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- Title
Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study.
- Authors
Fuentes, Jorge; Armijo-Olivo, Susan; Funabashi, Martha; Miciak, Maxi; Dick, Bruce; Warren, Sharon; Rashiq, Saifee; Magee, David J.; Gross, Douglas P.
- Abstract
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.
- Subjects
HEALTH outcome assessment; ANALYSIS of variance; LUMBAR pain; CHRONIC pain; CONFIDENCE intervals; ELECTRIC stimulation; PATIENT-professional relations; MULTIVARIATE analysis; MYALGIA; PLACEBOS; QUESTIONNAIRES; RESEARCH funding; SCALE analysis (Psychology); STATISTICS; DATA analysis; EFFECT sizes (Statistics); PAIN measurement; PAIN tolerance; RANDOMIZED controlled trials; REPEATED measures design; BLIND experiment; SEVERITY of illness index; ALGOMETRY; DATA analysis software
- Publication
Physical Therapy, 2014, Vol 94, Issue 4, p477
- ISSN
0031-9023
- Publication type
Article
- DOI
10.2522/ptj.20130118