, A., Boström, C., Giusti, L. M., Landry, M., Lowe, R., Wilhelmsen, K. T., & van Wijchen, J. (2021). Collaborative effort to increase the physiotherapist’s competency in rehabilitation of torture survivors. 61-66. https://doi.org/10.7146/torture.v30i3.121793
Amris, K., & Prip, K. (2000, March 3). Physiotherapy for Torture Victims. http://doc.rct.dk/doc/TORT2000-3-3.pdf
Amris, K., & Williams, A. C. de C. (2015a). Managing chronic pain in survivors of torture. ResearchGate, 5(1), 5–12. https://doi.org/10.2217/pmt.14.50
Amris, K., & Williams, A. C. de C. (2015b). Managing chronic pain in survivors of torture. ResearchGate, 5(1), 5–12. https://doi.org/10.2217/pmt.14.50
Baird, E., Williams, A. C. de C., Hearn, L., & Amris, K. (2017). Interventions for treating persistent pain in survivors of torture. The Cochrane Database of Systematic Reviews, 8, CD012051. https://doi.org/10.1002/14651858.CD012051.pub2
Basic Body Awareness Therapy (BBAT) | International Association of Teachers in Basic Body Awareness Therapy | Kineoo—Jordy den Engelsman. (n.d.). Retrieved February 9, 2023, from http://iatbbat.com/basic-body-awareness-therap.html
Carinci, A. J., Mehta, P., & Christo, P. J. (2010). Chronic pain in torture victims. Current Pain and Headache Reports, 14(2), 73–79. https://doi.org/10.1007/s11916-010-0101-2
Centering—Maintaining Focus in Stressful Situations. (n.d.). Retrieved March 26, 2023, from https://www.mindtools.com/ashwpqm/centering
Dale, R., & Stacey, B. (2016). Multimodal Treatment of Chronic Pain. The Medical Clinics of North America, 100(1), 55–64. https://doi.org/10.1016/j.mcna.2015.08.012
Dibaj, I., Halvorsen, J. Ø., Kennair, L. E. O., & Stenmark, H. I. (2017). An evaluation of combined narrative exposure therapy and physiotherapy for comorbid PTSD and chronic pain in torture survivors. Torture Journal, 27(1), 1. https://doi.org/10.7146/torture.v27i1.26534
Flynn, D. M. (2020). Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments. American Family Physician, 102(8), 465–477.
Gamble, A., Ahmed, A. M. A., Rahim, S. H., & Hartman, J. (2020). The effects of a combined psychotherapy and physiotherapy group treatment program for survivors of torture incarcerated in an adult prison in Kurdistan, Iraq: A pilot study. Torture Journal, 30(2), 2. https://doi.org/10.7146/torture.v30i2.119199
George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021). Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304
Global Trends Report 2021. (n.d.). UNHCR. Retrieved April 30, 2023, from https://www.unhcr.org/media/40152
Gueron, L. J. P., Amoyi, A., Chao, W., Chepngetich, J., Kibet, J. J., Nyambok, S., & Wesonga, J. (2020). Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya. Torture Journal, 30(3), 3. https://doi.org/10.7146/torture.v30i3.121785
Gueron, L. J. P., & Ruiter, M. de. (2020). International survey of the utilisation of physiotherapy in treatment centers for survivors of torture. Torture Journal, 30(3), 3. https://doi.org/10.7146/torture.v30i3.122775
Holten, K. B., & Veasey Sr., G. D. (2008). Managing chronic pain: What’s the best approach? Journal of Family Practice, 57(12), 806–811.
