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Richardson M, Cathro M, Kleinstäuber M. Nocebo Hypothesis Cognitive Behavioural Therapy (NH-CBT) for non-epileptic seizures: a consecutive case series. Behav Cogn Psychother 2024; 52:356-375. [PMID: 38018147 DOI: 10.1017/s1352465823000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Research has demonstrated that implementation of Nocebo Hypothesis Cognitive Behavioural Therapy (NH-CBT) achieved full symptom remission in 93% of people with Functional Neurological Symptoms Disorder (FNSD), most of them exhibiting motor symptoms. The basis for NH-CBT is consistent with a predictive coding aetiological model of FNSD. This idea is transparently shared with people with FNSD in the form of telling them that their symptoms are caused by a nocebo effect, usually followed by some physical activity that aims to change the person's belief about their body. AIMS To demonstrate that a version of NH-CBT can also be effective in eliminating or reducing non-epileptic seizures (assumed to be a sub-type of FNSD). METHOD A consecutive case series design was employed. Participants were treated with NH-CBT over a 12-week period. The primary outcome measure was seizure frequency. Numerous secondary measures were employed, as well as a brief qualitative interview to explore participants' subjective experience of treatment. RESULTS Seven out of the 10 participants became seizure free at least 2 weeks before their post-treatment assessment, and all stayed seizure-free for at least 5 months. Six of those seven remained seizure free at 6-month follow-up. There were large positive effect sizes for the majority of secondary measures assessed. CONCLUSIONS This case series provides evidence of feasibility and likely utility of NH-CBT in reducing the frequency of non-epileptic seizures.
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Affiliation(s)
- Matt Richardson
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael Cathro
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Psychology, Utah State University, Logan, Utah, USA
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Pottkotter K, Hazlett M, Mansfield CJ, Rethman K, Fritz JM, Quatman-Yates CC, Briggs MS. Understanding social determinants of health and physical therapy outcomes in patients with low back pain: A scoping review. Musculoskeletal Care 2024; 22:e1888. [PMID: 38747557 DOI: 10.1002/msc.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Low back pain (LBP) is the number one cause of disability worldwide; however, it is not clear how social determinants of health (SDOH) impact care management and outcomes related to physical therapy (PT) services for patients with LBP. OBJECTIVE The purposes of this scoping review are to examine and assimilate the literature on how SDOH and PT care relate to non-specific LBP outcomes and identify gaps in the literature to target for future research. METHODS Data were extracted from eight electronic databases from January 2011 to February 2022. Reviewers independently screened all studies using the PRISMA extension for scoping review guidelines. Data related to study design, type of PT, type of non-specific LBP, patient demographics, PT intervention, SDOH, and PT outcomes were extracted from the articles. RESULTS A total of 30,523 studies were screened, with 1961 articles undergoing full text review. Ultimately, 76 articles were identified for inclusion. Sex and age were the most frequent SDOH examined (88% and 78% respectively) followed by education level (18%). Approximately half of the studies that examined age, sex, and education level identified no effect on outcomes. The number of studies examining other factors was small and the types of outcomes evaluated were variable, which limited the ability to pool results. CONCLUSIONS Sex and age were the most frequent SDOH examined followed by education level. Other factors were evaluated less frequently, making it difficult to draw conclusions. Study design and heterogeneity of determinants and outcomes were barriers to examining the potential impact on patients with LBP.
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Affiliation(s)
- Kristy Pottkotter
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Miriam Hazlett
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Cody J Mansfield
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Katherine Rethman
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Julie M Fritz
- College of Health, The University of Utah, Salt Lake City, Utah, USA
| | - Catherine C Quatman-Yates
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Matthew S Briggs
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Fritz JM, Ford I, George SZ, Vinci de Vanegas L, Cope T, Burke CA, Goode AP. Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials. FRONTIERS IN PAIN RESEARCH 2024; 5:1324096. [PMID: 38706872 PMCID: PMC11066221 DOI: 10.3389/fpain.2024.1324096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.
