Table Of ContentUMEÅ UNIVERSITY MEDICAL DISSERTATIONS
New Series No. 774 - ISSN 0346-6612 - ISBN 91-7305-200-0
»
From the Department of Community Medicine and Rehabilitation, Physiotherapy and
the Department of Psychology, Umeå, Sweden
Health Problems and Treatment Effects in Patients
with Non-specific Musculoskeletal Disorders
A comparison between Body Awareness Therapy, Feldenkrais
and Individual Physiotherapy *
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by
V Eva-Britt Malmgren-Olsson
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Umeå 2002
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UMEÅ UNIVERSITY MEDICAL DISSERTATIONS
New Series No. 774 - ISSN 0346-6612 - ISBN 91-7305-200-0
From the Department of Community Medicine and Rehabilitation, Physiotherapy
and the Department of Psychology, Umeå, Sweden
Health Problems and Treatment Effects in Patients
with Non-specific Musculoskeletal Disorders
A comparison between Body Awareness Therapy,
Feldenkrais and Individual Physiotherapy
AKADEMISK AVHANDLING
som med vederbörligt tillstånd av rektorsämbetet vid
Umeå Universitet för avläggande av medicine doktorsexamen,
kommer att offentligen försvaras i
Aulan, Vårdvetarhuset, Umeå Universitet,
Fredagen den 15 mars, 2002, klockan 09.00
av
Eva-Britt Malmgren-Olsson
Vi
Fakultetsopponent: Professor Charlotte Ekdahl, Institutionen för
rörelseorganens sjukdomar, Sjukgymnastik, Lunds Universitet, Lund
Health Problems and Treatment Effects in Patients with
Non-specific Musculoskeletal Disorders
A comparison between Body Awareness Therapy, Feldenkrais and
Individual Physiotherapy
Eva-Britt Malmgren-Olsson, RPT, MSc, Department of Community Medicine and
Rehabilitation, Physiotherapy and the Department of Psychology, Umeå University, Umeå.
ABSTRACT
Persistent non-specific musculoskeletal pain disorders are an increasing health problem in
primary care causing suffering for the individual and a burden for the society. Appropriate
and effective treatments for these patients have been hard to find. The aims of this thesis
were to get an extensive description of patients with non-specific musculoskeletal disorders
and to evaluate the effects of different physiotherapeutic treatment modalities in primary
care. The design was a clinical, quasi-experimental comparison with measurements at three
time-points; before the interventions, and follow-ups at six months and at one year. A total
of 78 patients, 64 women and 14 men, were consecutively recruited to the three modalities;
Body Awareness Therapy (BAT), Feldenkrais (FK) and individual physiotherapy (TAU).
The outcome variables included different pain dimensions as well as physical, psychosocial
and health-related aspects.
The results showed that the patients were a very heterogeneous group and had different
problem profiles. Nearly half of the patients reported severe psychological problems
probably due to both present living conditions and to negative previous life events. In
comparison to two reference groups of healthy individuals these patients were more
psychologically distressed and had a more negative self-image. Both the patient group with
non-specific musculoskeletal disorders and a patient group with whiplash associated
disorders showed significandy poorer balance than a healthy control group on clinical
balance tests.
An overall result was that all treatment groups (BAT, FK and TAU) showed significant
improvements over time on several outcome variables but there were few significant
differences between the groups. Calculating the outcome as effect-size values showed that
the group treatments achieved larger effects than the individual treatment group.
The identification of three distinct subgroups revealed more obvious differences in
outcome patterns and magnitude of effect-size values. Two of the subgroups achieved a
positive treatment outcome, and one subgroup was associated with a zero or negative
outcome. A logistic multivariate regression analysis showed that the only explanatory factor
for treatment outcome was which treatment modality the patients had been given. The
chance of achieving a positive treatment outcome for patients with non-specific
musculoskeletal disorders increased 6.6 times with Body Awareness Therapy and 4.1 times
with Feldenkrais compared to individual physiotherapy.
