title: Testing a path-analytic mediation model of how motivational enhancement physiotherapy improves physical functioning in pain patients.
abstract: OBJECTIVE
  Pain is a complex phenomenon not easily discerned from psychological, social, and environmental characteristics and is an oft cited barrier to return to work for people experiencing low back pain (LBP). The purpose of this study was to evaluate a path-analytic mediation model to examine how motivational enhancement physiotherapy, which incorporates tenets of motivational interviewing, improves physical functioning of patients with chronic LBP.
  
  
  METHODS
  Seventy-six patients with chronic LBP were recruited from the outpatient physiotherapy department of a government hospital in Hong Kong.
  
  
  RESULTS
  The re-specified path-analytic model fit the data very well, χ (2)(3, N = 76) = 3.86, p = .57; comparative fit index = 1.00; and the root mean square error of approximation = 0.00. Specifically, results indicated that (a) using motivational interviewing techniques in physiotherapy was associated with increased working alliance with patients, (b) working alliance increased patients' outcome expectancy and (c) greater outcome expectancy resulted in a reduction of subjective pain intensity and improvement in physical functioning. Change in pain intensity also directly influenced improvement in physical functioning.
  
  
  CONCLUSIONS
  The effect of motivational enhancement therapy on physical functioning can be explained by social-cognitive factors such as motivation, outcome expectancy, and working alliance. The use of motivational interviewing techniques to increase outcome expectancy of patients and improve working alliance could further strengthen the impact of physiotherapy on rehabilitation outcomes of patients with chronic LBP.
authors.affiliation: The Hong Kong Polytechnic University, Kowloon, Hong Kong.
authors.forename: Gladys
authors.initials: G
authors.lastname: Cheing
authors.forename: Sinfia
authors.initials: S
authors.lastname: Vong
authors.forename: Fong
authors.initials: F
authors.lastname: Chan
authors.forename: Nicole
authors.initials: N
authors.lastname: Ditchman
authors.forename: Jessica
authors.initials: J
authors.lastname: Brooks
authors.forename: Chetwyn
authors.initials: C
authors.lastname: Chan
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000534:rehabilitation*; D005080:Exercise Test; D005260:Female; D006801:Humans; D017770:Lifting; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D062405:Motivational Interviewing; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D010147:Pain Measurement; D058748:Pain Perception; D026741:Physical Therapy Modalities / Q000523:psychology; D011369:Professional-Patient Relations; D016896:Treatment Outcome