DO INITIAL IMPRESSIONS OF TRUST PREDICT RECOVERY FOR PEOPLE PRESENTING WITH MUSCULOSKELETAL CONDITIONS?

S. Coates^1,2, K. Evans¹, C. Ashton-James³, E. Boyle⁴, D. Beales⁵, K. Kang⁶, T. Rebbeck¹

¹The University of Sydney, Faculty of Medicine & Health, Sydney, Australia, ²Australian Catholic University, School of Allied Health, Sydney, Australia, ³The University of Sydney, The Kolling Research Institute, Sydney, Australia, ⁴Curtin University, Faculty of Health Science, Perth, Australia, ⁵Curtin University, Faculty of Health Sciences, Perth, Australia, ⁶University of Sydney, Faculty of Medicine & Health, Sydney, Australia

Background: A positive therapeutic alliance between patients and their health care professionals (HCPs) is associated with improved health outcomes in musculoskeletal conditions including low back pain and whiplash. An essential component of therapeutic alliance is patients' perceived trustworthiness in their HCP, with suggestions that impressions of trust are formed within the first interaction. For example, in medicine, patients' initial impression of the trustworthiness of their physician has been shown to influence health outcomes. In allied health, initial impressions of trust have not been evaluated and other measures of therapeutic alliance such as the Working Alliance Inventory (WAI) are usually administered after care has been provided. Whether there is an association between initial trust, therapeutic alliance and health outcomes for people with musculoskeletal conditions is unknown.

Purpose: The aims of this study were to determine the relationship between initial impressions of trust and trust and therapeutic alliance at 3-months. This study also sought to evaluate the relationship between initial trust and recovery at 3-months and to explore factors predicting initial trust.

Methods: Prospective-cohort study embedded in a multi-centre randomised controlled trial investigating pathways of care for people with musculoskeletal conditions. Participants presenting with low back pain, neck pain and knee osteoarthritis within 4 weeks of seeking care were eligible. Seven hundred and sixty-seven participants completed baseline questionnaires (demographics, clinical, pain, disability and psychological measures) and impressions of initial trust relating to perceptions of
(i) competence,
(ii) warmth and
(iii) feeling safe with their self-nominated primary HCP.
Outcomes assessed at three months included: 3-month trust, therapeutic alliance (SF-WAI) and recovery (Global Perceived Effect Scale (GPE), pain-related disability (Neck Disability Index (NDI), Oswestry Disability Index (ODI) and WOMAC), Associations between initial trust, 3-month trust and therapeutic alliance were assessed using Pearson's correlation coefficient. Known (eg initial pain, disability, psychological distress) and hypothesised (initial trust, therapeutic alliance) factors associated with recovery (GPE and 3-month disability scores) will be analysed using a forward, step-wise multivariate regression model.

Results: Initial impression of trust was moderately correlated with trust at 3-months (r=0.60, p<0.001) and the SF-WAI at 3-months (r=0.48, p<0.001). Trust at 3-months and therapeutic alliance at 3-months are moderately correlated (r=0.65, p<0.001). Of the individual three factors, the feeling of being safe with one’s HCP was the most strongly correlated factor with trust at 3-months (r=0.58, p<0.001) and the SF-WAI (r=0.46, p<0.001). Multi-regression analysis of the relationship between initial trust, recovery and pain-related disability will be completed by the conference.

Conclusions: Initial trust was moderately associated with trust and therapeutic alliance at 3 months as measured by the SF- WAI. We hypothesise that it will also be associated with recovery at 3 months.

Implications: Given the relationship between initial impression of trust and trust and therapeutic alliance at 3-months, clinicians should consider the impact of their first interaction with a patient on their perceived trustworthiness. An understanding of the impact of perceived trustworthiness on recovery will be explored.

Funding acknowledgements: This work is supported by The National Health and Medical Research Council of Australia (NHMRC, GNT1141377).

Keywords:
Therapeutic alliance
Working alliance inventory
Musculoskeletal conditions

Topics:
Musculoskeletal
Primary health care
Professional practice: other

Did this work require ethics approval? Yes

Institution: The University of Sydney

Committee: Human Research Ethics Committee

Ethics number: 2018/926