No Magic Bullet but Many Solutions
“New Thoughts on Rehabilitation”
The challenge of musculoskeletal injuries is in many ways similar to the various issues that confront other areas of modern medicine. They include the effects of an aging population, increased disease complexity, and the accompanying changes in the threshold of what is considered an acceptable treatment outcome. The important question is the reasonable comparison between the efficacy of various treatment approaches. Interestingly, numerous interventions in psychotherapy with very different treatment philosophies have very similar outcomes as per meta analysis (Wampold, 2015). Similarly, it is well known that in the musculoskeletal treatment of the low back, approaches as varied as exercise, education and manipulation have similar outcomes when subjected to randomized control trials (Keller et al., 2007).
To explain the similarity in outcome across various methods in physical therapies as well as psychological therapies, the “common factors” approach is a developing trend. This approach suggests that underlying factors common to the various therapies contribute more significantly to the outcome than the particular therapeutic technique itself. In a recent communication by Maxi Miciak PhD from the University of Alberta, she suggested that contextual factors such as the therapeutic relationship established between patient and practitioner provides a major portion of the outcome variance in physical therapy procedures. Some researchers (Keller et al) suggest that intangibles such as patient expectation and self-efficacy contribute up to four times more than the specific intervention itself.
Evidently successful physical rehabilitation will be an intersection of emotional factors and the particular physical therapy intervention. Actively building patient self efficacy through the therapeutic relationship such as clear goal setting and tactfully managing but elevating client expectations will likely enhance outcomes.
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Miciak, M, Gross, D & Joyce , A. (2012). Scan J Caring 26; 394-403