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Table 2 Description of included cohort studies and one Randomized controlled study

From: Does working alliance have an influence on pain and physical functioning in patients with chronic musculoskeletal pain; a systematic review

Author

−Country, Number of patients (% female), Inclusion criteria, Age (y) Mean(SD), Duration of pain (mnth), Mean(SD), Intervention, therapists

Working alliance

Dependent variable measurement

Influence of Working alliance

 
  

Pre

Post

r

B-value

R2

Qality

Cohort studies

      

Higdon [28] 1997 Cohort

  

Pain

 

3 months after therapy end

  

14/22

−United States of Amerika (Illinois)

−Work hardening programm of Healthsouth.

−53

−%♂♀:na

−>3 mnth MSP

−Age 39.98 (11.59)

−Pain duration 8.36 (5.86)

−Individual program with aerobic and various strengthening exercises

−Delivered by female occupational therapists and a case manager

−5 days a week for 2–6 h daily

−Total 4–6 weeks of treatment

WAI 12-item (12–60) 8 days after start of treatment

Pain Severity (MPI) (0–7)

3.19 (1.11)

2.92 (1.22)

 

na

na

 

Pain Interference (MPI) (0–7)

3.70 (1.16)

3.23 (1.32)*

 

na

na

 

Activity

 

Therapy end

    
 

Floor/Bench

44.58 (22.50)

54.97 (21.59)*

.27*

.26

.07*

 
 

Overhead lift

31.33 (12.85)

40.83 (13.56)*

ns

np

np

 

Push/Pull

66.81 (15.40)

74.42 (22.67)*

ns

np

np

 

Carrying

43.57 (21.72)

55.39 (23.42)*

ns

np

np

 

Bliss [29] 2009 Cohort

  

Pain

 

Therapy end

  

17/22

−United States of Amerika (Indiana)

−Outpatient rehabilitation clinics and multidisciplinary pain clinics

−59

−67 %♀

−>3 mnth CLBP

−Age 47.47 (14.14)

−Pain duration 74.36 (83.76)

−Exercises, not specifically mentioned

−Delivered by Physical Therapists

−Total 5 weeks

WAI 12-item (12–60) 5 weeks after start of treatment

Pain severity (BPI) (0–40)

 

Change 4.21 (9.3)*

.29*

.29

.08*

 

Pain Interference (BPI)(0–70)

 

Change 4.95 (13.8) (ns)

.29*

.30

.08*

 

Farin [30] 2012 Cohort

  

Pain

 

Therapy end

 

Risk factor

 

20/22

−Germany (several regions)

−Inpatient and outpatients orthopedic rehabilitation centers

−688

−57.2 %♀

−497 employed

−>6 mnth CLBP

−Age 51.0 (11.2)

−Pain duration 13.0 % (<12 mnth), 29.7 (12–60 mnth), 56.5 % (>72 mnth), 0.8 % unknown

−Various interventions. Aerobic, strengthening

−Delivered by various professional groups (physicians, physical-, occupational-, and sport therapists, psychologists)

−3 weeks, 4–5 therapy sessions a day on workdays

PHYSAT (0–10) At the end of therapy

Pain severity (VAS (0–100)

52.9 (22.7)

41.35 (22.77)

na

1.44*a

  

6 months after

6 months after

40.22 (36.04)

1.15*a

 

Activity

 

Therapy end

    
 

ODI (0–100)

31.11 (15.87)

26.15 (15.96)

na

1.23*

  

6 months after

 

6 months after

23.9 (17.14)

.75*

Ferreira [5] 2013 Cohort

  

Pain

   

Therapy end

20/22

−Australia (Sydney)

−Outpatient hospital physical therapy departments

−182

−♀(70.0 % GE, 66.3 % MCE, 70.0 % SMT)

−>3mth CLBP

−Age 54.2(15.4)

−Pain duration median 60 (GE), 36 (MCE), 84 (SMT)

−General exercise (GE), or Motor control exercise (MCE), or spinal manipulation (SMT)

−Delivered by 7 experienced physical therapists

−8 weeks 12 sessions of treatment

WATOCI (16–112) 2nd treatment

Pain severity VAS (0–10)

GE 6.5 (2.1)

MCE 6.3 (2.0)

SMT 6.2 (2.0)

na

na

na

-.04 95 % CI (−.070 to -.017)*

 

Activity

      
 

RMDQ (0–24)

GE 13.9 (5.4) MCE 14.0 (5.3) SMT 12.4 (5.8)

na

na

na

-.11 95 % CI (−.166 to -.060)*

Randomized Controlled Trial

     

Fuentes [31] 2014 RCT

  

Pain

 

1st treatment session

 

9/10

−Canada (Edmonton)

−Sport physical therapy laboratory

−59

−I (n = 29) 65.5 % ♀

−C (n = 30) 60.0 %♀

−>3 Mo CLBP

−Age, I 29.7(11.33); C 30.5(10.26)

−Pain duration, I 51.21(38.30); C 45.3 (56.76)

−I One interferential therapy during 30 min. at comfortable sensory level

−C One interferential therapy and a 10 min. working alliance interventionb

−Delivered by 3 experienced female physical therapists that were trained in patient-therapeutic interactions by a clinical psychologist

 

Pain severity NRS (0–10)

I: 4.03 (0.92)

I: 0.89 (0.98)

  

C: 4.01 (0.91)

C: 2.18 (1.17)

MD: −12.949, 95 % CI (−18.766 to −7.132)*

Muscle pain sensitivity PPT

I: 4.11 (1.8)

I: 6.21 (2.6)

  

C: 3.89 (1.8)

C: 5.15 (2.6)

MD: −0.856, 95 % CI(−1.682 to −0.030) after Bonferroni correction ns

  1. N number of participants, * sign difference (p < 0.05), ns not significant; na, not applicable ( not mentioned or analyses is not performed), BPI, Brief Pain Inventory pain severity scale and pain interference scale on functioning. (rate the level of interference that pain has caused in the last 24 h on specific domains of functioning like general activity, work etc. ), PHYSAT consisting of 3 items (the physician showed empathy and understanding; the physician explained my symptoms in a way I understood; the physician arranged the proper therapy for me. PPT ( kg/cm3/s), pressure pain threshold, CI confidence interval, WATOCI Working alliance Theory of Change Inventory, RMDQ Roland-Morris Disability Questionnaire (0–24), ODI Oswestry Disability Index; ccohort study; RCT Randomized controlled trail, MSP musculoskeletal pain, Mnth months, y, years, r, correlation, R 2 regression coefficient; a, predictor’s regression coefficient (Risk factor); b, 10 min questioned and therapeutic interaction was enhanced through verbal behaviours including active listening, tone of voice, nonverbal behaviors and empathy, to create an optimal clinician patient relationship; PT physical therapist; MD mean difference; I intervention group IFT with working alliance, CControl group IFT without working alliance; np not performed, for those variable demonstrating no significant relationships no regression analysis was performed