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Abstract
The relationship between physiotherapist and patient is very important in the outcome of treatment, affecting both pain and disability. The aim of this paper is to review the evidence for the effects of the interaction. These can conveniently be described by a number of different models including: (1) the quality of communication and patient education; (2) compliance and adherence to a treatment programme; (3) self-efficacy or the patient's perception of control over the problem and ability to cope; (4) the patient's expectations and the physiotherapist's enthusiasm for the treatment; and (5) the principles of operant conditioning in influencing pain behaviour.
The physiotherapist has an opportunity to build rapport with a patient and affect both attitudes and behaviour, for example encouraging individuals to take control of their problem and take up a graded return to previous activities. Self-efficacy is now accepted as an important component of health care which needs to be emphasised by the therapist. Conversely, care needs to be taken to avoid inadvertently increasing pain behaviour by focusing on the patient's pain complaint and reinforcing it through its repeated assessment.