Taccolini Manzoni Ana Carolina, Bastos de Oliveira Naiane Teixeira, Nunes Cabral Cristina Maria, Aquaroni Ricci Natalia
a Master's and Doctoral Program in Physical Therapy , Universidade Cidade de São Paulo (UNICID) , São Paulo - SP , Brazil.
Physiother Theory Pract. 2018 Dec;34(12):901-915. doi: 10.1080/09593985.2018.1431343. Epub 2018 Feb 5.
The aim of this systematic review was to investigate the role of therapeutic alliance in pain relief in patients with musculoskeletal disorders treated by physiotherapy. Manual and database searches (Medline, Embase, ISI Web of Knowledge, CINAHL, PEDro, Lilacs, Cochrane Library, and PsycINFO) were performed with no restrictions of language and publication date. We included prospective studies with samples of patients undergoing physiotherapy for musculoskeletal conditions, with one measure of therapeutic alliance and the outcome pain. Methodological quality was assessed by the Methodological Index for Nonrandomized Studies and the Cochrane tool for risk of bias. Six articles from four studies were included out of the 936 manuscripts identified. All studies used samples composed of patients with chronic low back pain. Two studies applied therapeutic alliance incentive measures during treatment and reported significant improvement in pain. The remaining studies, without alliance incentives, showed divergence regarding the relationship between the therapeutic alliance and pain. Methodological quality analysis determined low risk of bias of the studies. A lack of studies on the therapeutic alliance regarding musculoskeletal physiotherapy was verified. Existing studies fail to provide evidence of a strong relationship between the therapeutic alliance and pain relief.
本系统评价的目的是研究治疗联盟在接受物理治疗的肌肉骨骼疾病患者疼痛缓解中的作用。进行了手工检索和数据库检索（Medline、Embase、ISI 科学网、CINAHL、PEDro、Lilacs、Cochrane 图书馆和 PsycINFO），不受语言和出版日期的限制。我们纳入了对接受肌肉骨骼疾病物理治疗的患者样本进行的前瞻性研究，其中一项测量指标为治疗联盟，另一项为疼痛结局。采用非随机研究方法学指标和Cochrane偏倚风险工具评估方法学质量。在识别出的936篇手稿中，纳入了来自四项研究的六篇文章。所有研究均使用由慢性下腰痛患者组成的样本。两项研究在治疗期间采用了治疗联盟激励措施，并报告疼痛有显著改善。其余未采用联盟激励措施的研究，在治疗联盟与疼痛的关系上存在分歧。方法学质量分析确定这些研究的偏倚风险较低。证实了关于肌肉骨骼物理治疗中治疗联盟的研究不足。现有研究未能提供治疗联盟与疼痛缓解之间存在密切关系的证据。
