The relationship between trust and outcomes during physical therapy care for chronic low back pain

Introduction Enhancing the therapeutic alliance has been associated with improved outcomes for patients with chronic low back pain (CLBP). Qualitatively trust has been described to be part of the therapeutic alliance, but it has not been measured quantitatively within the physical therapy literature. Objective Examine the relationship between trust and outcomes during physical therapy for CLBP. Methods Observational study of patients with CLBP being seen for physical therapy were assessed through self-report measures. The Primary Care Assessment Survey (PCAS) trust measurement scale was completed by patients at initial, post-initial, and discharge visit. These measurements were compared for correlations with patient reported outcome measures for pain and function recorded at initial visit and discharge. Results A convenience sample of 29 patients (49.3 +/- 15 years old) with CLBP were measured. The PCAS showed correlations for changes in trust throughout treatment for improvements in pain and discharge pain rating. Average discharge pain rating correlated to changes in the PCAS (r(s) = -0.692, p < .001), with lower pain ratings relating to higher changes in trust over time. Average change in pain (r(s) = 0.745, p < .001) throughout treatment also correlated with higher changes in trust. Higher trust scores at discharge also correlated with improved Global Rating of Change and Oswestry Disability Index scores at discharge. The linear regression model showed adjusted R-2 values for the trust scores and outcomes varied between 0.247 and 0.642. Conclusion Both increases in trust throughout the treatment and end trust scores during physical therapy were related to improved outcomes for patients with CLBP.