Therapeutic Alliance: Patients’ Expectations Before and Experiences After Physical Therapy for Low Back Pain—A Qualitative Study With 6-Month Follow-Up

OBJECTIVE: The aim of this study was to explore patients’ expectations before and experiences after physical therapy for low back pain. METHODS: Qualitative in-depth, semi-structured interviews with patients attending physical therapy were performed before, immediately after, and 6 months after treatment. Data were analyzed from a hermeneutical perspective with decontextualization, recontextualization, and identification of themes. RESULTS: Patients’ pretreatment expectations to physical therapy focused around exercises and a body-oriented diagnosis. After treatment, reassurance, active listening with explanations, and personally adapted strategies for self-managing pain and regaining control over everyday activity were expressed as decisive for a meaningful therapeutic alliance. CONCLUSION: Expectations before treatment focused on exercises and diagnosis. Empathetic and personally adapted education aimed at empowerment was experienced as a meaningful aspect of the therapeutic alliance after treatment. The therapeutic alliance provided a basis to integrate knowledge on the complexity of pain. IMPACT: Our findings indicate that patients emphasize physical therapists’ interactional and pedagogical skills as meaningful aspects of the therapeutic alliance, which has implications for clinical practice and training physical therapist students.