Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study
| العنوان: | Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study |
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| المؤلفون: | Dawn Carnes, Miznah Al-Abbadey, Katherine Bradbury, Carol Fawkes, Hugh MacPherson, Lisa Roberts, Lucy Yardley, Felicity L. Bishop, Beth Stuart |
| المصدر: | Bishop, F, Al-Abbadey, M, Roberts, L, MacPherson, H, Stuart, B, Carnes, D, Fawkes, C, Yardley, L & Bradbury, K 2021, ' Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study ', BMJ Open, vol. 11, no. 5, e044831 . https://doi.org/10.1136/bmjopen-2020-044831 BMJ Open, Vol 11, Iss 5 (2021) BMJ Open Bishop, F, Al-Abbadey, M, Roberts, L, MacPherson, H, Stuart, B, Carnes, D, Fawkes, C, Yardley, L & Bradbury, K 2021, ' Direct and mediated effects of treatment context on low back pain outcome : a prospective cohort study ', BMJ Open, vol. 11, no. 5, e044831 . https://doi.org/10.1136/bmjopen-2020-044831 |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Adult, medicine.medical_specialty, Psychological intervention, back pain, Context (language use), Rehabilitation Medicine, 03 medical and health sciences, primary care, 0302 clinical medicine, Patient satisfaction, medicine, Back pain, complementary medicine, Humans, 030212 general & internal medicine, Prospective Studies, Physical Therapy Modalities, business.industry, General Medicine, Low back pain, Therapeutic relationship, Distress, Treatment Outcome, Osteopathic Physicians, Physical therapy, Medicine, Physical and Mental Health, medicine.symptom, business, Psychosocial, Low Back Pain, 030217 neurology & neurosurgery, Osteopathic Medicine |
| الوصف: | ObjectivesContextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches.DesignProspective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months.SettingPhysiotherapy, osteopathy and acupuncture clinics throughout the UK.Participants166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP).Primary and secondary outcomesThe primary outcome was back-related disability. Secondary outcomes were pain and well-being. Contextual components measured were: therapeutic alliance; patient satisfaction with appointment systems, access, facilities; patients’ treatment beliefs including outcome expectancies; practitioners’ attitudes to LBP and practitioners’ patient-specific outcome expectancies. The hypothesised mediators measured were: patient self-efficacy for pain management; patient perceptions of LBP and psychosocial distress.ResultsAfter controlling for baseline and potential confounders, statistically significant predictors of reduced back-related disability were: all three dimensions of stronger therapeutic alliance (goal, task and bond); higher patient satisfaction with appointment systems; reduced patient-perceived treatment credibility and increased practitioner-rated outcome expectancies. Therapeutic alliance over task (ηp2=0.10, 95% CI 0.07 to 0.14) and practitioner-rated outcome expectancies (ηp2=0.08, 95% CI 0.05 to 0.11) demonstrated the largest effect sizes. Patients’ self-efficacy, LBP perceptions and psychosocial distress partially mediated these relationships. There were no interactions with treatment approach.ConclusionsEnhancing contextual components in musculoskeletal healthcare could improve patient outcomes. Interventions should focus on helping practitioners and patients forge effective therapeutic alliances with strong affective bonds and agreement on treatment goals and how to achieve them. |
| وصف الملف: | application/pdf; text |
| اللغة: | English |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0f0c8f387a322a5b85791b521c1d960e https://researchportal.port.ac.uk/ws/files/27710130/Bishop2021_BMJ_Open_mocam_final.pdf |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....0f0c8f387a322a5b85791b521c1d960e |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |