Working Alliance Inventory (WAI) and its relationship to patient-reported outcomes in painful musculoskeletal conditions

Disability and Rehabilitation · 2022 · 23 citations

• Physical therapy
• Medicine
• Psychology

PURPOSE: Therapeutic alliance (TA) has been positively correlated to improvements in patient outcomes. This study examined the Working Alliance Inventory (WAI) relationship with changes in disability and pain intensity for patients receiving physical therapy (PT) treatment for acute and chronic musculoskeletal pain conditions. METHODS: -tests compared WAI scores across categorical variables. RESULTS: WAI scores were higher for those meeting MCIDs on PROM and NPRS compared to those who did not. WAI scores were significantly correlated with improvement on region-specific outcome measures and NPRS. Regression analysis found the patient rating of the TA to be a positive predictor for improvement on regions specific outcome measures and NPRS. CONCLUSIONS: Patients who rated the TA higher were more likely to meet the MCID for region-specific disability and pain intensity. Patient ratings of the TA were associated with improved change scores on pain rating and standardized outcome measures during a course of treatment for musculoskeletal pain conditions.Implications for rehabilitationPatients' early rating of the therapeutic alliance (TA) is associated with improvements seen on pain and functional outcomes.Physical therapists should assess the TA and use strategies to enhance the alliance to optimize patient's experiences with physical therapy.

Quadriceps Strength After Anterior Cruciate Ligament Reconstruction Compared With Uninjured Matched Controls: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine · 2021 · 56 citations

• Medicine
• Physical medicine and rehabilitation
• Physical therapy

BACKGROUND: The limb symmetry index may overestimate the recovery of quadriceps muscle strength after anterior cruciate ligament reconstruction. Comparison of individuals who have had anterior cruciate ligament reconstruction with age-, sex-, and activity-matched individuals might be more appropriate to guide rehabilitation interventions. PURPOSE: To compare the quadriceps strength between the injured limb of people with anterior cruciate ligament reconstruction and the limb of an age-, sex-, and activity-matched control group. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: MEDLINE, CINAHL, EMBASE, SCOPUS, and SPORTDiscus were searched between inception and April 2019. Studies were included if they reported the peak quadriceps strength for persons with anterior cruciate ligament reconstruction and age-, sex-, and activity-matched control groups measured using isometric or isokinetic dynamometry. Risk of bias was assessed, and meta-analyses and metaregression (for effect of time since surgery) were performed. RESULTS: < .001). CONCLUSION: In people with anterior cruciate ligament reconstruction, the injured limb had lower quadriceps strength compared with the limb of age-, sex-, and activity-matched controls up to 4 years after surgery. Clinicians should consider comparison with matched cohorts for return to sports decision making.

Association of Physical Therapy Interventions With Long-term Opioid Use After Total Knee Replacement

JAMA Network Open · 2021 · 15 citations

• Medicine
• Physical therapy
• Internal medicine

Importance: Many individuals who undergo total knee replacement (TKR) become long-term opioid users after TKR. Associations of physical therapy (PT) interventions before or after TKR with long-term use of opioids are not known. Objectives: To evaluate associations of PT interventions before and after TKR with long-term opioid use after TKR. Design, Setting, and Participants: This cohort study used data from the OptumLabs Data Warehouse on 67 322 individuals aged 40 years or older who underwent TKR from January 1, 2001, to December 31, 2016, stratified by history of opioid use. The analyses for the study included data from January 1, 1999, to December 31, 2018. Exposures: Any PT interventions within 90 days before or after TKR, post-TKR PT dose as number of sessions (ie, 1-5, 6-12, and ≥13 sessions), post-TKR PT timing as number of days to initiation of care (ie, <30 days, 31-60 days, or 61-90 days after TKR), and post-TKR PT type (ie, active vs passive). Main Outcomes and Measures: The association of pre- and post-TKR PT with risk of long-term opioid use occurring more than 90 days after TKR was assessed using logistic regression while adjusting for confounders, including age, sex, race and ethnicity (Asian, Black, Hispanic, or White), obesity, type of insurance, geographical location, and physical and mental health comorbidities. Results: A total of 38 408 opioid-naive individuals (21 336 women [55.6%]; mean [SD] age, 66.2 [9.2] years) and 28 914 opioid-experienced individuals (18 426 women [63.7%]; mean [SD] age, 64.4 [9.3] years) were included. Receipt of any PT before TKR was associated with lower odds of long-term opioid use in the opioid-naive (adjusted odds ratio [aOR], 0.75 [95% CI, 0.60-0.95]) and opioid-experienced (aOR, 0.75 [95% CI, 0.70-0.80]) cohorts. Receipt of any post-TKR PT was associated with lower odds of long-term use of opioids in the opioid-experienced cohort (aOR, 0.75 [95% CI, 0.70-0.79]). Compared with 1 to 5 sessions of PT after TKR, 6 to 12 sessions (aOR, 0.82 [95% CI, 0.75-0.90]) and 13 or more sessions (aOR, 0.71 [95% CI, 0.65-0.77) were associated with lower odds in the opioid-experienced cohort. Compared with initiation of PT within 30 days after TKR, initiation 31 to 60 days or 61 to 90 days after TKR were associated with greater odds in the opioid-naive (31-60 days: aOR, 1.45 [95% CI, 1.19-1.77]; 61-90 days: aOR, 2.15 [95% CI, 1.43-3.22]) and opioid-experienced (31-60 days: aOR, 1.10 [95% CI, 1.02-1.18]; 61-90 days: aOR, 1.32 [95% CI, 1.12-1.55]) cohorts. Compared with passive PT, active PT was not associated with long-term opioid use in the opioid-naive (aOR, 1.00 [95% CI, 0.81-1.24]) or opioid-experienced (aOR, 0.99 [95% CI, 0.92-1.07]) cohorts. Conclusions and Relevance: This cohort study suggests that receipt of PT intervention before and after TKR, receipt of 6 or more sessions of PT care after TKR, and initiation of PT care within 30 days after TKR were associated with lower odds of long-term opioid use. These findings suggest that PT may help reduce the risk of long-term opioid use after TKR.