The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain

Ferreira, Paulo H.; Ferreira, Manuela L; Maher, Christopher G.; Refshauge, Kathryn M.; Latimer, Jane; Adams, Roger

doi:10.2522/ptj.20120137

Cited by 298 publications

(223 citation statements)

References 39 publications

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“…It was not possible to blind the therapist. [31] From the four included cohort studies, three were of methodological high quality [5,29,30]. The methodological quality of the selected articles can be reviewed in Table 1.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…In four studies, the patient population consisted of chronic low back pain patients (CLBP) that had been experiencing pain for more than three months and, in the study of Farin, the inclusion criterion was having pain for more than six months (Table 2). In three studies, patients with specific musculoskeletal pain were excluded, i.e., pain of the upper and lower limbs, neck, and lower back that is not attributed to a recognizable specific pathology such as infection, tumor, osteoporosis, ankylosing spondylitis, fracture, inflammatory process, radicular syndrome, or cauda equina syndrome [5,[30][31][32]. The mean age of all included patient populations varied between 29.7 and 54.2 years old.…”

Section: Participantsmentioning

confidence: 99%

“…The most commonly used was the WAI, which was employed in three out of five studies [5,28,29]. It is important to realize that the moments of measurement differed and ranged from a measurement after the first treatment and a measurement after the complete rehabilitation program.…”

Section: Working Alliance Measurementmentioning

confidence: 99%

“…A total of 16 articles remained. After applying the inclusion and exclusion criteria, five final articles were selected [5,[28][29][30][31]. Visualization of the selection of articles is indicated in Figure 1.…”

Section: Included Studiesmentioning

confidence: 99%

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Does working alliance have an influence on pain and physical functioning in patients with chronic musculoskeletal pain; a systematic review

Lakke

Meerman

2016

J of Compassionate Health Care

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Background: Working alliance can possibly influence patients' experiences of pain and physical functioning. The aim of this systematic review is to merge evidence from literature regarding the influence of patients' perceived working alliance on pain and physical functioning in patients with chronic musculoskeletal pain. Methods: A systematic review in which randomized controlled trials and cohort studies were included that assessed the influence of working alliance on either pain or physical functioning in patients with chronic musculoskeletal pain. The methodological quality of the included studies were rated by means of the PEDro score and STROBE statement. Results: The first step of the search process provided 1469 studies. After screening, five studies were included in this review including one RCT and four cohort studies of patients with chronic musculoskeletal pain. One cohort study was rated as low methodological quality and the other studies as high methodological quality. There was a significant effect of working alliance on the outcome of pain severity, pain interference, and physical functioning in all studies. Physical functioning was measured by means of questionnaires and functional capacity tests. The effect on questionnaires was positive; the effect was conflicting on functional capacity. Conclusion: When influencing pain with treatment, a patient's perceived working alliance during treatment does predict pain reduction and improvement in physical functioning. It is recommended to inquire about a patient's working alliance during treatment in patients with chronic musculoskeletal pain.

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Section: Methodological Qualitymentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Working Alliance Measurementmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

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Does working alliance have an influence on pain and physical functioning in patients with chronic musculoskeletal pain; a systematic review

Lakke

Meerman

2016

J of Compassionate Health Care

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“…[26][27][28] Recently, we studied 7 a physiotherapist leading a 6-week ''Back-to-Fitness'' programme for injured military personnel with chronic LBP, that was modelled after a self-management programme 29 designed to enhance self-efficacy. Using a checklist of BCT derived from both psychology and physiotherapy literature (see Appendix 1 online), we observed that the physiotherapist used 24 different BCTs with her patients during classroom and group exercise sessions.…”

mentioning

confidence: 99%

Working with People to Make Changes: A Behavioural Change Approach Used in Chronic Low Back Pain Rehabilitation

