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Citation:  Cheing, G., Vong, S., Chan, F., Ditchman, J., Brooks, N., & Chan, C. (2014). Testing a Path-Analytic Mediation Model of How Motivational Enhancement Physiotherapy Improves Physical Functioning in Pain Patients. Journal of Occupational Rehabilitation, 24 (4), 798-805.
Title:  Testing a Path-Analytic Mediation Model of How Motivational Enhancement Physiotherapy Improves Physical Functioning in Pain Patients
Authors:  Cheing, G., Vong, S., Chan, F., Ditchman, J., Brooks, N., & Chan, C.
Year:  2014
Journal/Publication:  Journal of Occupational Rehabilitation
Publisher:  Springer Science + Business Media LLC
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported

Structured abstract:

Background:  Pain is a complex phenomenon. It is reported that low back pain may impact 60% to 85% of all adults in industrialized countries at some time in their lives. Chronic back pain can impact numerous life activities, including work. Notably, back related injuries and strain represent the majority of work disabilities. Because pain is complex, it can be difficult to discern from psychological, social, and environmental aspects of the condition. Recognition of the impact of the psychosocial factors on pain treatment and outcomes is on the rise. The working relationship between the patient and rehab team can impact treatment and outcomes. Motivation has also been shown to influence outcomes related to treatment. A study investigated the impact of motivational enhancement physiotherapy on outcomes of pain patients showed support for integrating motivational based interventions in physiotherapy treatment for pain patients. The specific pathway of how this occurs has not been explored.
Purpose:  Based on social cognitive theory and motivation interviewing literature, the researchers hypothesized better patient outcome expectations and enhanced patient provider relationships play a role in the process. This study examined whether psychosocial factors, worker alliance, outcome expectancy, and perceived pain intensity, mediate the relationship between motivational enhancement physiotherapy and change in physical functioning of low back pain patients using path analysis.
Setting:  The setting was the outpatient physiotherapy department of a government hospital in Hong Kong.
Study sample:  Data were extracted from an earlier study by Vong et al (2011) that researched the effectiveness of motivational enhancement physiotherapy compared to conventional physiotherapy. Those patients had been recruited from an outpatient physiotherapy department of a local hospital in Hong Kong. The study sample included 76 participants; the majority or (63.25%) were female.
Intervention:  Six physiotherapists with an average of 14 years clinical experience participated in the current study. They were randomly divided into two groups: the motivational enhancement physiotherapy group and the physiotherapy only group. All patients in the study received conventional physiotherapy and did not know if they were in the control or the experimental group. The patients in the experimental group received motivational enhancement physiotherapy along with physiotherapy. Those sessions incorporated the principles and strategies associated with motivational interviewing in their interactions and communication with patients with low back pain.
Data collection and analysis:  A number of measures were used. These included the following instruments. One, the Pain Rehabilitation Expectancy Scale; only the working alliance and outcomes expectancy subscales were used. Two, the Visual Analog Scale, a common tool for measuring self perceived pain intensity. And three, the, Lifting Capacity Test was used as a proxy measure for physical ability. The mean score from two trails was recorded. Since the Lifting Capacity Test pretest between the control and experimental groups differed significantly residual change scores were used. The researchers also used a regression approach. Path analysis was used. All model estimations were made using AMOS 18.0 using maximum-likelihood estimation. The mode data fit was examined using Chi square goodness of fit test and several additional fit indices. The standardized path coefficients were reported to describe each causal path.
Findings:  There were no significant differences in the baseline characteristics for the two groups, the motivational enhancement physiotherapy plus physiotherapy group and the physiotherapy group alone, except for lifting capacity. Path analysis revealed the mediational model may not be a good fit to the data. Therefore, the model was revised. Based on the empirical guidance and conceptual theory reasons, the researchers eliminated and added some pathways. This led to a re-specified path analytic mediation model predicting how motivational enhancement physiotherapy leads to better functioning than physiotherapy treatment alone.
Conclusions:  Motivational enhancement physiotherapy is a relatively new physiotherapy intervention used in pain management. The current study based on social cognitive theory provides further explanation for the underlying change mechanisms accounting for motivational enhancement physiotherapy benefits to enhancing pain rehabilitation outcomes. Expectations are unique to each patient’s psychosocial profile and may play an important role in improving physiotherapy outcomes. The use of motivational enhancement physiotherapy as an adjunct to physiotherapy is in alignment with the profession’s move to biopsychological approach to treat chronic pain and enhance employment.

Disabilities served:  Chronic pain
Populations served:  Gender: Female and Male
Race: Asian
Interventions:  Other
Outcomes:  Other