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“Works on every patient that walks in the door!” “Teaching things you can use with the first patient on Monday!” “I’ve been treating for X years and this system is effective!” What weekend course am I selling? Sounds like EVERY course you have ever gone to, right? #wisethoughts
Here’s the abrasive and controversial thought: they all kind of work, don’t they? Every time some PT brings back some new system or intervention, real excited about it, they use it on patients and the patients GET BETTER. It doesn’t seem to matter how hokey it is.
In our well-intended but desperate search to help our patients, can we stop to question what are alternative explanations for how what we do works? One common thread across all of PT might provide at least part of the answer: therapeutic alliance.
Quick definition for those new to the concept: agreement on the goals and tasks of treatment, and the formation of a personal bond between patient and provider. No @owens_dpt , this doesn’t mean to friend all your patients on MySpace.
This 2017 article was a scoping review with the goal of investigating the relationships between TA and adherence/outcomes and how TA is measured. 130 studies including 7k patients, 1.2k OT’s and 1k PT’s. Most studies contained both qualitative as quantitative assessments
Somewhat expectedly, there were 18 different models of TA in the review. So we don’t really agree as a profession on what it is. But do we all even agree on what an exercise program is? Or skilled MT? Not really. Key factors across models: congruence, connectedness, communication
How do we measure it? 27 different ways apparently. Most commonly used was the Working Alliance Inventory. It is validated to measure relationship between TA and adherence. Positive TA accounted for 18-23% improved adherence.
TA was found to correlate with reduced pain and disability and higher satisfaction. Highly correlated with improvements in pain and function in chronic LBP. TA had an effect on pain modulation in manual therapy, exercise, and electro physical agents. You can put it on everything!
I believe that it is UNETHICAL to promote an intervention that you know provides no significant or supported benefit to a patient while using TA to get a positive outcome anyway. We are healthcare providers and scientists, not sales people.
Please use this for Good PT’s! Remember Uncle Ben’s one line. Maximizing TA in your practice will maximize the non-specific effects of your treatment. Just don’t let that be the only effect you make.
