Patient-Clinician Relationships and Chronic Low Back Pain: The Effect on Objective Measures of Function, Appraisals of Pain, and an Examination of Health Disparities

Abstract

This study examined: the effects of an enhanced patient-clinician relationship compared to a limited patient clinician relationship on objective measures of function and appraisals of pain at rest for individuals with chronic low back pain, relationships between changes in objective measures of function and pain at rest by group, and qualitatively investigated lived experiences of patient-clinician relationships by intersectional identity. This single-blind randomized controlled trial included individuals with chronic low back pain (≥ 3-months and half the days in the past 6- months) with at least 3/10 average pain in the past week. Participants, unaware of the two groups, were randomly assigned using concealed allocation to an enhanced or limited patient-clinician relationship condition in which they shared their patient history. The fingertip-to-floor, 1-minite lift, and Biering-Sorensen tests, and visual analogue scale for pain at rest were completed before and after the relationship condition. Lastly, semi-structured interviews were conducted. Analyses of covariance assessed between group differences, controlling for clinician and relevant covariates. Hayes PROCESS Macro assessed how group moderated the relationship between changes in pain and function. A grounded theory approach used in-vivo coding followed by axial and selective coding. The enhanced patient-clinician relationship group demonstrated significantly greater improvements in the 1-minute lift test (F(1, 49) = 7.47, p < 0.01, ηp ² = 0.13) and pain at rest (F(1, 46) = 4.63, p = 0.04, ηp ² = 0.09), but not the fingertip-to-floor or Biering-Sorensen tests, compared to the limited group. There was no evidence of significant interactions between changes in pain, group, and changes in function. “Being taken seriously” and “person-centered care” were core components of patient-clinician relationships, discussed in contexts of the healthcare system and disparities by intersectional identity. This mixed-methods study identified single-session effects of patient-clinician relationships and lived experiences of individuals with chronic low back pain.