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Affiliation(s)
- Julie M. Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Laura Vinci de Vanegas
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Tyler Cope
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Colleen A. Burke
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
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Levin AW, Lancelotta R, Sepeda ND, Gukasyan N, Nayak S, Wagener TL, Barrett FS, Griffiths RR, Davis AK. The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder. PLoS One 2024; 19:e0300501. [PMID: 38483940 PMCID: PMC10939230 DOI: 10.1371/journal.pone.0300501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
We examined if the therapeutic alliance between study participants and intervention facilitators in a psilocybin-assisted therapy (PAT) trial changed over time and whether there were relationships between alliance, acute psilocybin experiences, and depression outcomes. In a randomized, waiting list-controlled clinical trial for major depressive disorder in adults (N = 24), participants were randomized to an immediate (N = 13) or delayed (N = 11) condition with two oral doses of psilocybin (20mg/70kg and 30mg/70kg). Ratings of therapeutic alliance significantly increased from the final preparation session to one-week post-intervention (p = .03, d = .43). A stronger total alliance at the final preparation session predicted depression scores at 4 weeks (r = -.65, p = .002), 6 months (r = -.47, p = .036), and 12 months (r = -.54, p = .014) post-intervention. A stronger total alliance in the final preparation session was correlated with higher peak ratings of mystical experiences (r = .49, p = .027) and psychological insight (r = .52, p = .040), and peak ratings of mystical experience and psychological insight were correlated with depression scores at 4 weeks (r = -.45, p = .030 for mystical; r = -.75, p < .001 for insight). Stronger total alliance one week after the final psilocybin session predicted depression scores at 4 weeks (r = -.85, p < .001), 3 months (r = -.52, p = .010), 6 months (r = -.77, p < .001), and 12 months (r = -.61, p = .001) post-intervention. These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes. Trial registration: Registration: Clinicaltrials.gov NCT03181529. https://classic.clinicaltrials.gov/ct2/show/NCT03181529.
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Affiliation(s)
- Adam W. Levin
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Department of Psychiatry, The Ohio State University, Columbus, Ohio, United States of America
| | - Rafaelle Lancelotta
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
| | - Nathan D. Sepeda
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Natalie Gukasyan
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Sandeep Nayak
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Frederick S. Barrett
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Roland R. Griffiths
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Alan K. Davis
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
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Seebacher B, Geimer C, Neu J, Schwarz M, Diermayr G. Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study. PLoS One 2024; 19:e0299909. [PMID: 38457374 PMCID: PMC10923432 DOI: 10.1371/journal.pone.0299909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. PURPOSE To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. METHODS In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. RESULTS The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. CONCLUSIONS In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Carole Geimer
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Julia Neu
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Maria Schwarz
- Department of Psychosocial Rehabilitation, Clinic for Rehabilitation Münster, Münster, Österreich
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
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Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
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Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Rodríguez-Nogueira Ó, Leirós-Rodríguez R, Pinto-Carral A, Álvarez-Álvarez MJ, Morera-Balaguer J, Moreno-Poyato AR. Relationship between competency for evidence-based practice and level of burnout of physical therapists with the establishment of the therapeutic relationship. Physiother Theory Pract 2024; 40:357-365. [PMID: 35972934 DOI: 10.1080/09593985.2022.2112638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) interventions and effective therapeutic alliance (TA) are associated with greater treatment success. Furthermore, burnout syndrome could be detrimental to the development of such TA. OBJECTIVE To examine the association between EBP competencies and burnout level with the quality of TA among Spanish physiotherapists. METHODS Cross-sectional research with an electronic survey including the EBP Questionnaire-19, Maslach Burnout Inventory and Working Alliance Inventory-Short (WAI-S) and administered to 471 physiotherapists. RESULTS Regarding the EBP Questionnaire-19, physiotherapists scored highest on attitude and lowest on knowledge. For WAIS which achieved appropriate results of internal consistency and validity in the sample analyzed, bond scored the highest and goals the lowest. Years of experience was significantly associated with the task (r = 0.5; p = .003) and bond (r = 0.7; p = .002) and the WAIS total score (r = 0.8; p < .001), and all burnout subscales (-0.7 < r > 0.7; p < .001 for all). CONCLUSION Lower levels of burnout and improved EBP competencies are associated with a TA of greater quality. The association between attitudes toward EBP, a higher level of self-confidence and a lower perception of depersonalization appear to be determinant factors for improving TA.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Arrate Pinto-Carral
