Original article
Is regular use of physiotherapy treatment associated with health locus of control and self-management competency? A study of patients with musculoskeletal disorders undergoing physiotherapy in primary health care

https://doi.org/10.1016/j.msksp.2018.04.008Get rights and content

Highlights

  • Physiotherapy in primary care is relevant in Musculoskeletal disorder (MSK).

  • There is a relationship between locus of control and high frequent healthcare usage.

  • People with MSK should be empowered to increase their self-management competency.

Abstract

Objective

To investigate the relationship between regular use of physiotherapy treatment, health locus of control and self-management competency in people with musculoskeletal disorders.

Methods

This cross-sectional study included 507 patients between 18 and 70 years of age with musculoskeletal disorders who attended a physiotherapy clinic. The Health Education Impact Questionnaire (heiQ) was used to assess self-management competency; the Health Locus of Control Scale (HLCS) was used to assess health locus of control. Multiple linear regression analyses were performed to estimate the relationships between variables.

Results

Results showed that patients who attended physiotherapy on a regular basis had lower levels of internal control than those who did not. Furthermore, regular patients reported more health-directed activities and more emotional distress than patients not attending physiotherapy on a regular basis. Finally, internal health locus of control showed statistically significant associations with all heiQ domains, indicating that a stronger internal control is associated with higher levels of self-management competency.

Conclusion

Our findings suggest that attending physiotherapy on a regular basis is related to self-management competency and internal health locus of control.

Practical implications

A treatment aim in primary care for people with long term conditions should include development of self-management capacity.

Introduction

Musculoskeletal disorders are of major public health importance as such disorders often involve high amounts of health services and economic support in form of sick leave and disability pensions (Lærum, 2013). The umbrella term “musculoskeletal disorders” includes a wide range of diagnoses and conditions, but in most cases pain is the major symptom. Musculoskeletal pain is a common complaint, and 80% of the Norwegian population reported having musculoskeletal pain in cross-sectional population studies (Ihlebaek et al., 2002, Ihlebaek et al., 2007). For most people it involves short-term pain that must be considered as a natural part of life. However, it is alarming that a growing number of people also report long-term musculoskeletal pain (Breivik et al., 2006, Rustøen et al., 2004), i.e. pain lasting more than three months, which has been found to be one of the leading causes of disability worldwide (GBD 2016, 2017).

Musculoskeletal pain, both short- and long-term, can be a major reason for seeking treatment. In many cases musculoskeletal pain lacks physiological or morphological findings of changes that may explain the pain (Jutel, 2010), and especially in chronic unexplained pain conditions limited effects are seen from pharmacological interventions (Bergman, 2007). Thus, several of these patients are offered non-pharmacological therapies, e.g. patient education, exercise and cognitive behavioral therapies (Bergman, 2007). According to what we are told by physiotherapists in clinical work both in Norway and internationally it is of great concern that there are large individual variations when it comes to how patients perceive their problems and how pain impacts the ability to work and perform daily activities, and consequently also patients' quality of life.

The ability to self-manage is a particularly critical component for individuals with a long-term illness, such as long-lasting musculoskeletal pain. The essence of self-management is that people actively participate in maintaining and promoting their own health and care (Lorig and Holman, 2003, Barlow et al., 2002). For instance, self-management may be about health behavior, motivation and involvement in life, and insight into living with a health condition. Furthermore, self-management includes persons' attitudes toward the impact of their condition, emotional distress related to that condition, and interaction with their partner, communication, decision processes, and relationship with health professionals with regard to getting their needs met (Osborne et al., 2011). Health locus of control is also an important phenomenon with regard to treatment relationships between health care personnel and patients. It generally refers to the extent to which individuals believe they can control events affecting them, in this case health issues. A person's “locus” is conceptualized as either internal (the person believes they can influence their own life situation) or external (meaning that they believe their decisions and life are beyond their own influence, but decided by environmental factors which they cannot influence), or external in the sense that decisions and life are determined by chance or fate (Wallston et al., 1976). Health locus of control may also be of importance to the patients' competency to self-manage health challenges (Nai-Hsin et al., 2013).

People with long-term musculoskeletal pain are usually referred to physiotherapists in primary health care (Hendriks et al., 2003), and research has shown that physiotherapy may relieve regional pain and to a lesser extent multisite pain (Babatunde et al., 2017). The main target area of physiotherapy is body movement and function, and it includes different methods-of, pain relieving techniques and exercises, as well as information and guidance that can stimulate learning and change processes to achieve the best possible way of functioning for the patient (Babatunde et al., 2017). For treatment to be successful, the patient's active participation in treatment is essential. With regard to musculoskeletal pain, the aim of treatment is to promote change processes that can contribute to pain relief and functional improvement (Babatunde et al., 2017). However, some patients with musculoskeletal pain are long-term consumers of physiotherapy (Opseth et al., 2014). This has been of great concern for physiotherapists in clinics in Norway as the health authorities claim that physiotherapy should be efficient and accordingly that the patients' needs of physiotherapy should be time-limited (Meld. St. 26, 2014, Meld. St. 29, 2012-2013). One may ask whether patients who need to use physiotherapy on a regular basis receive the most effective treatment options and also whether they may have developed a too strong dependency on treatment. It is therefore of interest to examine whether patients who are tong-term consumers of physiotherapy or not may differ from those who do not attend regularly with regard to self-management competency and health locus of control.

To the best of our knowledge, no previous study has investigated self-management competency together with health locus of control in relation to regularity of physiotherapy treatment in the primary health care setting. Hence, the present study aims to investigate the relationship between regularity in physiotherapy treatment (attending physiotherapy on a regular basis or not), health locus of control and self-management competency in people with musculoskeletal disorders. The following research question is asked: What is the relationship between regularity in physiotherapy treatment (attending physiotherapy on a regular basis or not), health locus of control and self-management competency, controlling for socio-demographic data?

Section snippets

Study design and population

The present study is part of a larger study conducted in a private physiotherapy clinic located in Oslo, Norway. Most of the patients attending this clinic are affected by musculoskeletal disorders and their pain condition is often medically unexplainable. The study has a cross-sectional survey design including 507 patients, out of 619 eligible, between 18 and 70 years of age with musculoskeletal disorders who attended the physiotherapy clinic during the one week of data collection. The

Sample characteristics

The mean age of the respondents was 46 years (SD 12.8), the youngest being 18 years and the oldest being 69 years. Seventy % of the sample was female and 45% reported more than 4 years of university education. Seventy-three percent were employed, and 54% reported to attend physiotherapy on a regular basis. Sixty-one percent reported the duration of pain to be over one year, with the following areas being affected (in descending order, multiple responses possible): shoulder (58%), neck (53%),

Discussion

Our results show that patients attending physiotherapy on a regular basis had more emotional distress compared to those who did not attend it regularly. High scores identify individuals who have high levels of overall health-related negative affect, negative attitudes towards life, and high levels of anxiety, stress, anger and depression (Osborne et al., 2007). Similar findings have been reported in the GP context (Vedsted and Christensen, 2005, Bellón et al., 1999, Dowrick et al., 2000,

Acknowledgement

Gratitude is expressed to the participants, Hans & Olaf Physiotherapy clinic and the physical therapist recruiting patients for the study.

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