Key words: Non-specific musculoskeletal disorders; treatment effects effect-size; Body
Awareness Therapy; Feldenkrais; Individual Physiotherapy; primary care
UMEÅ UNIVERSITY MEDICAL DISSERTATIONS
New Series No. 11A - ISSN 0346-6612 - ISBN 91-7305-200-0
From the Department of Community Medicine and Rehabilitation,
Physiotherapy and the Department of Psychology Umeå University
Health Problems and Treatment Effects in Patients
with Non-specific Musculoskeletal Disorders
A comparison between Body Awareness Therapy,
Feldenkrais and Individual Physiotherapy
by
Eva-Britt Malmgren-Olsson
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Umeå 2002
Copyright © 2002 by Eva-Britt Malmgren-Olsson
ISBN 91-7305-200-0
Printed in Sweden by Solfjädern Offset AB, Umeå
“The great art of life is sensation,
to feel that we exist, even in pain"
Lord Byron
(1788-1824)
To Tommy, Erika, Ida and Daniel
To my parents and sister
CONTENT
INTRODUCTION 1
Definition and classification 2
Physical factors 4
Psychological factors 6
Social factors 7
Health related factors 9
Physiotherapy in primary care 12
Body and mind approaches 12
AIMS 16
METHODS 17
Subjects and procedure 17
Paper I, III, IV and V 17
Paper II 19
Instruments 21
Description dimension 22
Physical dimension 23
Pain dimension 23
Psychological dimension 24
Health-related dimension 25
Intervention 26
Body Awareness Therapy group 27
Feldenkrais group 27
Treatment as usual group 28
Statistical analysis 28
Descriptive methods 28
Comparisons of treatment effects 29
Ethical Considerations 30
RESULTS 31
Health problems (Paper I) 31
Prevalence of symptoms 31
Prevalence of problem areas 31
Correlation analysis 32
Dimension 1 : Psychological well-being 33
Dimension 2: Physical vs. relationship problems 33
Balance performance (Paper II) 34
Treatment effects in BAT, FK and TAU (Paper III - V) 36
Subgroups and outcome patterns (Paper V) 37
Gender differences (Paper I-V) 39
Predictors of outcome (Paper III-V) 40
DISCUSSION 41
Heterogeneity of health problems 41
Treatment effects 43
Positive and negative outcome patterns 44
Predictors of outcome 45
Gender aspects 47
Methodological considerations 47
CONCLUSIONS 51
ACKNOWLEDGEMENTS 53
REFERENCES 56
PAPER I -V
ABSTRACT
Health Problems and Treatment Effects in Patients with
Non-specific Musculoskeletal Disorders
A comparison between Body Awareness Therapy, Feldenkrais
and Individual Physiotherapy
Eva-Britt Malmgren-Olsson, RPT, MSc, Department of Community
Medicine and Rehabilitation, Physiotherapy and the Department of
Psychology, Umeå University
Persistent non-specific musculoskeletal pain disorders are an increasing
health problem in primary care causing suffering for the individual and a
burden for the society. Appropriate and effective treatments for these
patients have been hard to find. The aims of this thesis were to get an
extensive description of patients with non-specific musculoskeletal disorders
and to evaluate the effects of different physiotherapeutic treatment
modalities in primary care. The design was a clinical, quasi-experimental
comparison with measurements at three time-points; before the
interventions, and follow-ups at six months and at one year. A total of 78
patients, 64 women and 14 men, were consecutively recruited to the three
modalities; Body Awareness Therapy (BAT), Feldenkrais (FK) and
individual physiotherapy (TAU). The outcome variables included different
pain dimensions as well as physical, psychosocial and health-related aspects.
The results showed that the patients were a very heterogeneous group and
had different problem profiles. Nearly half of the patients reported severe
psychological problems probably due to both present living conditions and
to negative previous life events. In comparison to two reference groups of
healthy individuals these patients were more psychologically distressed and
had a more negative self-image. Both the patient group with non-specific
musculoskeletal disorders and a patient group with whiplash associated
disorders showed significantly poorer balance than a healthy control group
on clinical balance tests.
An overall result was that all treatment groups (BAT, FK and TAU)
showed significant improvements over time on several outcome variables
but there were few significant differences between the groups. Calculating
the outcome as effect-size values showed that the group treatments achieved
larger effects than the individual treatment group.
The identification of three distinct subgroups revealed more obvious
differences in outcome patterns and magnitude of effect-size values. Two of
the subgroups achieved a positive treatment outcome, and one subgroup
was associated with a zero or negative outcome. A logistic multivariate
regression analysis showed that the only explanatory factor for treatment
