Article

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.
The purpose of this study was to investigate whether the therapeutic
alliance between physical therapists and patients with chronic LBP predicts
clinical outcomes. 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.

Langue : ANGLAIS