Lonsdale Chris, Hall Amanda M, Murray Aileen, Williams Geoffrey C, McDonough Suzanne M, Ntoumanis Nikos, Owen Katherine, Schwarzer Ralf, Parker Phillip, Kolt Gregory S, Hurley Deirdre A
Australian Catholic University, Strathfield, New South Wales, Australia.
Oxford University, Oxford, United Kingdom.
Arch Phys Med Rehabil. 2017 Sep;98(9):1732-1743.e7. doi: 10.1016/j.apmr.2017.02.025. Epub 2017 Mar 28.
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.
Cluster randomized controlled trial.
Publicly funded physiotherapy clinics.
A sample (N=308) of physiotherapists (n=53) and patients with chronic low back pain (n=255; 54% female patients; mean age, 45.3y).
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.
(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.
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.
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.
评估一项旨在提高物理治疗师沟通技巧的干预措施对患者坚持慢性下腰痛居家康复建议的影响。
整群随机对照试验。
公共资助的物理治疗诊所。
抽取了物理治疗师（n = 53）和慢性下腰痛患者（n = 255；54%为女性患者；平均年龄45.3岁）作为样本（N = 308）。
患者接受公共资助的个体化物理治疗。在对照组，由完成了1小时循证慢性下腰痛管理工作坊的物理治疗师提供治疗。试验组的患者接受同样完成了8小时沟通技巧培训的物理治疗师的治疗。
（1）患者报告的在初次治疗 session 后1、4、12和24周坚持物理治疗师关于居家康复建议的情况。（2）在基线以及4、12和24周时测量的疼痛及与疼痛相关的功能。
线性混合模型分析显示，试验组患者的依从性评分高于对照组（总体平均差异为0.41；95%置信区间为0.10 - 0.72；d = 0.28；P = 0.01）。调节分析显示，无论干预措施如何，男性患者与疼痛相关的功能随时间推移均有改善。只有试验组的女性患者显示出功能改善；女性对照组的功能随时间变化不大。物理治疗中的沟通方式与运动依从性干预对患者的疼痛没有影响，无论其性别如何。
对物理治疗师进行沟通技巧培训对患者的依从性有短期积极影响。这种培训可能为行为改变提供动机基础，并且可能是促进依从性的复杂干预措施中的一个有用组成部分。沟通技巧培训也可能改善女性的一些临床结局，但对男性则不然。
