An Evaluation of Physiotherapy for the Management of Chronic Pain in Torture and Trauma Survivors.

STARTTS, Carramar, Australia
BACKGROUND AND AIMS:
The prevalence of chronic pain among survivors of torture and trauma is well documented. However, very few studies have evaluated the efficacy of methods to manage chronic pain in this population. STARTTS provides physiotherapy services for refugees and asylum seekers, as an adjunct to individual counselling. Clients are invariably referred to physiotherapy for chronic
pain with associated functional impairment and sleep disturbance.
The aims of this project were to:

1. Identify the presenting problems of clients referred for physiotherapy;
2. Document the common interventions used; and
3. Examine the impact of physiotherapy on pain, physical functioning and sleep.
   METHODS:
   Clients received twelve sessions of physiotherapy with evaluation data collected at baseline, session six, and session twelve. Evaluation tools included a Faces pain-rating scale, a body diagram, the Disability Rating Scale, and items from the Pittsburg Sleep Quality Index. Detailed records of interventions used were collected using a specially developed checklist.
   RESULTS AND CHALLENGES:
   We will present results from the first 20 participants. Clients were a mix of refugees and asylum seekers from the Middle East, Afghanistan and Sri Lanka. Over half had been tortured or experienced intense interpersonal violence. The most common
   presenting problems were back pain, leg or knee pain, neck pain, and headache. Preliminary analyses suggest that physical functioning improved markedly over the course of treatment, with sleep also substantially improved by session twelve. We will
   discuss the strengths and challenges of our evaluation methodology for this population.
   IMPLICATIONS AND CONCLUSIONS:
   Physiotherapy shows promise as an adjunct therapy for torture and trauma survivors with chronic pain, with benefits achievable in a relatively short time-frame. We will discuss how physiotherapy can be tailored to the needs of torture survivors, and the implications for others working with people from refugee backgrounds.