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Communication skills training for physiotherapists can provide
motivational basis for behavior change and serve as an important part in
complex interventions to promote patient adherence.
Chronic low back pain is a long-lasting disease that continues for more than three months. The patients with low back pain do not usually adhere to their physiotherapist's recommendations. This nonadherence may reduce the effectiveness of advice and home-based rehabilitation exercises.
Recently, a cluster randomized controlled trial was conducted to analyze the impact of an intervention designed to enhance physiotherapists' communication skills on patients' adherence to recommendations about home-based rehabilitation for chronic low back pain. Total participants (N=308) consisted of physiotherapists (n=53) and chronic low back pain patients (n=255; 54% female patients; mean age, 45.3 year). Publicly funded physiotherapy care was provided to all the patients. Patients in the control arm received care from the physiotherapist who had completed a 1-hour workshop conducted on evidence-based chronic low back pain management. In experimental arm, care was delivered by those physiotherapists who had finished 8 hours of communication skills training.
The primary outcome of the study was patient-reported adherence to their physiotherapists' recommendations about home-based rehabilitation estimated at 1, 4, 12, and 24 weeks after the first treatment session. The other outcome was pain and pain-related function measured at baseline and 4, 12, and 24 weeks.
The linear mixed model analysis reported that the rating of adherence was higher in experimental arm patients as compared to control (overall mean difference, .41; 95% confidence interval, .10–. patients72; d=.28; P=.01). Moderation analyses showed that men showed improvements in pain-related function over time regardless of the intervention. In the experimental arm, only women were found to have functional improvements while in control group women had little change in function over time. The Communication Style and Exercise Compliance in Physiotherapy intervention brought no effect on patients' pain, regardless of their sex.
The study
concludes that communication skills training for physiotherapists may provide
short-term positive effects on patient adherence. This type of training might
become a motivational criterion for behavior change and could be a valuable
part of difficult interventions to promote adherence. Communication skills
training can also bring improvement in some clinical outcomes for women, but not
for men.
Archives of Physical Medicine and Rehabilitation
Communication skills training for practitioners to increase patient adherence to home-based rehabilitation for chronic low back pain: Results of a cluster randomized controlled trial
Chris Lonsdale et al.
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