Evaluation is treatment for low back pain.

Review written by Dr Tom Walters info

Key Points

  • Therapeutic alliance is defined as the positive relationship that forms between the clinician and the patient, and has been shown to reduce pain.
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When an individual experiencing pain seeks medical care, they typically encounter certain clinical rituals. At the time of the initial evaluation, these rituals usually include history taking, physical examination and the application of treatment interventions. Healthcare providers and patients tend to attribute any reduction in pain to the provided treatment and often do not consider the potential influence of the history taking and examination portions of the visit.

As clinicians have shifted to viewing health through a biopsychosocial lens, the concept of therapeutic alliance (TA) and its effects on outcomes has emerged. TA describes the relationship between the patient and the clinician, and has been shown to have a positive impact on pain (1-4).

This study aimed to examine the potential impact of the history taking and physical examination components of the initial evaluation on pain and function in patients with low back pain (LBP) who were attending physical therapy. This was the first study to investigate this topic.

Strong therapeutic alliance has been shown to have a positive impact on pain.
Clinicians should not only aim to become skilful in delivering various interventions, but also strive to build strong relationships with their patients during the history taking and physical examination.


Over a three-month period, 40 consecutive patients with LBP (with or without leg pain) from three outpatient physical therapy clinics were invited to participate in the study. Six patients were excluded from the study resulting in a sample size of

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