Abstract
Objective
To assess the effect of an intervention designed to enhance physiotherapists' communication
skills on patients' adherence to recommendations regarding home-based rehabilitation
for chronic low back pain.
Design
Cluster randomized controlled trial.
Setting
Publicly funded physiotherapy clinics.
Participants
A sample (N=308) of physiotherapists (n=53) and patients with chronic low back pain
(n=255; 54% female patients; mean age, 45.3y).
Interventions
Patients received publicly funded individual physiotherapy care. In the control arm,
care was delivered by a physiotherapist who had completed a 1-hour workshop on evidence-based
chronic low back pain management. Patients in the experimental arm received care from
physiotherapists who had also completed 8 hours of communication skills training.
Main Outcome Measures
(1) Patient-reported adherence to their physiotherapists' recommendations regarding
home-based rehabilitation measured at 1, 4, 12, and 24 weeks after the initial treatment
session. (2) Pain and pain-related function measured at baseline and at 4, 12, and
24 weeks.
Results
A linear mixed model analysis revealed that the experimental arm patients' ratings
of adherence were higher than those of controls (overall mean difference, .41; 95%
confidence interval, .10–.72; d=.28; P=.01). Moderation analyses revealed that men, regardless of the intervention, showed
improvements in pain-related function over time. Only women in the experimental arm
showed functional improvements; female controls showed little change in function over
time. The Communication Style and Exercise Compliance in Physiotherapy intervention
did not influence patients' pain, regardless of their sex.
Conclusions
Communication skills training for physiotherapists had short-term positive effects
on patient adherence. This training may provide a motivational basis for behavior
change and could be a useful component in complex interventions to promote adherence.
Communication skills training may also improve some clinical outcomes for women, but
not for men.
Keywords
List of abbreviations:
CONNECT (Communication Style and Exercise Compliance in Physiotherapy)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: March 28, 2017
Footnotes
Supported by the Health Research Board of the Republic of Ireland (grant no. HRA_POR/2010/102).
Clinical Trial Registration No.: ISRCTN63723433.
Disclosures: Geoffrey C. Williams has consulted with Pfizer and was a medical director with Self-Determined Health, Florida (outside the research reported in this article). The other authors have nothing to disclose.
Identification
Copyright
Crown Copyright © 2017 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
