Rehabilitation and management interventions for people with chronic musculoskeletal condition/s and mental distress: a systematic scoping review

Abstract Background Musculoskeletal (MSK) conditions and mental distress present significant challenges for rehabilitation services. Currently, mental and physical healthcare is often segregated despite growing recognition for integrative interventions. This review aimed to map out and provide an overview of non-pharmacological management and rehabilitation interventions for adults with long-term MSK conditions and mental distress, to identify evidence gaps and provide recommendations for future research. Method MEDLINE, CINAHL, PsycInfo, and Cochrane Library were searched for peer-reviewed articles published between 2003 and 2024 for studies involving rehabilitation/ management interventions for adults with long-term MSK conditions and mental distress. Titles and abstracts were divided among three reviewers for screening and full-texts of included articles were screened by two. Data were extracted on year, location, condition, design, key intervention characteristics and outcomes. Results Fifty-seven primary studies involving 62 interventions were included. Most studies (70%) were Randomised Controlled Trials conducted in Europe (65%), with substantial heterogeneity in the design of the remaining studies. 42% included adults with low back pain and five major intervention approaches were identified: In-person multidisciplinary, Internet, digital and telephone, Additional in-person psychological, Education-based, and Predominantly self-management. Eight studies did not fit a distinct category. Most interventions were conducted in primary or tertiary care, all included a physical activity/exercise component and 65% integrated psychologically-orientated strategies, of which Cognitive Behavioural Therapy was the most common, while 35% were undefined. 54% were delivered by multidisciplinary teams involving physiotherapists. There was substantial heterogeneity in outcome measures, with 202 outcome measures identified spanning 13 domains and 22 subdomains. Only 19% of studies included economic evaluations. Conclusions This review highlights global interest on the topic, with a growing number of studies evaluating internet, digital and telephone interventions, however insufficient intervention reporting and limited representation from community-based and low-income settings reduces global relevance. The findings are broadly discussed in relation to physiotherapists’ role in psychologically-orientated care when access to psychologists is limited, promoting access to care with a focus on underserved and low-income communities, and reporting for an international audience. Systematic Review Registration: Open Science Framework registration (OSF) on the 13th July 2023 https://osf.io/489fj/