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - María José Álvarez-Álvarez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Jaume Morera-Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Elche, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, Hospitalet del Llobregat, Spain
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Smith MP, Tracy B, Soncrant J, Young JL, Rhon DI, Cook CE. What factors do physical therapists consider when determining patient prognosis: A mixed methods study. Musculoskeletal Care 2023; 21:1412-1420. [PMID: 37712685 DOI: 10.1002/msc.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION A prognosis provides valuable information to expected progress and anticipated outcome over the course of care. Although it is known that physical therapists can accurately prognose, it is unknown what factors are utilised in clinical practice. OBJECTIVE The purpose of this study was to determine the prognostic domains and factors that influenced a PT's clinical reasoning processes. DESIGN Mixed Methods Design, affirming the prognostic ability of the physical therapists and the qualitative exploration of the prognostic factors considered by physical therapists. METHODS Twenty-nine physical therapists participated in this study. Participants underwent semi-structured qualitative interviews that were coded to populate a prognostic framework. In addition, de-identified patient data was used to determine the ability of the PT to form a prognosis. Linear regression was used to determine if an initial prognostic score was related to function at discharge. RESULTS There were significant relationships (p = <0.05) between the prognosis score and Focus on Therapeutic Outcomes (B = 2.25), Numeric Pain Rating Scale (B = 0.257), and GROC (B = 0.289) upon patient discharge. Qualitative factors were categorised into prognostic domains (prevalence): Mood, Motivation, Pain Behaviours (100%), Disease Severity (93.1%), Health Status (86.2%), Social, Occupation, Environmental (67.0%), and Genetics, Biology, Biomarkers (44.8%). Factors that did not fit established domains were reported and categorised as Other (86.2%). CONCLUSION Our findings support the relationship between PT prognosis of patients with musculoskeletal pain and patient outcomes. In addition, the domains and factors PTs use to formulate prognosis during evaluation present a complex biopsychosocial framework, suggesting that PTs consider factors from multiple domains when forming a prognosis.
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Affiliation(s)
- Matthew P Smith
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
- Northwestern University, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois, USA
| | - Brad Tracy
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Jason Soncrant
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Jodi L Young
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Daniel I Rhon
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
| | - Chad E Cook
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, Wisconsin, USA
- Duke University, Department of Orthopaedics, Durham, North Carolina, USA
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Dillon M, Olson RE, Plage S, Miciak M, Window P, Stewart M, Christoffersen A, Kilner S, Barthel N, Setchell J. Distress in the care of people with chronic low back pain: insights from an ethnographic study. FRONTIERS IN SOCIOLOGY 2023; 8:1281912. [PMID: 38033352 PMCID: PMC10687466 DOI: 10.3389/fsoc.2023.1281912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023]
Abstract
Introduction Distress is part of the experiences and care for people with chronic low back pain. However, distress is often pathologised and individualised; it is seen as a problem within the individual in pain and something to be downplayed, avoided, or fixed. To that end, we situate distress as a normal everyday relational experience circulating, affecting, moving in, through, and across bodies. Challenging practices that may amplify distress, we draw on the theorisation of affect as a relational assemblage to analyse physiotherapy clinical encounters in the care of people with chronic low back pain. Methods Adopting a critical reflexive ethnographic approach, we analyse data from a qualitative project involving 15 ethnographic observations of patient-physiotherapist interactions and 6 collaborative dialogues between researchers and physiotherapists. We foreground conceptualisations of distress- and what they make (im)possible-to trace embodied assemblage formations and relationality when caring for people with chronic low back pain. Results Our findings indicate that conceptualisation matters to the clinical entanglement, particularly how distress is recognised and navigated. Our study highlights how distress is both a lived experience and an affective relation-that both the physiotherapist and people with chronic low back pain experience distress and can be affected by and affect each other within clinical encounters. Discussion Situated at the intersection of health sociology, sociology of emotions, and physiotherapy, our study offers a worked example of applying an affective assemblage theoretical framework to understanding emotionally imbued clinical interactions. Viewing physiotherapy care through an affective assemblage lens allows for recognising that life, pain, and distress are emerging, always in flux. Such an approach recognises that clinicians and patients experience distress; they are affected by and affect each other. It demands a more humanistic approach to care and helps move towards reconnecting the inseparable in clinical practice-emotion and reason, body and mind, carer and cared for.
