1. Investigación

Background: The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance. Objective: The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them. Design: Cross-sectional research. Methods: An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out. Results: Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (􀀀 0.13 < B > 􀀀 0.09; p < 0.01). Conclusions: The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist’s personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.

The biopsychosocial paradigm contemplates the patient’s personality traits in physiotherapy treatments for chronic pain. Among these traits, the locus of control has a direct relationship with the person’s coping strategies in the face of their health problems. The objective of this systematic review was to assess the influence of locus of control on the efficacy of physiotherapy treatments in patients with chronic pain. A systematic review of the publications of the last ten years in Pubmed, Scopus, Science Direct and Web of Science databases was conducting with the terms physical therapy modalities, chronic pain, internal-external control, self-management, physical therapy and physiotherapy. The inclusion criteria were participants with chronic pain lasting at least three months who have received at least one session of physical therapy; the studies should have collected the patient’s locus of control as a prognostic factor at the beginning of physiotherapy treatment; the variables studied should include the pain intensity or clinical variables related to pain. A total of 13 articles were found, of which three were experimental studies and ten were observational studies. The included samples had chronic knee pain, nonspecific back pain, low back pain or neck pain; were people over 65 years of age or patients who had undergone hand surgery. In patients with chronic pain for more than three months, the locus of control construct participates as a predictor of the results of physiotherapy treatment. The presence of an internal locus of control favors better results. The personality traits of the subjects represent an important factor to take into account when planning physiotherapy treatments.

The aim of this study was to quantify the level of burnout and competence for evidencebased practice among Spanish physical therapists and to determine if there is a relationship between these and other socio-professional factors. A cross-sectional study with 472 Spanish Physiotherapists. An electronic survey was conducted that included the Maslach Burnout Inventory, Evidence-Based Practice Questionnaire and sociodemographic data. The three subscales of the Burnout correlated with attitude and total Evidence-Based Practice Questionnaire. Attitude and practice for evidencebased practice, educational level and experience were the variables that showed the greatest influence on burnout. Burnout and the degree of evidence-based practice were identified as being discretely related. Specifically, it seems that the evidence-based practice could improve the lack of personal accomplishment, meaning that through interventions perceived as more effective and advantageous, a sense of mastery and self-efficacy is experienced.

Objective To determine the psychometric properties of the Person-Centered Therapeutic Relationship in Physiotherapy Scale (PCTR-PT) in order to find the most appropriate fit for the tool. Methods Patients who had received treatment at the physiotherapy service of nine hospitals in Spain were invited to complete the 31 items of the PCTR-PT scale. To select the most appropriate items of the PCTR-PT, an exploratory factorial analysis (EFA) was performed using the maximum likelihood and oblique rotation (promin) methods. Factor validity, goodness-of-fit and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent (CFA) and discriminant validity were calculated. Internal consistency was verified using the Cronbach’s alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability. Results 366 patients over 18 years old who had received, at least, 15 physiotherapy treatment sessions completed the questionnaire. The results of the exploratory factor analysis revealed a tool with 15 items in four factors [Relational Bond (N items = 4); Individualized Partnership (N items = 4); Professional Empowerment (N items = 3) and Therapeutic Communication (N items = 4)], explaining 78.4% of the variance of the total variables of this tool. The confirmatory factor analysis further confirmed the four-structure model. Reliability of the tool was approved by Cronbach’s alpha in all four dimensions, as all were above .70, ranging from .84 (Individualized Partnership) to .91 (Professional Empowerment). = 0.94. Test-retest was performed with two-week intervals, indicating an appropriate stability for the scale (ICC = 0.900). Conclusion The Person-Centered Therapeutic Relationship in Physiotherapy Scale (PCTR-PT) is a useful, valid and applicable instrument to evaluate the person-centered therapeutic relationship during physiotherapy interventions. It would be interesting to investigate the predictive capacity (sensitivity and specificity) of the PCTR-PT scale.

Objectives This study sought to develop a tool for evaluating person-centered therapeutic relationships within physiotherapy services, and to examine the content validity of the same. Methods A mixed qualitative and quantitative study was performed in three distinct phases: 1) the items were generated based on a literature review and a content analysis of focus groups of patients and physiotherapists; 2) an e-Delphi survey process was performed based on three rounds to select and refine the proposed questionnaire; 3) two rounds of cognitive interviews were conducted to evaluate the comprehension of items, the clarity of language and the appropriateness and relevance of content. Results Thirty-one items were generated based on the seven domains identified after the analysis of four focus groups of physiotherapists and four patient focus groups. Nine experts participated in the e-Delphi survey. Fifty-five patients participated in the two rounds of the cognitive pre-tests. Participating patients were from public and private physical therapy services. Based on the participants’ suggestions, four items were removed, and four were added, whereas 16 were reworded. Conclusions The final tool comprised 31 items divided into seven domains. The response format was based on a 5-point Likert frequency scale. The response options ranged from “strongly agree” to “strongly disagree”.

La fisioterapia ha comenzado a adoptar rápidamente un modelo biopsicosocial donde se reconoce al paciente y su contexto general. Bajo este nuevo paradigma, la comunicación centrada en la persona entre los profesionales de la salud y los beneficiarios de sus cuidados es una de las claves del éxito terapéutico. Objetivo: describir y reflexionar acerca de la importancia de la comunicación centrada en la persona en el establecimiento y satisfacción con el tratamiento en el ámbito de la fisioterapia. Material y métodos: Se ha realizado una revisión bibliográfica sobre la comunicación centrada en la persona entre el fisioterapeuta y el paciente en las bases de datos de ciencias de la salud PEDro y Pubmed, seleccionándose los artículos que se adecuaban a los objetivos del trabajo. Se integró posteriormente la información de los artículos seleccionados junto a los conocimientos y experiencia de los autores en la materia. Conclusiones: La comunicación centrada en la persona es el vehículo mediante el cual se mejora la alianza terapéutica, facilitando un papel activo del paciente en la toma de decisiones terapéuticas y mejorando la satisfacción de este con el tratamiento y con los resultados clínicos. Es necesaria la creación de un instrumento de medida de dicha comunicación en el ámbito de fisioterapia. / Introduction: Physiotherapy is fast adopting a biopsychosocial patient-centred approach where the patient is recognized and its general context. Under this new paradigm, the person-centered communication between health professionals and the beneficiaries of their care is one of the keys to therapeutic success. Objective: to describe and reflect on the importance of person-centered communication in the establishment and satisfaction with treatment in the field of physiotherapy. Material and methods: A bibliographic review of the person-centered communication between the physiotherapist and the patient was carried out in the main databases of health sciences: PEDro, Pubmed, selecting articles that fit the objectives of the study, integrating subsequently the information of the selected articles and the knowledge and experience of the authors in the matter. Conclusions: Patientcentered communication is the vehicle through which the therapeutic alliance is improved, facilitating an active role of the patient in making therapeutic decisions and improving patient satisfaction with treatment and clinical outcomes. It is necessary to create an instrument to measure such communication in the field of physiotherapy.