Communication Skills Training for Practitioners to Increase Patient Adherence to Home-based Rehabilitation for Chronic Low Back Pain: Results of a Cluster Randomized Controlled Trial

Publication date: Available online 28 March 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chris Lonsdale, Amanda M. Hall, Aileen Murray, Geoffrey C. Williams, Suzanne M. McDonough, Nikos Ntoumanis, Curtin University, Katherine Owen, Ralf Schwarzer, Phillip Parker, Gregory S. Kolt, Deirdre A. Hurley
ObjectiveTo assess the effect of an intervention designed to enhance physiotherapists' communication skills on chronic low back pain patients' adherence to home-based rehabilitation recommendations.DesignCluster randomized controlled trial.SettingPublicly funded physiotherapy clinics in Dublin, Ireland;ParticipantsPhysiotherapists (N = 53) and patients with chronic low back pain (N = 255, 54% female, M age = 45.3 years).Interventions.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 communications skills training.Main Outcome Measure.Patient-reported adherence to their physiotherapist's recommendations regarding home-based rehabilitation, measured at 1, 4, 12, and 24 weeks after initial treatment session. Pain and pain-related function measured at baseline, 4, 12 and 24 weeks.ResultsLinear mixed model analysis showed the experimental arm patients' ratings of adherence were greater than controls (overall mean difference = .41 [95% CI = .10 to .72, d = .28, p = .01). Moderation analyses showed that men, regardless of intervention, showed improvements in pain-related function over time. Only women in the experimental condition showed functional improvements; female controls saw little change in function over time. The CONNECT intervention did not influence patients' pain, regardless of their sex.ConclusionsCommunication 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 men. Trial registration: ISRCTN63723433.



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