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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