Can Aspects of Physiotherapist Communication Influence Patients' Pain Experiences? A Systematic Review

Abstract

Aim: Todetermine whether the empirical evidence exists, to support the suggestions that 'aspects of physiotherapist-patient communication can influence the patients' pain experience'.

Design: A systematic review. Database searches were conducted using: Medline, Cinahl, PsycINFO, AMED, Cochrane controlled register and Pedro. Articles were screened for inclusion according to criteria determined by the authors. A total of 1125 abstracts were identified as potentially suitable studies from the database searches. A random sample of 225 abstracts were screened by a second researcher and agreement reached.

Results: Eight studies met the inclusion criteria for effects of physiotherapist communication on pain experiences. Sample sizes ranged from 5 to 26 participants. With the exception of one study (being set within a hospital), all were performed within a laboratory environment. The methodological quality varied considerably within the studies. The highest scoring study achieved 7 (out of a possible 10), and the lowest achieved 3.5. All of the studies provide some support to the suggestion that physiotherapist communication can influence the pain experience. This may be achieved by reinforcement (verbal and visual), distraction, paying attention to the pain, and analgesic suggestions (placebo). However, due to the lack of studies conducted prospectively within a clinical setting, which involve a direct interaction between physiotherapist and patient, the authors acknowledge the results cannot be generalised to this population.

Conclusion: This systematic review suggests that elements of physiotherapist communication have the potential to alter patients' pain experiences. This compares favourably with the general views expressed within the literature. However, the review highlights the need for welldesigned, randomised trials, within a clinical setting, which examine the effects of different types of physiotherapist communication on patients' pain experiences.