IASP Taxonomy—IASP. (n.d.). Retrieved December 29, 2015, from http://www.iasp-pain.org/Taxonomy
Kim, H. J., & Yu, S. H. (2015). Effects of complex manual therapy on PTSD, pain, function, and balance of male torture survivors with chronic low back pain. Journal of Physical Therapy Science, 27(9), 2763–2766. https://doi.org/10.1589/jpts.27.2763
Lakke, S. E., & Meerman, S. (2016). Does working alliance have an influence on pain and physical functioning in patients with chronic musculoskeletal pain; a systematic review. Journal of Compassionate Health Care, 3(1), 1. https://doi.org/10.1186/s40639-016-0018-7
Liedl, A., Müller, J., Morina, N., Karl, A., Denke, C., & Knaevelsrud, C. (2011). Retracted: Physical Activity within a CBT Intervention Improves Coping with Pain in Traumatized Refugees: Results of a Randomized Controlled Design. Pain Medicine, 12(2), 234–245. https://doi.org/10.1111/j.1526-4637.2010.01040.x
Longstreth, G. F., Attix, C., & Kuck, J. (2022). Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives. The American Journal of Medicine, S0002-9343(22)00808-7. https://doi.org/10.1016/j.amjmed.2022.10.014
Madsen, T. S., Carlsson, J., Nordbrandt, M., & Jensen, J. A. (2016). Refugee experiences of individual basic body awareness therapy and the level of transference into daily life. An interview study. Journal of Bodywork and Movement Therapies, 20(2), 243–251. https://doi.org/10.1016/j.jbmt.2015.10.007
Main, C. J., & George, S. Z. (2011). Psychologically Informed Practice for Management of Low Back Pain: Future Directions in Practice and Research. Physical Therapy, 91(5), 820–824. https://doi.org/10.2522/ptj.20110060
McPherson, J. I. (2019). Traumatic brain injury among refugees and asylum seekers. Disability and Rehabilitation, 41(10), 1238–1242. https://doi.org/10.1080/09638288.2017.1422038
Negron, A. (2018). Supporting asylum seekers and refugees who suffer chronic pain: An experience. International Journal of Migration, Health, and Social Care; Hove, 14(1), 55–67. http://dx.doi.org/10.1108/IJMHSC-02-2016-0011
Nielsen, H. (2014). Publication-series-6.pdf. Interventions for Physiotherapists Working with Torture Survivors. Retrieved March 23, 2023, from https://www.dignity.dk/wp-content/uploads/publication-series-6.pdf
Nordbrandt, M. S., Sonne, C., Mortensen, E. L., & Carlsson, J. (2020). Trauma-affected refugees treated with basic body awareness therapy or mixed physical activity as augmentation to treatment as usual-A pragmatic randomised controlled trial. PloS One, 15(3), e0230300. https://doi.org/10.1371/journal.pone.0230300
Policy statement: Torture. (n.d.). World Physiotherapy. Retrieved March 26, 2023, from https://world.physio/policy/ps-torture
Rabin, M., & Willard, C. (2014). Torture and Refugees. In: Annamalai, A. (Ed.), Refugee Health Care: An Essential Medical Guide (pp. 181–192). Springer. https://doi.org/10.1007/978-1-4939-0271-2_14
Sigvardsdotter, E., Vaez, M., Rydholm Hedman, A.-M., & Saboonchi, F. (2016). Prevalence of torture and other warrelated traumatic events in forced migrants: A systematic review. Torture : Quarterly Journal on Rehabilitation of Torture Victims and Prevention of Torture, 26(2), 41–73.
Singh, T. D., Roy, L. D., Thoibi, P., Kumari, N., Devi, T. S., & Surjit, N. (2019). The Role of Physiotherapy in Direct Assistance to Victims of Torture: A Holistic Approach to Healing and Wellbeing. IRA-International Journal of Management & Social Sciences (ISSN 2455-2267), 54. https://doi.org/10.21013/jmss.v14.n2sp.p6
Sjölund, B. H., Kastrup, M., Montgomery, E., & Persson, A. L. (2009). Rehabilitating torture survivors. Journal of Rehabilitation Medicine, 41(9), 689–696. https://doi.org/10.2340/16501977-0426
Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
Tsur, N., Defrin, R., Shahar, G., & Solomon, Z. (2020). Dysfunctional pain perception and modulation among torture survivors: The role of pain personification. Journal of Affective Disorders, 265, 10–17. https://doi.org/10.1016/j.jad.2020.01.031
Vereinte Nationen (Ed.). (2022). Istanbul protocol: Manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment (Rev. 2). United Nations.
Wang, S.-J., Bytyçi, A., Izeti, S., Kallaba, M., Rushiti, F., Montgomery, E., & Modvig, J. (2016). A novel bio-psycho-social approach for rehabilitation of traumatized victims of torture and war in the post-conflict context: A pilot randomized controlled trial in Kosovo. Conflict and Health, 10, 34. https://doi.org/10.1186/s13031-016-0100-y
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