MSK Conditions Clinical Trial
Official title:
How do Pilates Trained Physiotherapists Utilise and Value Pilates Exercise for MSK Conditions: A Qualitative Study
A self-designed qualitative questionnaire survey was used to investigate opinions and views among thirty Physiotherapists practising in the UK, who had undertaken formal training in Pilates exercise therapy to treat people with MSK conditions.
Pilates is a popular exercise therapy approach that focuses on strength, core stability,
flexibility, muscle control, and posture (Wells et al., 2014). This approach has evolved over
time, to form a valuable therapeutic tool in the prevention and rehabilitation of a variety
of injuries (Di Lorenzo, 2011). More recently, Pilates has become increasingly popular due to
its wide-ranging health benefits for individuals with a range of MSK (musculoskeletal)
disorders, as well as other conditions (Byrnes, Wu, & Whillier, 2018). This method has become
more commercially recognised and accessible through various professional institutions. The
Australian Physiotherapy & Pilates Institute (APPI), is a globally run organisation licensed
in sixteen countries, delivering over 17000 classes per year, as a "graduated system of
specific exercise rehabilitation" (Appihealthgroup.com, 2018).
In the UK, Pilates based exercise therapy is used within both the National Health Service
(NHS) and private healthcare sectors in the management of low back pain (LBP), general MSK
pain, and various degenerative conditions (Yamato et al. 2015). An estimated 17.8 million
people live with a musculoskeletal condition in the UK, around 28.9% of the total population
(Global Burden of Disease network, 2016). Over 8.75 million people aged 45 and over have
sought treatment for osteoarthritis (Arthritis Research UK, 2013), for which the main
management strategy is exercise-based therapy. MSK healthcare services are under increasing
pressure to provide care to the ageing population, and tackle the healthcare impact
associated with inactivity (Hubbard et al., 2004). Group based exercise such as class
Pilates, offers an accessible opportunity to increase activity levels in such individuals
(Karlsson, Gerdle, Takala, Andersson, & Larsson, 2018).
There is considerable evidence that Pilates has numerous physical benefits and may improve
self-management of MSK conditions. This includes a wealth of quantitative research, several
systematic reviews have demonstrated positive improvements on pain, quality of life and
functionality (Aladro-Gonzalvo, Araya-Vargas, Machado-Díaz, & Salazar-Rojas, 2013; Byrnes et
al., 2018). However, of the Randomised Controlled Trials (RCTs) reviewed, high levels of
heterogeneity were reported, in terms of sample (sub-types of back pain), exercise selection,
delivery and frequency of treatment.
In contrast to this, there is a dearth of qualitative research evaluating Pilates as a
treatment approach, mostly focusing on LBP populations (Gaskell & Williams, 2018). These
methods can be valuable to review the definition, scope and rationale of Pilates treatment
methods used by Physiotherapists, to provide optimum rehabilitation. Use of a qualitative
approach could also gain understanding of how Physiotherapists utilise Pilates for a range of
conditions other than LBP (Wells et al., 2014). Therefore, this study aims to investigate the
variation in Pilates delivery and why, and in line with previous qualitative studies, further
explore the perceived benefits, risks and rationale for this exercise approach. This is the
first study to review NHS and private physiotherapists in their use of Pilates group
exercise.
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