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How both patients and care providers perceive pain from exercise and mobilization

Understanding the needs and concerns of patients is integral to facilitating recovery

Pain is an extremely subjective sensation, and the perception and processing of it varies greatly from person-to-person. The prevalence of chronic painful conditions (e.g. neck and low-back pain, osteoarthritis) is increasing throughout the world, making their management a major concern for many health-care systems. Treatment for many of these conditions consists of physical therapy (PT), which usually includes exercise and mobilization techniques such as aerobic training, strength exercises and active and passive mobilization. Though these programs are proven to reduce pain, they may also provoke pain for some, which leads to less patient compliance. Despite the fact that this is such an important topic, the management of pain induced by exercise and mobilization (PIEM) hasn't received much attention, and studies investigating the perception of it from patients and providers are lacking. Therefore, a study was conducted that assessed patient and care providers' views concerning PIEM management through interviews.

Detailed interviews designed to gather personal insight on treatment process

In order to be eligible, patients had to be in a PT program and experience pain during at least one session, which led to 12 patients and 14 care providers selected for the interviews. The interviews were focused on individual behaviors, personal feelings and interpretations, social interactions and material backgrounds throughout each patient's therapeutic journey.

Perceptions between patients and care providers differ

Overall, patients were ambivalent towards PIEM, as some regarded it as necessary to help them improve, while others viewed it as excessive and not always constructive. Many patients could process the pain accordingly, but for a remote few, this pain led to a loss of confidence and a fear of reactivation of the disease, which drew some away from PT. For care providers, PIEM was identified more by PTs than by physicians, and most of them expressed how pain may be provoked when examining and treating a patient, but that it's only to help make a diagnosis and not meant to be malicious. They also said if there's too much pain, it might have psychological effects and make patients afraid to come to treatment. The biggest difference and overall issue was the fact that some patients viewed PIEM negatively due to lack of competency from a care provider, who was unable to properly explain it. Based on this, the most important change is that all health providers are educated on the management of PIEM, and that they improve communications with patients by providing information and education on the subject. Only when patients and care providers are on the same page can the most optimal management of chronic conditions and PIEM be administered, and that requires a conscious effort with these findings in mind. These outcomes underscore the importance of the patient response guiding the intervention strategy to ensure optimal management.

-As reported in the July '11 edition of BioMed Central