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Affiliation(s)
- Miriam Dillon
- School of Social Science, University of Queensland, Brisbane, QLD, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Rebecca E. Olson
- School of Social Science, University of Queensland, Brisbane, QLD, Australia
| | - Stefanie Plage
- School of Social Science, University of Queensland, Brisbane, QLD, Australia
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Matthew Stewart
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | | | - Simon Kilner
- Psychology Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Natalie Barthel
- Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
- Institute for Urban Indigenous Health, Brisbane, QLD, Australia
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Huang L, Li J, Xiao B, Tang Y, Huang J, Li Y, Fang F. Bibliometric Analysis of Research Trends on Manual Therapy for Low Back Pain Over Past 2 Decades. J Pain Res 2023; 16:3045-3060. [PMID: 37701559 PMCID: PMC10493154 DOI: 10.2147/jpr.s418458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose Low back pain (LBP) is a prevalent musculoskeletal disorder, and manual therapy (MT) is frequently employed as a non-pharmacological treatment for LBP. This study aims to explore the research hotspots and trends in MT for LBP. MT has gained widespread acceptance in clinical practice due to its proven safety and effectiveness. The study aims to analyze the developments in the field of MT for LBP over the past 23 years, including leading countries, institutions, authoritative authors, journals, keywords, and references. It endeavors to provide a comprehensive summary of the existing research foundation and to analyze the current cutting-edge research trends. Methods Relevant articles between 2000 and 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. We used the software VOSviewer and CiteSpace to perform the analysis and summarize current research hotspots and emerging trends. Results Through screening, we included 1643 papers from 2000 to 2023. In general, the number of articles published each year showed an upward trend. The United States had the highest number of publications and citations. Canadian Memorial Chiropractic College was the most published research institution. The University of Pittsburgh in the United States had the most collaboration with other research institutions. Long, Cynthia R. was the active author. Journal of Manipulative and Physiological Therapeutics was the most prolific journal with 234 publications. Conclusion This study provides an overview of the current status and trends of clinical studies on MT for LBP in the past 23 years using the visualization software, which may help researchers identify potential collaborators and collaborating institutions, hot topics, and new perspectives in research frontiers, while providing new clinical practice ideas for the treatment of LBP.
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Affiliation(s)
- Lele Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, People’s Republic of China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Jiamin Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Baiyang Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
- Department of Traditional Chinese Medicine, Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Yin Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Jinghui Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Ying Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
| | - Fanfu Fang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of the Naval Medical University, Shanghai, 200433, People’s Republic of China
- Department of Traditional Chinese Medicine, Naval Medical University, Shanghai, 200433, People’s Republic of China
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11
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Main CJ, Ballengee LA, George SZ, Beneciuk JM, Greco CM, Simon CB. Psychologically Informed Practice: The Importance of Communication in Clinical Implementation. Phys Ther 2023; 103:pzad047. [PMID: 37145093 PMCID: PMC10390082 DOI: 10.1093/ptj/pzad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 05/06/2023]
Abstract
There has been increasing interest in the secondary prevention of chronic pain and pain-associated disability over the past 3 decades. In 2011, psychologically informed practice (PiP) was suggested as a framework for managing persistent and recurrent pain, and, since then, it has underpinned the development of stratified care linking risk identification (screening). Although PiP research trials have demonstrated clinical and economic advantage over usual care, pragmatic studies have been less successful, and qualitative studies have identified implementation difficulties in both system delivery and individual clinical management. Effort has been put into the development of screening tools, the development of training, and the assessment of outcomes; however, the nature of the consultation has remained relatively unexplored. In this Perspective, a review of the nature of clinical consultations and the clinician-patient relationship is followed by reflections on the nature of communication and the outcome of training courses. Consideration is given to the optimization of communication, including the use of standardized patient-reported measures and the role of the therapist in facilitating adaptive behavior change. Several challenges in implementing a PiP approach in day-to-day practice are then considered. Following brief consideration of the impact of recent developments in health care, the Perspective concludes with a brief introduction to the PiP Consultation Roadmap (the subject of a companion paper), the use of which is suggested as a way of structuring the consultation with the flexibility required for a patient-centered approach to guided self-management of chronic pain conditions.
