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Education with therapeutic alliance did not influence the improvement of symptoms of patients with chronic low back pain and low risk of poor prognosis compared to education without therapeutic alliance: a randomized controlled trial
Miyamoto GC, Ribeiro Cabral Fagundes F, de Melo do Espirito Santo C, Mendonca de Luna Teixeira F, Vanelli Tonini T, Turina Prado F, Nunes Cabral CM
The Journal of Orthopaedic and Sports Physical Therapy 2021 Aug;51(8):392-400
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To assess the effectiveness of an educational intervention with or without the addition of the therapeutic alliance in patients with nonspecific chronic low back pain (LBP) and low risk of poor prognosis. DESIGN: Randomized controlled trial. Randomization was performed using random generated numbers. METHODS: 222 patients with nonspecific chronic LBP and low risk of poor prognosis from two university physical therapy services in Taubate, Sao Paulo, were randomized into three groups: education plus therapeutic alliance, education only, no education. Primary outcomes were pain (measured with the Pain Numerical Rating Scale) and patient-specific disability (measured with the Patient-Specific Functional Scale) assessed one month after randomization. Patients, therapist, and assessors were not blinded due to the nature of intervention and self-reported outcomes. RESULTS: Patients were recruited between November 2015 and February 2017. There was a loss of 17 (7.6%) follow-up assessments at one-month, 28 (12.6%) at six-month, and 31 (13.9%) at 12-month after randomization and intention-to-treat analyses were conducted. There were no significant differences in pain between groups. However, there was a significant improvement in patient-specific disability for the education plus therapeutic alliance and education only groups compared to no education after one month (mean difference -1.41, 95% CI -2.31 to -0.51; and -0.95, 95% CI -1.85 to -0.04, respectively). CONCLUSION: Educational intervention did not confer clinically-relevant improvements in patient-specific disability, and did not influence pain in patients with nonspecific chronic LBP and low risk of poor prognosis. Additionally, there was no difference between intervention with or without emphasis on the therapeutic alliance.

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