The relationship between patient and therapist and patients' perception of illness can enhance treatment effect

By Louise Fleng Sandal, Associate Professor at the Department of Sports and Biomechanics, University of Southern Denmark.

In the article 'Impact of contextual factors on patient outcome following conservative low back pain treatment: systematic review', British researchers examine the influence contextual factors have on the effect of non-pharmacological treatment of low back pain through a comprehensive and systematic review of scientific literature. Contextual factors can be understood as the physical, psychological and social aspects that are part of the context surrounding a treatment. They are divided into 5 categories: 1) the patient's beliefs/attitudes and characteristics, 2) the therapist's beliefs/attitudes and characteristics, 3) the patient-therapist relationship, 4) the surrounding physical environment and 5) the characteristics of the treatment.

The systematic review showed that most research deals with how modulating the patient's belief/attitude and characteristics, and the patient-therapist relationship can enhance the effect of the non-pharmacological treatment. Examples of this are changing the patient's inappropriate or erroneous perception of illness using cognitive strategies for managing thought patterns or emotional responses. Examples of modulating the patient-therapist relationship are the use of communication techniques (active listening, paraphrasing, verbal encouragement), as well as empathic and sincere interaction between patient and therapist. The study concludes that there is evidence that contextual factors can enhance the effect of the non-pharmacological treatment on pain and functional level for low back patients and that the factors must be seen as tools to enhance the therapeutic effect.

As a clinician and therapist, you might think "isn't this common knowledge?" Perhaps, but the good patient-therapist relationship comes in many guises and many factors can be decisive. Literature studies like this map our current knowledge in the field, but also show that there is currently very little knowledge about how the surrounding physical environment affects treatment, and that there is no research into how the therapist's own beliefs/attitude and characteristics influence treatment. Therefore, we need a systematic approach and continued research on contextual factors to identify the most reliable and effective factors and then work on how they can be transferred to clinical practice both in Denmark and internationally.

Bronwyn Sherriff, Carol Clark, Clair Killingback, Dave Newell. Impact of contextual factors on patient outcome following conservative low back pain treatment: systematic review. Chiropractic and Manual Therapies.