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; Amanda M Hall; Aileen Murray; Geoffrey C Williams; Suzanne M McDonough; Nikos Ntoumanis; Katherine Owen; Ralf Schwarzer; Phillip Parker; Gregory S Kolt; Deirdre A Hurley

doi:10.1016/j.apmr.2017.02.025

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

Arch Phys Med Rehabil. 2017 Sep;98(9):1732-1743.e7. doi: 10.1016/j.apmr.2017.02.025. Epub 2017 Mar 28.

Authors

Affiliations

¹ Australian Catholic University, Strathfield, New South Wales, Australia. Electronic address: Chris.Lonsdale@acu.edu.au.
² Oxford University, Oxford, United Kingdom.
³ University College Dublin, Belfield, Dublin 4, Ireland.
⁴ University of Rochester, Rochester, New York.
⁵ Ulster University, Newtownabbey, United Kingdom.
⁶ Curtin University, Bentley, Western Australia, Australia.
⁷ Australian Catholic University, Strathfield, New South Wales, Australia.
⁸ Western Sydney University, Sydney, New South Wales, Australia.

PMID: 28363702
DOI: 10.1016/j.apmr.2017.02.025

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: Competence; Compliance; Motivation; Rehabilitation; Self care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Chronic Pain / psychology
Chronic Pain / rehabilitation
Cluster Analysis
Female
Health Communication / methods*
Humans
Low Back Pain / psychology*
Low Back Pain / rehabilitation
Male
Middle Aged
Patient Compliance
Physical Therapists / education*
Physical Therapy Modalities / psychology*
Professional-Patient Relations
Self Care / methods
Self Care / psychology*
Treatment Outcome
Young Adult

Associated data

ISRCTN/ISRCTN63723433