Improving care by integrating sociocultural factors within physiotherapy practice; 
the CuPiD project   January 20th, 2021

Non-specific musculoskeletal pain is highly prevalent, with point estimations up to 51% in Europe1,2. Percentages are higher in women than in men3 and most commonly represent pain in the lower back, shoulder, neck, hip or knee. Besides the high social economic burden4, musculoskeletal pain generally affects multiple life domains, such as work, sports, and social activities1.

Non-specific musculoskeletal complaints are the most common health problems treated by a physiotherapist in the Netherlands5. For a physiotherapist, it appears to be a real challenge to provide effective interventions for people with non-specific musculoskeletal pain, particularly for subgroups of people with a different socio-cultural background. Therefore, conducting research on musculoskeletal pain in relation to sociocultural factors is important. This is especially valid for areas such as the city of Rotterdam where more than half of the inhabitants have a migration background6. This was the reason for starting the CuPiDproject7.

The current debate about inequality based on sociocultural differences is an important discussion, also in relation to the provision of high quality healthcare. Previous research from the US showed that there are clear differences in the experience of pain and quality of life between subgroups of people based on background alone8,9. This is supported by qualitative studies that show that physiotherapists experience barriers in providing effective care for people with a different sociocultural background, such as the lack of sufficient knowledge about the role of sociocultural factors on pain and not fully mastering appropriate communication skills10,11. Common barriers for the client are insufficient command of the language, low health literacy, and other expectations with regard to physiotherapy10.

Since there is a general lack of studies on this topic conducted in the Netherlands, research is needed to improve the overall understanding of relationships between pain and sociocultural factors (e.g. language, educational status, migration background). With the CuPiD project we hope to fill in this void and we aim at improving the counselling process of physiotherapists for people with musculoskeletal pain in general and more specifically when sociocultural factors play a role.

Sanneke Don

2020Pain in Motion

Interested to know more about the CuPiD project? You can contact us by email: Good to know: Renske Annevelink is the leading researcher on the CuPiD project and is keen to share her ideas and answer your questions!

References and further reading:

1. Breivik H, Eisenberg E, O’Brien T. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health 2013: 1229.

2. Smith E, Hoy DG, Cross M, et al. The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases 2014; 73: 1462-9.

3. Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Gender differences in chronic pain2014;findings from a population-based study of Norwegian adults. Pain Management Nursing 2004; 5: 105-17.

4. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain 2006; 10: 287.

5. Dool vd, J., Schermer, T. Nivel Zorgregistraties - Zorg door de fysiotherapeut; Jaarcijfers 2017 en trendcijfers 2013-2017. Utrecht: NIVEL, 2018.

6. CBS. Kerncijfers wijken en buurten. 2019.

7. Annevelink R, Don, S., Nijs, J., Beckwée, D., Ickmans, K., Voogt, L. Socio-cultural diversity in patients with non-specific musculoskeletal pain in primary care physiotherapy; the Cultural Pain Diversity (CuPiD) Prospective Cohort Study 2019.

8. Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine 2003; 4: 277-94.

9. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag 2012; 2: 219-30.

10. Yoshikawa K, Brady, B., Perry, M.A., Devan, H. Sociocultural factors influencing physiotherapy management in culturally and linguistically diverse people with persistent pain : a scoping review. Physiotherapy (United Kingdom) 2020; 107: 292-305.

11. Grandpierre V, Milloy, V., Sikora, L., Fitzpatrick, E., Thomas, R., Potter, B. Barriers and facilitators to cultural competence in rehabilitation services: a scoping review. BMC Health Service Research 2018; 15.