The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of chronic low back pain (LBP) has not been previously investigated.
To investigate whether the therapeutic alliance between physical therapists and chronic LBP patients predicts clinical outcomes.
Retrospective observational study nested within a randomized controlled trial.
182 patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate if the alliance was a predictor of outcome or moderated the effect of treatment.
The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for two of three treatment contrasts (general exercise vs motor control exercise, spinal manipulative therapy vs motor control exercise). There was no treatment effect modification when outcome was measured with function, pain and disability measures.
Therapeutic alliance was measured at the second treatment session and it is likely to bias the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks.
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.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120137v1?rss=1
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