What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis

O’Keeffe, Mary; Cullinane, P.; Hurley, John A.; Leahy, I.; Bunzli, Samantha; O’Sullivan, Peter

doi:10.2522/ptj.20150240

Cited by 184 publications

(162 citation statements)

References 54 publications

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“…Hall et al [61] reported positive associations between TA and global perceived effect, change in pain, physical function, patient satisfaction, depression and general health status. In a recent meta-synthesis of qualitative studies, O’Keeffe et al [62] identified 4 themes of TA from 12 codes across 13 MSK studies. These included physical therapist interpersonal and communication skills (listening, empathy, friendliness, encouragement, confidence, nonverbal communication), physical therapist practical skills (patient education, physical therapist expertise and training), individualized patient-centred care (individualized, taking patient preferences and opinion into consideration) and organizational and environmental factors (time, flexibility with patient appointment and treatment).…”

Section: Resultsmentioning

confidence: 99%

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

Babatunde

MacDermid

MacIntyre

2017

BMC Health Serv Res

143

126

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BackgroundMost conventional treatment for musculoskeletal conditions continue to show moderate effects, prompting calls for ways to increase effectiveness, including drawing from strategies used across other health conditions. Therapeutic alliance refers to the relational processes at play in treatment which can act in combination or independently of specific interventions. Current evidence guiding the use of therapeutic alliance in health care arises largely from psychotherapy and medicine literature. The objective of this review was to map out the available literature on therapeutic alliance conceptual frameworks, themes, measures and determinants in musculoskeletal rehabilitation across physiotherapy and occupational therapy disciplines.MethodsA scoping review of the literature published in English since inception to July 2015 was conducted using Medline, EMBASE, PsychINFO, PEDro, SportDISCUS, AMED, OTSeeker, AMED and the grey literature. A key search term strategy was employed using “physiotherapy”, “occupational therapy”, “therapeutic alliance”, and “musculoskeletal” to identify relevant studies. All searches were performed between December 2014 and July 2015 with an updated search on January 2017. Two investigators screened article title, abstract and full text review for articles meeting the inclusion criteria and extracted therapeutic alliance data and details of each study.ResultsOne hundred and thirty articles met the inclusion criteria including quantitative (33%), qualitative (39%), mixed methods (7%) and reviews and discussions (23%) and most data came from the USA (23%). Randomized trials and systematic reviews were 4.6 and 2.3% respectively. Low back pain condition (22%) and primary care (30.7%) were the most reported condition and setting respectively. One theory, 9 frameworks, 26 models, 8 themes and 42 subthemes of therapeutic alliance were identified. Twenty-six measures were identified; the Working Alliance Inventory (WAI) was the most utilized measure (13%). Most of the therapeutic alliance themes extracted were from patient perspectives. The relationship between adherence and therapeutic alliance was examined by 26 articles of which 57% showed some correlation between therapeutic alliance and adherence. Age moderated the relationship between therapeutic alliance and adherence with younger individuals and an autonomy support environment reporting improved adherence. Prioritized goals, autonomy support and motivation were facilitators of therapeutic alliance.ConclusionTherapeutic Alliance has been studied in a limited extent in the rehabilitation literature with conflicting frameworks and findings. Potential benefits described for enhancing therapeutic alliance might include better exercise adherence. Several knowledge gaps have been identified with a potential for generating future research priorities for therapeutic alliance in musculoskeletal rehabilitation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2311-3) contains supplementary material, wh...

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Section: Resultsmentioning

confidence: 99%

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

Babatunde

MacDermid

MacIntyre

2017

BMC Health Serv Res

143

126

View full text Add to dashboard Cite

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“…The relationship between the patient and the practitioner has been shown to be useful in predicting and influencing outcomes in other chronic conditions such as low back pain52 53 and a positive alliance is seen to have an overall positive influence on rehabilitation 54. The influences on this relationship or ‘working alliance’ include a mix of interpersonal skills, practical skills and individualised patient-centred care 55. Working alliance involves technical skill and the reflective capacity of the therapist to respond to the patient, but extends beyond good communication to a sense of collaboration, warmth and support 56 57.…”

Section: Discussionmentioning

confidence: 99%

Association of psychological variables and outcome in tendinopathy: a systematic review

Mallows

Debenham

Walker³

et al. 2016

Br J Sports Med

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The association of psychological variables and outcome in tendinopathy: a systematic review ABSTRACT Objective: Fear, anxiety, depression, distress and catastrophisation are all factors known to affect pain and disability levels. To date, the association of such psychological factors has yet to be established in tendinopathy. Therefore, the purpose of this paper was to determine if psychological variables are associated with tendinopathy and whether any such variables may be associated with pain and disability outcomes in conservative management of tendinopathy.Design: A systematic review was undertaken and included studies were appraised for risk of bias using the Newcastle Ottawa Scale. Due to heterogeneity of studies, a qualitative synthesis was undertaken.Data sources: An electronic search of MEDLINE, CiNAHL, SPORTDiscus, PsycINFO, EMBASE and PsycARTICLES was undertaken from their inception to April 2016.Eligibility criteria for selecting studies: Any study design that incorporated psychological measures and clinical outcomes using participants with tendinopathy.Results: Ten articles describing nine studies and 1108 participants were included. Conflicting evidence exists regarding the association of anxiety, depression and lateral epicondylalgia (LE). Strong evidence suggests LE is not associated with kinesiophobia. Moderate evidence links catastrophisation and distress with LE. Moderate evidence suggests distress is not associated with rotator cuff tendinopathy, but kinesiophobia and catastrophisation are. Limited evidence suggests patella tendinopathy is not associated with anxiety or depression and kinesiophobia may be linked with suboptimal outcomes in Achilles tendinopathy. Summary/conclusions:Tendinopathy requires an individualised approach to management. Clinicians should consider using validated screening tools for the presence of psychological variables as a part their holistic management. What are the new findings Psychological variables may be associated with tendinopathy and a suboptimal outcome  Multi-dimensional factors influence the development and maintenance of pain and disability in tendinopathy  The underlying factors for the presence of these variables and their amenability to change warrant further investigation How might it impact on clinical practice in the near future  Tendinopathy management should include an individualised, holistic assessment  Management strategies may need to be adapted to address individual psychological variables and any underlying cognitive barriers.

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“…10 Based on contemporary evidence, we contend that once red flags and specific lumbar pathology are excluded, adoles cents with LBP require a flexible and targeted multidimensional approach to assessment and management (FIGURE 2). 44 A strong therapeutic relationship is con sidered central to this process, 40 and ado lescents' primary caregivers should also be included in the management.…”

Section: Discussionmentioning

confidence: 99%

Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management

O’Sullivan¹,

Smith²,

Beales³

et al. 2017

J Orthop Sports Phys Ther

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What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis

Cited by 184 publications

References 54 publications

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

Association of psychological variables and outcome in tendinopathy: a systematic review

Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management

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