Recommendations for Physiotherapist-Delivered Lifestyle Interventions for Patients with Comorbid Mental and Physical Health Disorders

Abstract

Introduction: Lifestyle interventions enhance health and well-being in patients with mental disorders. Mental disorders affect many bodily systems, compromising health and wellbeing. Epidemiological studies have found significant associations between mental disorders and non-communicable diseases. Lifestyle interventions address modifiable risk factors to prevent or manage chronic diseases. There are no guidelines for physiotherapists in South Africa to manage patients with mental disorders and multimorbidity. Purpose: This study aimed to develop evidence-based, contextually relevant recommendations for physiotherapist-delivered lifestyle interventions in the management of patients with mental disorders (depression and anxiety) and comorbidities. Methods. A mixed-methods multiphase framework, using an exploratory, convergent design was used in this study. Phase one of the study, a systematic review of effectiveness, identified effective lifestyle interventions in managing patients with mental disorders and comorbidities. Phase two, an international, multidisciplinary Delphi study, including South African experts, was used to develop recommendations. In the final phase, focus groups determined the acceptability and feasibility of these recommendations for South African physiotherapists. Data collected from the first two phases were collected concurrently. The findings of phases one and two were then used to inform the focus groups (qualitative) and finalise the recommendations. Results: The meta-analysis showed that lifestyle interventions which combined a psychological behavioural change strategy and physical activity had modest effect sizes in improving quality of life. Thirty-two recommendations across five categories: general, sleep, physical activity and exercise, nutrition, and stress management emerged from the Delphi study. The South African physiotherapists found the recommendations from the Delphi study mostly acceptable and feasible. Concerns were raised about the feasibility of some of the recommendations due to the scope of practice of physiotherapists and resource constraints in the public health sector. Eighteen final recommendations were agreed upon following the focus groups. vii Conclusion: Recommendations for physiotherapist-delivered lifestyle interventions were developed and contextualised to the South African environment. These recommendations can be used to manage patients with mental disorders and comorbidities, as no other guidelines exist to guide management in this specific patient population. Future research should focus on the implementation and evaluation of the recommendations, developing full clinical practice guidelines, increasing the inclusion of mental health in the physiotherapy undergraduate curriculum and addressing the resource constraints in mental health.