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Affiliation(s)
- Chris J Main
- School of Medicine, Keele University, Keele, Newcastle, ST5 5BG, UK
| | - Lindsay A Ballengee
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
- Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Carol M Greco
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Corey B Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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12
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Holmes MB, Scott A, Camarinos J, Marinko L, George SZ. Working Alliance Inventory (WAI) and its relationship to patient-reported outcomes in painful musculoskeletal conditions. Disabil Rehabil 2023; 45:1363-1369. [PMID: 35416110 DOI: 10.1080/09638288.2022.2060337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Therapeutic alliance (TA) has been positively correlated to improvements in patient outcomes. This study examined the Working Alliance Inventory (WAI) relationship with changes in disability and pain intensity for patients receiving physical therapy (PT) treatment for acute and chronic musculoskeletal pain conditions. METHODS Fifty participants were dichotomized into success or failure by the minimal clinically important difference (MCID) on region-specific patient-reported outcome measures (PROM) and Numeric Pain Rating Scale (NPRS). Regression and correlation statistics examined the relationship between WAI with change scores and quantity of PT. Independent t-tests compared WAI scores across categorical variables. RESULTS WAI scores were higher for those meeting MCIDs on PROM and NPRS compared to those who did not. WAI scores were significantly correlated with improvement on region-specific outcome measures and NPRS. Regression analysis found the patient rating of the TA to be a positive predictor for improvement on regions specific outcome measures and NPRS. CONCLUSIONS Patients who rated the TA higher were more likely to meet the MCID for region-specific disability and pain intensity. Patient ratings of the TA were associated with improved change scores on pain rating and standardized outcome measures during a course of treatment for musculoskeletal pain conditions.Implications for rehabilitationPatients' early rating of the therapeutic alliance (TA) is associated with improvements seen on pain and functional outcomes.Physical therapists should assess the TA and use strategies to enhance the alliance to optimize patient's experiences with physical therapy.
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Affiliation(s)
- Mary Beth Holmes
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Amanda Scott
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - James Camarinos
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Lee Marinko
- Department of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Steven Z George
- Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University, Durham, NC, USA
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13
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What's wrong with osteopathy? INT J OSTEOPATH MED 2023. [DOI: 10.1016/j.ijosm.2023.100659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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14
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Baseline health-related quality of life predicts falls: a secondary analysis of a randomized controlled trial. Qual Life Res 2022; 31:3211-3220. [PMID: 35798988 DOI: 10.1007/s11136-022-03175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Among older adults, health-related quality of life (HRQoL) and falls are associated. Generic patient-reported outcomes measures (PROMs) assess individual's HRQoL. The role for PROMs, a potential tool for predicting subsequent falls, remains under-explored. Our primary aim was to determine whether a baseline PROMs assessment of HRQoL may be a useful tool for predicting future falls. METHODS A secondary analysis of a 12-month randomized clinical trial (RCT) of a home-based exercise program among 344 adults (67% female), aged ≥ 70 years, with ≥ 1 falls in the prior year who were randomized (1:1) to either a home-based exercise program (n = 172) or usual care (n = 172). A negative binomial regression model with total falls count as the dependent variable evaluated the main effect of the independent variable-baseline HRQoL (measured by the Short-Form-6D)-controlling for total exposure time and experiment group (i.e., exercise or usual care) for the total sample. For the usual care group alone, the model controlled for total exposure time. RESULTS For the total sample, the rate of subsequent total falls was significantly predicted by baseline HRQoL (IRR = 0.044; 95% CI [0.005-0.037]; p = .004). For the usual care group, findings were confirmed with wider confidence intervals and the rate of prospective total falls was significantly predicted by baseline HRQoL (IRR = 0.025; 95% CI [0.001-0.909]; p = .044). CONCLUSION These findings suggest the ShortForm-6D should be considered as part of falls prevention screening strategies within a Falls Prevention Clinic setting. Trial Registrations ClinicalTrials.gov Protocol Registration System. Identifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171 . Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596 .
