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Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain: a pilot randomised controlled trial
  1. Bernadette Brady1,2,
  2. Irena Veljanova3,
  3. Siobhan Schabrun1,
  4. Lucinda Chipchase1
  1. 1 School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
  2. 2 Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
  3. 3 School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia
  1. Correspondence to Ms Bernadette Brady; bernadette.brady{at}


Objective To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach.

Design A participant-blinded and assessor-blinded pilot randomised controlled trial.

Setting Outpatient physiotherapy departments at two public hospitals and one district pain clinic.

Participants Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions.

Interventions 24 participants underwent combined group and individualised treatment described as ‘culturally adapted physiotherapy’, while 24 underwent evidence-informed ‘usual physiotherapy care’. Both treatment arms consisted of up to 10 sessions over a 3-month period.

Outcome measures Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state.

Results 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar.

Conclusions Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes.

Trial registration number ACTRN12616000857404; Pre-results.

  • cultural diversity
  • chronic pain
  • physical therapy speciality
  • cultural competency

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors All authors made a substantial contribution to this work. Conception, design, analysis and interpretation of data completed by BB under the supervision of IV, SS and LC. All authors involved in interpretation of the data, writing and editing of the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by the Physiotherapy Research Foundation, grant number S16-005. The development of the culturally adapted assessment protocols used in this trial was supported by a South Western Sydney Local Health District and Ingham Institute Research Scholarship. BB is the recipient of a Sir Robert Menzies Memorial Research Scholarship in the Allied Health Sciences, from the Menzies Foundation, while SS receives salary support from the National Health and Medical Research Council of Australia (1105040).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the South Western Sydney Local Health District (SWSLHD) Human Research Ethics Committee (HREC/16/LPOOL/194), Western Sydney University Human Research Ethics Committee (RH11741).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available by contacting the corresponding author at

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