Maxi Miciak

Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study

Background Physical therapy influences chronic pain by means of the specific ingredient of an intervention as well as contextual factors including the setting and therapeutic alliance (TA) between provider and patient. Objective The purpose of this study was to compare the effect of enhanced versus limited TA on pain intensity and muscle pain sensitivity in patients with chronic low back pain (CLBP) receiving either active or sham interferential current therapy (IFC). Design An experimental controlled study with repeated measures was conducted. Participants were randomly divided into 4 groups: (1) AL (n=30), which included the application of active IFC combined with a limited TA; (2) SL (n=29), which received sham IFC combined with a limited TA; (3) AE (n=29), which received active IFC combined with an enhanced TA; and (4) SE (n=29), which received sham IFC combined with an enhanced TA. Methods One hundred seventeen individuals with CLBP received a single session of active or sham IFC. Measurements included pain intensity as assessed with a numerical rating scale (PI-NRS) and muscle pain sensitivity as assessed via pressure pain threshold (PPT). Results Mean differences on the PI-NRS were 1.83 cm (95% CI=14.3–20.3), 1.03 cm (95% CI=6.6–12.7), 3.13 cm (95% CI=27.2–33.3), and 2.22 cm (95% CI=18.9–25.0) for the AL, SL, AE, and SE groups, respectively. Mean differences on PPTs were 1.2 kg (95% CI=0.7–1.6), 0.3 kg (95% CI=0.2–0.8), 2.0 kg (95% CI=1.6–2.5), and 1.7 kg (95% CI=1.3–2.1), for the AL, SL, AE, and SE groups, respectively. Limitations The study protocol aimed to test the immediate effect of the TA within a clinical laboratory setting. Conclusions The context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects. Enhanced TA combined with active IFC appears to lead to clinically meaningful improvements in outcomes when treating patients with CLBP.

Fostering change in back pain beliefs and behaviors: when public education is not enough

Mass media campaigns designed to alter societal views and individual behaviors about back pain have been undertaken and evaluated in multiple countries. In contrast to the original Australian campaign, subsequent campaigns have been less successful, with improvements observed in beliefs without the corresponding changes in related behaviors. This article summarizes the results of a literature review, expert panel, and workshop held at the Melbourne International Forum XI: Primary Care Research on Low Back Pain in March 2011 on the role and interplay of various social behavior change strategies, including public education, law and legislation, healthy public policy, and social marketing in achieving a sustained reduction in the societal burden of back pain. Given the complexities inherent to health-related behaviors change, the Rothschild framework is applied in which behavior change strategies are viewed on a continuum from public education at one end through law and health policy at the other. Educational endeavors should likely be augmented with social marketing endeavors and supportive laws and health policy to foster sustained change in outcomes such as work disability and health utilization. Practical suggestions are provided for future interventions aimed at changing back pain-related behaviors. Evaluation of previous back pain mass media campaigns reveals that education alone is unlikely to foster positive and persisting behavioral change without concomitant strategies.

Are Performance-Based Functional Assessments Superior to Semistructured Interviews for Enhancing Return-to-Work Outcomes?

OBJECTIVE To examine whether use of functional capacity evaluation (FCE) leads to better outcomes for injured workers. DESIGN Cluster randomized controlled trial conducted with analysis at level of claimant. SETTING Rehabilitation facility. PARTICIPANTS Participants included claimants (N=203); of these, 103 were tested with FCE. Data were collected on all claimants undergoing RTW assessment at the facility for musculoskeletal conditions. Participants were predominantly employed (59%) men (73%) with chronic musculoskeletal conditions (median duration, 496d). INTERVENTIONS FCEs are commonly used to identify work abilities and inform return-to-work (RTW) decisions. Therefore, FCE results have important consequences. Clinicians who were trained and experienced in performing FCEs were randomized into 2 groups. One group included 14 clinicians who were trained to conduct a semistructured functional interview; the other group (control group) continued to use standard FCE procedures. MAIN OUTCOME MEASURES Outcomes included RTW recommendations after assessment, functional work level at time of assessment and 1, 3, and 6 months after assessment, and compensation outcomes. Analysis included Mann-Whitney U, chi-square, and t tests. RESULTS All outcomes were similar between groups, and no statistically or clinically significant differences were observed. Mean differences between groups on functional work levels at assessment and follow-up ranged from 0.1 to 0.3 out of 4 (3%-8% difference, P>.05). CONCLUSIONS Performance-based FCEs did not appear to enhance RTW outcomes beyond information gained from semistructured functional interviewing. Use of functional interviewing has the potential to improve efficiency of RTW assessment without compromising clinical, RTW, or compensation outcomes.

Novel clinical learning from a student-led clinic

Student‐led clinics have the potential to meet community rehabilitation needs and provide valuable clinical placement experiences. Student‐led clinical learning may offer pedagogical advantages similar to problem‐based learning; however, this line of research is new and little is known about student‐led clinical learning. The purpose of this study was to describe the novel learning experiences of a clinical placement in a student‐led clinic from student perspectives.

A framework for establishing connections in physiotherapy practice

ABSTRACT The therapeutic relationship between practitioner and patient is embedded in the clinical interaction. Research using self-report tools has illustrated that positively evaluated therapeutic relationships can have favorable impacts on patient satisfaction with services and clinical outcomes. However, little is known about how physiotherapists develop the connections, or positive attachments, that help establish the therapeutic relationship. This study aimed to identify the various ways that physiotherapists establish meaningful connections with their patients. Interpretive description, a qualitative methodology, was used to structure the inductive and iterative design. Eleven physiotherapists and 7 patients from private practice clinics participated in semi-structured interviews to describe their experiences of the therapeutic relationship. Textual data were analyzed using qualitative content analysis and constant comparison. The iterative data generation and analysis process resulted in a framework composed of three “ways” (i.e. categories) of establishing connections: (1) acknowledging the individual, (2) giving-of-self, and (3) using the body as a pivot point. Findings were supported by various rigor strategies including peer debrief and external audit. This framework demonstrates that establishing connections is a multi-faceted endeavor with personal and professional characteristics. The findings provide practical knowledge that can be used to guide clinicians, educators, and researchers in addressing the therapeutic relationship.

Measuring therapeutic relationship in the care of patients with haemophilia: A scoping review

We conducted a scoping review of the tools used to measure therapeutic relationship in patients with haemophilia.

Informing the Public: Preventing Work Disability and Fostering Behavior Change at the Societal Level

In the past decade, multi media campaigns have been held in several countries to change the general public’s maladaptive beliefs and behaviors about back pain and work disability. In this chapter, we will describe: (1) Previous campaigns and their results, (2) Key lessons learned from these campaigns, (3) The key questions remaining, and (4) Future research and strategies that should be attempted.