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15
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Horton AM, Hebson G, Holman D. A Qualitative Study on Patients’ Use of Emotion Regulation Strategies During Therapeutic Relationships. Br J Occup Ther 2022. [DOI: 10.1177/03080226221111959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Emotion regulation may be an important tool that therapists and patients use to build and maintain therapeutic relationships. This exploratory study investigates how patients use intrapersonal and interpersonal emotion regulation strategies during interactions with occupational therapists and physiotherapists. Methods A two-staged qualitative study was conducted. In the first stage 11 patients were interviewed regarding their use of emotion regulation during their therapeutic relationships. In the second stage, 14 patient/therapist dyads were observed during the course of the therapeutic relationship and then interviewed individually at the end of the relationship. Results Patients utilise the full range of intrapersonal emotion regulation strategies that can be categorised in Gross’s (1998) process model of emotion regulation including situation selection, situation modification, attentional deployment, cognitive reappraisal and response modulation. They used interpersonal emotion regulation strategies to a lesser extent, only reporting using strategies that fit into one of the four interpersonal emotion regulation strategies identified Williams’ (2007), altering the situation. Conclusions This study makes an important contribution to research on patients’ contribution to therapeutic relationship development/maintenance. It is the first study to explore patients use of intrapersonal and interpersonal emotion regulation in response to negative and positive emotions arising from interactions with therapists.
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Affiliation(s)
- Ayana M Horton
- College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK
| | - Gail Hebson
- Manchester Metropolitan Business School, Manchester, UK
| | - David Holman
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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16
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Rodríguez-Nogueira Ó, Leirós-Rodríguez R, Pinto-Carral A, Álvarez-Álvarez MJ, Morera-Balaguer J, Moreno-Poyato AR. The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study. Musculoskelet Sci Pract 2022; 59:102557. [PMID: 35338901 DOI: 10.1016/j.msksp.2022.102557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance. OBJECTIVE The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them. DESIGN Cross-sectional research. METHODS An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out. RESULTS Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01). CONCLUSIONS The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Arrate Pinto-Carral
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - María José Álvarez-Álvarez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Jaume Morera-Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Carrer Carmelitas 3, 03203, Elche, Alicante, Spain.
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
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17
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Fritz JM, Minick KI, Brennan G, McGee T, Lane E, Skolasky RL, Thackeray A, Bardsley T, Wegener ST, Hunter SJ. Outcomes of Telehealth Physical Therapy Provided Using Real-Time, Videoconferencing for Patients with Chronic Low Back Pain: A Longitudinal Observational Study. Arch Phys Med Rehabil 2022; 103:1924-1934. [DOI: 10.1016/j.apmr.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/16/2022] [Accepted: 04/29/2022] [Indexed: 11/02/2022]
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18
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Myers C, Thompson G, Hughey L, Young JL, Rhon DI, Rentmeester C. An exploration of clinical variables that enhance therapeutic alliance in patients seeking care for musculoskeletal pain: A mixed methods approach. Musculoskeletal Care 2022; 20:577-592. [PMID: 34984781 DOI: 10.1002/msc.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/OBJECTIVES Therapeutic alliance (TA) is an integral part of building a patient and clinician relationship. TA begins at the initial encounter; however, the specific TA behavioural practices that are most impactful and linked to pain reduction and improved function remain unclear. The primary objective of this study was to explore physical therapist behaviours and interactions during the initial physical therapy evaluation and how they related to the patient's perception of TA. A secondary objective was to explore the relationship between TA, pain intensity, and function. METHODS A mixed methods study was conducted. Pain intensity, TA and self-reported function were assessed at three time points. Spearman's Rho (ρ) was used to quantify if there was an association between increased TA and function and reduced pain intensity, while a checklist of TA themes and behavioural practices was used for the qualitative analysis. RESULTS There was a statistically significant negative correlation between patient-perceived TA and pain intensity immediately after the initial evaluation (ρ = -0.39 [p = 0.048]). Behavioural practices associated with higher TA included information gathering, pausing to listen, using humour and transitions, and use of clarifying questions. Behavioural practices associated with patient-perceived lower TA interactions were lack of touch, the absence of pain neuroscience education, and not restating what the patient said during the interview. CONCLUSION This study highlights a relationship between TA and reduction of pain intensity after the initial evaluation and identifies key behavioural practices that could positively and negatively impact TA during the clinical encounter.
