Associations between alliance, physiotherapists’ confidence in managing the patient and patient-reported distress in chronic low back pain practice

Abstract

Purpose

Physiotherapists often feel insecure when managing patients with chronic low back pain associated with psychological factors. This uncertainty could hinder physiotherapists in fostering strong patient-therapist alliances in chronic low back pain practice. The purpose of this study was to explore associations between patient-rated alliance, physiotherapists’ self-reported confidence in managing the patient and patient-reported psychological distress.

Methods

Patients with chronic low back pain (N = 21) self-reported their psychological status at baseline. After the intake session, physiotherapists self-reported their confidence (enthusiasm and competence) in managing the patient with chronic low back pain. Patient-rated alliance was measured after the third physiotherapy session. A linear mixed model estimated associations between alliance (dependent variable), physiotherapists’ confidence and patient-reported distress.

Results

The linear mixed model estimated a positive interaction effect (therapist confidence × patient distress) on patient-rated alliance (estimated effect, β = 0.15; 95% Confidence Interval = 0.03–0.27).

Conclusions

Higher self-reported confidence in managing the patient with chronic low back pain by physiotherapists was associated with higher patient-reported alliance after the third physiotherapy sessions. The positive effect between therapist confidence and patient-rated alliance appeared to be dependent on patient-reported psychological distress at baseline.

Keywords:

• Chronic pain
• low back pain
• physiotherapy
• alliance
• therapeutic relationship
• psychological factors

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The research was supported by funding from the Swiss Physiotherapy Association (physioswiss).