Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession

Dima Ivanova; Felicity L. Bishop; Dave Newell; Jonathan Field; Madeleine Walsh

doi:10.1186/s12998-022-00442-4

Table 6
The effect of working alliance on clinical outcomes and satisfaction
Study reference number How did the study measure clinical outcomes? Did the study measure satisfaction? If yes, how? What did the study find?
[54] Low back pain intensity, which was a primary study outcome, was assessed using the Modified Von Korff pain scale [56]. A path analysis was conducted to determine the effects of dose and doctor–patient encounter (DPE) on LBP intensity at the end of care (6 weeks) and primary end point (12 weeks) No The principal finding was that the DPE evaluated at the end of care and Spinal Manipulation Therapy (SMT) dose had similar effects on pain outcomes. DPE β = − 0.22 and − 0.15 and dose β = − 0.11 and − 0.12 for the six and 12-week pain outcomes, respectively. Patients’ perception of their practitioners’ enthusiasm and confidence related to the treatment process may impact the establishment of trust and respect, which underlies the bond between patients and their chiropractor
[55] At every follow-up assessment: functional status was measured by repeat Roland-Morris Low-Back Disability [58, 59]. Questionnaires, pain status was measured by repeat numerical rating scales and scales of global pain improvement, and pain frequency measured by 6-point ordinal scale Satisfaction with back care was measured on a 40-point scale and observed at 4 weeks following randomisation Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio (OR) for 10-point increase in satisfaction = 1.61, 95% confidence interval (CI) 0.99,2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI 0.76, 1.50)
[45] The “improved” variable reflected the patients’ subjective report of symptomatic improvement after receiving their treatment: it was dichotomised into two categories, either feeling much better or less than feeling much better after the treatment Satisfaction was assessed on a 7-point Likert scale from 1 being ‘Completely satisfied, couldn’t be better’ to 7 being ‘Completely dissatisfied, couldn’t be worse’ from the question: “All things considered, how satisfied are you with your regular chiropractor.” The results of regression analyses suggested that in general, patients who were completely satisfied with their overall chiropractic experience and felt much better following their treatment were positively associated with rating their chiropractor as a high performer on all the PCAS scales [57] when controlling for all other variables. For example, the adjusted odds ratio for the effect of being completely satisfied with your chiropractor when controlling for all other variables in the model was 9.97, suggesting a positive association between patients who are completely satisfied with their overall chiropractic experience and rating their chiropractor above the 75th percentile on the Trust in chiropractor scale. Similarly the variable improved was also positively associated with patients rating their chiropractor as a high performer in the Trust in chiropractor scale
The text in this table used phrasing as close as possible to the phrasing used by authors when reporting their studies

Study reference number	How did the study measure clinical outcomes?	Did the study measure satisfaction? If yes, how?	What did the study find?
[54]	Low back pain intensity, which was a primary study outcome, was assessed using the Modified Von Korff pain scale [56]. A path analysis was conducted to determine the effects of dose and doctor–patient encounter (DPE) on LBP intensity at the end of care (6 weeks) and primary end point (12 weeks)	No	The principal finding was that the DPE evaluated at the end of care and Spinal Manipulation Therapy (SMT) dose had similar effects on pain outcomes. DPE β = − 0.22 and − 0.15 and dose β = − 0.11 and − 0.12 for the six and 12-week pain outcomes, respectively. Patients’ perception of their practitioners’ enthusiasm and confidence related to the treatment process may impact the establishment of trust and respect, which underlies the bond between patients and their chiropractor
[55]	At every follow-up assessment: functional status was measured by repeat Roland-Morris Low-Back Disability [58, 59]. Questionnaires, pain status was measured by repeat numerical rating scales and scales of global pain improvement, and pain frequency measured by 6-point ordinal scale	Satisfaction with back care was measured on a 40-point scale and observed at 4 weeks following randomisation	Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio (OR) for 10-point increase in satisfaction = 1.61, 95% confidence interval (CI) 0.99,2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI 0.76, 1.50)
[45]	The “improved” variable reflected the patients’ subjective report of symptomatic improvement after receiving their treatment: it was dichotomised into two categories, either feeling much better or less than feeling much better after the treatment	Satisfaction was assessed on a 7-point Likert scale from 1 being ‘Completely satisfied, couldn’t be better’ to 7 being ‘Completely dissatisfied, couldn’t be worse’ from the question: “All things considered, how satisfied are you with your regular chiropractor.”	The results of regression analyses suggested that in general, patients who were completely satisfied with their overall chiropractic experience and felt much better following their treatment were positively associated with rating their chiropractor as a high performer on all the PCAS scales [57] when controlling for all other variables. For example, the adjusted odds ratio for the effect of being completely satisfied with your chiropractor when controlling for all other variables in the model was 9.97, suggesting a positive association between patients who are completely satisfied with their overall chiropractic experience and rating their chiropractor above the 75th percentile on the Trust in chiropractor scale. Similarly the variable improved was also positively associated with patients rating their chiropractor as a high performer in the Trust in chiropractor scale