Providing better physiotherapy care for Australia’s First Peoples


When physiotherapist Dr Ivan Lin first began researching musculoskeletal pain among Aboriginal Australians, there was a belief in the research literature that Aboriginal people were protected from the disabling effects of low back pain.

In an under-researched field, the now senior lecturer and NHMRC Early Career Research Fellow at the Western Australian Centre for Rural Health (WACRH) at the University of Western Australia, is part of a team of Indigenous and non-Indigenous researchers shining the spotlight on the issue of musculoskeletal pain in Aboriginal communities.

A non-Indigenous musculoskeletal physiotherapist with the Geraldton Regional Aboriginal Medical Service, Dr Lin is also an adjunct senior lecturer with the Curtin University School of Physiotherapy and Exercise Science.

Musculoskeletal pain

Musculoskeletal pain is the leading cause of disability in Australia. Statistics show 6.1 million people, or 28 per cent of the entire population, experienced arthritis or another musculoskeletal condition in 2011-12.

Back pain affects about 2.8 million people or 13 per cent of Australians. Those with back problems are 2.4 times more likely to report poor health than those without the condition, and 2.6 times more likely to report very high levels of psychological distress.

They are also 2.5 times more likely to experience severe and very severe pain, and 3.4 times more likely to experience difficulty completing every-day tasks.

The latest figures reveal 20 per cent of Aboriginal Australians experience long-term musculoskeletal pain.

Prior to his PhD research, Dr Lin worked part-time heading up an outpatient area of the physiotherapy department of a mainstream health care service, where he was involved in an audit of patients.

The audit revealed while Aboriginal Australians formed about 10 per cent of the local population, physiotherapists were treating less than one per cent of Aboriginal people.

The findings prompted Dr Lin to examine issues surrounding musculoskeletal pain in Aboriginal Australians.

“I worked with Aboriginal co-investigators and we went out and sat down with people,” he says.

“We yarned about what it was like - what were their experiences about having long-term low back pain? We found low back pain had impacts that hadn’t been picked up in previous research.

“People told us the typical things - they were unable to work, men told us they missed their participation in sport, people in general told us how they couldn’t participate in family and community activities.

“But also one of the things people talked about was the impact on cultural activities - people told us how they couldn’t attend cultural meetings, they couldn’t go out bush to care for country or to hunt.”

The project also revealed one reason Aboriginal people with musculoskeletal pain chose not to access care was due to major communication barriers with health care practitioners.

Improving Indigenous care

Dr Lin says more needs to be done to improve care for musculoskeletal pain in Aboriginal communities.

With Aboriginal people experiencing significantly poorer health outcomes than non-Aboriginal Australians, he says Aboriginal people are likely to be at greater risk of musculoskeletal pain conditions.

Dr Lin says better communication between practitioners and their Aboriginal patients, along with improving cultural security, is pivotal to boosting health outcomes.

One part of culturally-secure care is high quality communication.

Dr Lin has worked with colleagues to develop a communication framework, Clinical Yarning, in a bid to guide practitioners.

The approach taps into ‘yarning’, a culturally appropriate way for Aboriginal people to connect and exchange stories and information - to transform traditional clinical questioning into a conversational and informal way of sharing information.

Dr Lin says the yarning process begins with a social yarn - to understand the patient’s context, followed with a diagnostic yarn - which asks the patient to tell their story to gain an understanding of the health issue in their life, and then, lastly, a management yarn.

“The management yarn is more about really understanding what the person knows about their health, and really explaining their health in a way that makes sense,” he says.

“That might be using metaphors. When I see people with stiff osteoarthritic knees, I often say - you know the universal joint on a car, if it’s not used, all the grease gets stuck and gets clogged up in parts of that joint, that’s like your knee.

“If you move it, what happens to that universal joint? They say - the grease starts to get looser again and moves around the joint. I’ll say - that’s like your knee, you need to move your knee.”

Dr Lin, who is now studying the quality of care for Aboriginal people with non-traumatic musculoskeletal pain in primary and emergency care settings, says education for health practitioners on the framework is now being developed, and will be released next year.

It’s also crucial for physiotherapists to understand the patient’s cultural context, which varies between Aboriginal communities and regions.

“If you don’t know about the local Aboriginal culture where you’re working then you really don’t know enough about the context of that person, and you might make assumptions,” Dr Lin says.

“There’s also the fundamentals - you treat patients with respect, you listen to their story. It’s really a marrying of the patient-centred care factors, developing trust, and really good quality care.”

Tailoring care to the individual

Despite physiotherapists and other practitioners often believing they should treat every patient equally, Dr Lin says it’s important to treat people differently - tailoring care and treatment to each patient.

“People always say - I treat everyone the same. But, of course, you never treat anyone the same,” he says.

“One day you might see an 80-year-old lady with a sore hip and the next person might be a 25-year-old expecting mum, and then you might see a 13-year-old teenage boy who has hurt himself playing footy.

“And so you always adapt the way in which you interact with those people, the information you give to people, and the way you communicate. You always treat people differently,” Dr Lin says.

“Aboriginal health care is no different but the problem is people make assumptions that it’s the same, and it’s not.”