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Affiliation(s)
- Christina Myers
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Physical Therapy Department, South College School of Physical Therapy, Knoxville, Tennessee, USA
| | - Glenn Thompson
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Physical Therapy Department, South College School of Physical Therapy, Knoxville, Tennessee, USA
| | - Lindsey Hughey
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Physical Therapy Department, South College School of Physical Therapy, Knoxville, Tennessee, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA.,Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Casey Rentmeester
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
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19
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McCabe E, Roduta Roberts M, Miciak M, Sun H(L, Gross DP. An investigation of the measurement properties of the physiotherapy therapeutic relationship measure in patients with musculoskeletal conditions. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.2005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Douglas P. Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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20
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Beneciuk JM, Brown-Taylor L, Alodaibi F, Kareha S, Holmes R, Fritz J. Patient- and Physical Therapist-Level Predictors of Patient-Reported Therapeutic Alliance: An Observational, Exploratory Study of Cohorts With Knee and Low Back Pain. Arch Phys Med Rehabil 2021; 102:2335-2342. [PMID: 34283991 DOI: 10.1016/j.apmr.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To identify patient- and physical therapist-level predictors for therapeutic alliance at the end of an episode of physical therapy for knee or low back pain (LBP). DESIGN Secondary analysis of observational cohort. SETTING Outpatient physical therapy clinics. PARTICIPANTS Patients receiving physical therapy for knee (n=189) or LBP (n=252) and physical therapists (n=19). Candidate predictor variables included demographics, patient clinical characteristics, and physical therapist attitudes and beliefs (Pain Attitudes and Beliefs Scale for Physical Therapists) and confidence in providing patient-centered care (Self-Efficacy in Patient-Centeredness Questionnaire). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient-reported therapeutic alliance was measured using the 12-item Work Alliance Inventory-Short Revised (WAI-SR). RESULTS Final linear mixed models indicated different patient- and physical therapist-level factor contributions in predicting final WAI-SR scores across cohorts with knee and LBP. Female sex was a consistent patient-level predictor for both knee (estimated β=1.57, P<.05) and LBP (β=1.42, P<.05), with age (β=-0.07, P<.01) and baseline function (β=0.06, P<.01) contributing to cohorts with knee and LBP, respectively. Physical therapist-level predictors included female sex (β=6.04, P<.05), Pain Attitudes and Beliefs Scale for Physiotherapists behavioral (β=0.65, P<.01), and Self-Efficacy in Patient-Centeredness Questionnaire (SEPCQ) Exploring Patient Perspective (β=-0.75, P<.01) subscale scores for LBP, with SEPCQ Sharing Information and Power subscale scores (β=0.56, P<.05) contributing to both cohorts with knee (β=0.56, P<.05) and LBP (β=0.74, P<.01). Random effects for patients nested within physical therapists were observed for both cohorts. CONCLUSIONS These findings provide preliminary evidence for inconsistent relationships among patient- and physical therapist-level factors and therapeutic alliance across cohorts with knee and LBP.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, FL; Brooks Rehabilitation, Jacksonville, FL.
| | - Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA, Salt Lake City, UT
| | - Faris Alodaibi
- Rehabilitation Science Department, King Saud University, Riyadh, Saudi Arabia
| | - Stephen Kareha
- Physical Therapy at St. Luke's University Health Network, Bethlehem, PA; Department of Physical Therapy, DeSales University, Bethlehem, PA
| | - Rett Holmes
- Physical Therapy at St. Luke's University Health Network, Bethlehem, PA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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