The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain
The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain
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DOI：
10.2522/ptj.20120137
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发表时间：
2013-04-01
期刊：
影响因子：
3.2
通讯作者：
Adams, Roger D.
中科院分区：
文献类型：
--
作者：
Ferreira, Paulo H.;Ferreira, Manuela L.;Adams, Roger D.
背景患者和物理治疗师之间的关系（治疗联盟）对慢性腰痛（LBP）患者康复治疗结果的影响以前没有调查。本研究的目的是调查物理治疗师和慢性腰痛患者之间的治疗联盟是否能预测临床结果。这是一项随机对照试验中嵌套的回顾性观察研究。182名慢性LBP患者自愿参加一项随机对照试验，该试验比较了运动和脊柱推拿治疗的疗效，通过在第二次治疗时完成工作联盟清单来评估他们与物理治疗师的联盟。在治疗前和治疗8周后评估功能、治疗的总体感知效果、疼痛和残疾的主要结局。线性回归模型用于研究是否联盟是一个预测结果或调节治疗效果。治疗联盟是所有治疗结果指标的预测因子。治疗联合调节了2/3个治疗对比（一般运动与运动控制运动，脊柱推拿治疗与运动控制运动）的治疗对整体感知效应的影响。当用功能、疼痛和残疾指标测量结局时，没有治疗效果改变。在第二次治疗时测量治疗联盟，这可能会使治疗初始阶段的相互作用产生偏差：数据分析仅限于8周时的主要结局。物理治疗师和患者之间的积极治疗联盟评级与LBP结局的改善相关。未来的研究应该调查解释这种关系的因素和培训的影响。旨在优化联盟的干预措施。
Background. The impact of the relationship (therapeutic alliance) between patients and-physical therapists on treatment outcome in the rehabilitation of patients with chronic low back pain (LBP) has not been previously investigated.Objective. The purpose of this study was to investigate whether the therapeutic alliance between physical therapists and patients with chronic LBP predicts clinical outcomes.Design. This was a retrospective observational study nested within a randomized controlled trial.Methods. One hundred eighty-two 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 whether the alliance was a predictor of outcome or moderated the effect of treatment.Results. 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 2 of 3 treatment contrasts (general exercise versus motor control exercise, spinal manipulative therapy versus motor control exercise). There was no treatment effect modification when outcome was measured with function, pain, and disability measures.Limitations. Therapeutic alliance was measured at the second treatment session, which might have biased the interaction during initial stages of treatment: Data analysis was restricted to primary outcomes at 8 weeks.Conclusions. 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.