Hence, we believe that

the communication factors identified in this review are transferable to the field of rehabilitation and could be used, in the interim, by physiotherapists to adjust their interactions with patients. It is clear from this review that there is a lack of consensus about how communication factors should be measured and, consequently what instrument to use. As different studies used their own questionnaires or system to collect the information and to code behaviour, MG 132 grouping factors and comparisons among them is difficult to conduct. We suggest that future studies should be conducted with standardised instruments, and, if so, the Verona medical interview classification (Del Piccolo et al 2002) is a good example of an instrument able to capture the interplay of both verbal and nonverbal

factors. The variety of settings and population included in this review can also be considered as a limitation of this study. The therapeutic alliance might rely on different aspects depending on patients and the settings. Other aspects such as symptom duration (chronic versus acute) and type of encounter (first versus follow-up visits) are relevant features that may need to be considered when investigating communication factors that are associated with therapeutic alliance. In conclusion, the current evidence suggests that styles that facilitate the involvement and see more participation of patients in the consultation are associated with a positive therapeutic

alliance. Specifically, patient-centred care strategies – such as listening to what patients Terminal deoxynucleotidyl transferase have to say and asking them questions with a focus on emotional issues – might be used by clinicians to strengthen the therapeutic alliance with patients. This review also revealed a paucity of evidence related to clinicians’ verbal and non-verbal factors associated with therapeutic alliance. Further investigation is needed in this area to determine if patients’ communication factors can influence the therapeutic alliance. We would expect that future studies would evaluate intervention regimens which incorporate these identifiable factors and their impact on clinical outcomes. eAddenda: Appendix 1, 2, 3, and 4 available at jop.physiotherapy.asn.au Competing interests: None declared. Rafael Zambelli Pinto is a PhD student supported by CAPES Foundation, Ministry of Education, Brazil. Professor Maher is supported by a research fellowship funded by the Australian Research Council. “
“Low back pain has been a major public health burden for many years, responsible for substantial work disability and elevated healthcare costs. Around 70–80% of adults in the general population are believed to experience at least one episode of low back pain at some time in their lives (Walker et al 2004).