Background & Aims

Enhanced therapeutic alliance (TA) has been shown to improve the effectiveness of electrotherapy in decreasing pain and increasing pressure pain thresholds in people with chronic low back pain. However, the effects of TA during while applying exercises in patients with knee osteoarthritis are unknown. The purpose of this study was to determine the effects of different levels of TA during the three exercise sessions on pain intensity and pressure pain threshold (PPT) in patients with symptomatic knee osteoarthritis.

Methods

Randomized, parallel, two-arm clinical trial in the recruitment phase. Patients with symptomatic knee osteoarthritis aged 45-65 years, with pain intensity between 4-7 points on the numerical pain scale and lasting at least 3 months, were included. Participants were randomly assigned to an exercise group plus enhanced TA (active listening, personalized conversation, empathy) or limited TA (one-way verbalization, brief interaction). Two physical therapists were trained to generate the two TA levels during the exercise sessions. The exercise protocol considered a personalized dose of aerobic, mobility, and resistance exercise. The primary outcome measures were pain intensity during movement (VAS) and PPTs at the medial joint line of the symptomatic knee (pressure algometry). Disability was considered a secondary outcome measure (WOMAC). Repeated measures ANOVA with post hoc Bonferroni was used to determine differences between groups before and after interventions.

Results

Twenty participants were included in this preliminary report (55±6.6 years, 15 women, 5 men, 66.6±75.6 months with pain). Eleven participants were assigned to the enhanced TA and nine to the limited TA. The mean differences for pain intensity during movement were -4.10 cm (CI 95%=2.23 to 5.96; p<0.001; d=1.48) and -3.93 cm (CI 95%=1.70 to 6.17; p=0.004; d=1.35) for the enhanced TA and limited TA groups, respectively. The mean differences for PPT were 0.7 kg/cm2 (CI 95%=1.46 to 0.03; p=0.06; d=0.64) and 0.96 kg/cm2 (CI 95%=2.3 to 0.38; p=0.14; d=0.39) for the enhanced TA and limited TA groups, respectively. There were no differences between groups for pain intensity on movement (p=0.58) and PPT (p=0.36). The mean differences for disability were -17.00 points for the enhanced TA group (CI 95%=9.85 to 24.15; p<0.001; d=1.59) and -15.78 points (CI 95%=8.76 to 22.79; p<0.001; d=1.72) for the limited TA group, with no differences between groups post-intervention (p=0.29).

Conclusions

Preliminary results show that there are no differences between an exercise program with enhanced or limited TA. In both groups, clinically significant improvements were observed with only three exercise sessions in pain with movement and disability.

References

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Babatunde F, MacDermid J, MacIntyre N. Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature. BMC Health Serv Res. 2017 May 30;17(1):375.
Cuyul-Vásquez I, Fuentes C J. Effects of therapeutic alliance on clinical outcomes in patients with symptomatic knee osteoarthritis undergoing an exercise program: A randomized clinical trial protocol. Medwave. 2021 Apr 16;21(3):e8160. English. doi: 10.5867/medwave.2021.03.8159.
Kinney M, Seider J, Beaty AF, Coughlin K, Dyal M, Clewley D. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2020 Aug;36(8):886-898.
Cuyul-Vásquez I, Barría JA, Perez NF, et al. The influence of verbal suggestions in the management of musculoskeletal pain: a narrative review. Phys Ther Rev Published Online First: 2019
Fuentes J, Armijo-Olivo S, Funabashi M, Miciak M, Dick B, Warren S, Rashiq S, Magee DJ, Gross DP. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther. 2014 Apr;94(4):477-89. doi: 10.2522/ptj.20130118.

Presenting Author

Iván Cuyul-Vásquez or Felipe Araya Quintanilla

Poster Authors

Iván Cuyul-Vásquez, PT, MSc

BPT, MsC. PhD (C)

Dpto. de Procesos Terapéuticos, Facultad de Cs. de la salud. Universidad Católica de Temuco, Chile

Lead Author

Michelle Lacoste

BPT

Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile

Lead Author

Diego Bielefeldt

BPT

Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile

Lead Author

Felipe Araya-Quintanilla

BPT. MsC. PhD.

Escuela de Kinesiología, Fac. de Odontología y Cs. de la Rehabilitación, Universidad San Sebastián.

Lead Author

Matías Cuyul-Vásquez

BM.

Facultad de Medicina, Universidad de La Frontera, Chile.

Lead Author

Jorge Fuentes

BPT

Departamento de Kinesiología, Laboratorio de Investigación Clínica, Universidad Católica del Maule.

Lead Author

Topics

  • Patient Engagement and Co-Creation in Research and Education