Harman¹,

MacRae²,

Vallis

et al. 2014

Physiotherapy Canada

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Purpose: To describe the approach used by a physiotherapist who led a rehabilitation programme for injured members of the military with chronic low back pain designed to enhance self-efficacy and self-management skills. Method: This in-depth qualitative study used audio-and video-recorded data from interviews and field observations. Using an inductive analysis process, discussion of emerging themes led to a description of the physiotherapist's approach. Results: The approach has three elements: developing a trusting relationship through building rapport, establishing a need in patients' minds to be actively engaged in their rehabilitation, and finding workable rehabilitation solutions that are most likely to be adopted by individual patients. This approach fits into current theories about health behaviour change (e.g., Transtheoretical Model of Change, Motivational Interviewing, Motivational Model of Patient Self-Management and Patient Self-Management) and elements of the therapeutic alliance. Using the therapeutic alliance (rapport) and behaviour change techniques, the physiotherapist focused on the perceived importance of a behaviour change (need) and then shifted to the patient's self-efficacy in the solutions phase. Conclusions: If we recognize that rehabilitation requires patients to adopt new behaviours, becoming aware of psychological techniques that enhance behaviour change could improve treatment outcomes.Key Words: cognitive therapy; exercise; low back pain; professional-patient relations; rehabilitation. RÉ SUMÉObjet : Dé crire l'approche suivie par un physiothé rapeute qui a dirigé un programme de ré adaptation pour militaires blessé s atteints de lombalgie chronique. Le programme visait à amé liorer les techniques d'autoefficacité et d'autoprise en charge. Mé thode : Cette é tude qualitative en profondeur a utilisé des donné es audio et vidé o enregistré es à la suite d'entrevues et des observations sur le terrain. Basé e sur un processus d'analyse inductive, la discussion sur les thè mes é mergents a abouti à une description de la dé marche du physiothé rapeute. Ré sultats : L'approche comporte trois é lé ments: é tablissement d'une relation de confiance par la cré ation d'une complicité , é tablissement, dans l'esprit des patients, d'un besoin de participer activement à la ré adaptation et dé couverte de solutions de ré adaptation pratiques que chaque patient en particulier est le plus susceptible d'adopter. Cette approche correspond aux thé ories actuelles sur les changements de comportement en santé (p. ex., modè le transthé orique du changement, entrevues de motivation, modè le de motivation de l'autoprise en charge par les patients et autoprise en charge par les patients) et les é lé ments de l'alliance thé rapeutique. En se basant sur l'alliance thé rapeutique (complicité ) et des techniques de modification du comportement, le physiothé rapeute s'est concentré sur l'importance perç ue d'un changement de comportement (besoin) et est passé ensuite à l'autoefficacité du patient au cours ...

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Management of Persistent Pain in the Older Patient

Makris

Abrams

Gurland

et al. 2014

JAMA

260

200

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Importance Persistent pain is highly prevalent, costly, and frequently disabling in later life. Objective To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult. Evidence Acquisition Search of MEDLINE and the Cochrane database from January 1990 through May 2014, using the search terms older adults, senior, ages 65 and above, elderly, and aged along with non-cancer pain, chronic pain, persistent pain, pain management, intractable pain, and refractory pain to identify English-language peer-reviewed systematic reviews, meta-analyses, Cochrane reviews, consensus statements, and guidelines relevant to the management of persistent pain in older adults. Findings Of the 92 identified studies, 35 evaluated pharmacologic interventions, whereas 57 examined nonpharmacologic modalities; the majority (n = 50) focused on older adults with osteoarthritis. This evidence base supports a stepwise approach with acetaminophen as first-line therapy. If treatment goals are not met, a trial of a topical nonsteroidal anti-inflammatory drug, tramadol, or both is recommended. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. Careful surveillance to monitor for toxicity and efficacy is critical, given that advancing age increases risk for adverse effects. A multimodal approach is strongly recommended–emphasizing a combination of both pharmacologic and nonpharmacologic treatments to include physical and occupational rehabilitation, as well as cognitive-behavioral and movement-based interventions. An integrated pain management approach is ideally achieved by cultivating a strong therapeutic alliance between the older patient and the physician. Conclusions and Relevance Treatment planning for persistent pain in later life requires a clear understanding of the patient's treatment goals and expectations, comorbidities, and cognitive and functional status, as well as coordinating community resources and family support when available. A combination of pharmacologic, nonpharmacologic, and rehabilitative approaches in addition to a strong therapeutic alliance between the patient and physician is essential in setting, adjusting, and achieving realistic goals of therapy.

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The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain

Abstract: Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.

Cited by 298 publications

References 39 publications

Does working alliance have an influence on pain and physical functioning in patients with chronic musculoskeletal pain; a systematic review

Does working alliance have an influence on pain and physical functioning in patients with chronic musculoskeletal pain; a systematic review

Working with People to Make Changes: A Behavioural Change Approach Used in Chronic Low Back Pain Rehabilitation

Management of Persistent Pain in the Older Patient

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