The role of the therapeutic alliance on pain relief in musculoskeletal rehabilitation: A systematic review

• Published in: Physiotherapy theory and practice Vol. 34; no. 12; pp. 901 - 915
• Main Authors: Taccolini Manzoni, Ana Carolina, Bastos de Oliveira, Naiane Teixeira, Nunes Cabral, Cristina Maria, Aquaroni Ricci, Natalia
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02-12-2018; Taylor & Francis Ltd
• Subjects: Bias; Chronic back pain; Chronic low back pain; Humans; Musculoskeletal conditions; Musculoskeletal diseases; Musculoskeletal Diseases - therapy; Pain; Pain Management; Physiotherapy; Prospective studies; Rehabilitation; Research methodology; Systematic review; Therapeutic Alliance; Therapeutic alliances; pain; rehabilitation; therapeutic alliance; physiotherapy; Musculoskeletal conditions
• ISSN: 0959-3985; 1532-5040
• DOI: 10.1080/09593985.2018.1431343

The aim of this systematic review was to investigate the role of therapeutic alliance in pain relief in patients with musculoskeletal disorders treated by physiotherapy. Manual and database searches (Medline, Embase, ISI Web of Knowledge, CINAHL, PEDro, Lilacs, Cochrane Library, and PsycINFO) were performed with no restrictions of language and publication date. We included prospective studies with samples of patients undergoing physiotherapy for musculoskeletal conditions, with one measure of therapeutic alliance and the outcome pain. Methodological quality was assessed by the Methodological Index for Nonrandomized Studies and the Cochrane tool for risk of bias. Six articles from four studies were included out of the 936 manuscripts identified. All studies used samples composed of patients with chronic low back pain. Two studies applied therapeutic alliance incentive measures during treatment and reported significant improvement in pain. The remaining studies, without alliance incentives, showed divergence regarding the relationship between the therapeutic alliance and pain. Methodological quality analysis determined low risk of bias of the studies. A lack of studies on the therapeutic alliance regarding musculoskeletal physiotherapy was verified. Existing studies fail to provide evidence of a strong relationship between the therapeutic alliance and pain relief.