Reciprocity in Low Back Pain Care and Its Role in Power Dynamics: A Give-and-Take Approach

The shift toward patient-centered care in physical therapy fostered a deeper consideration of power-sharing in clinical interactions. Elements of reciprocity may enhance such power considerations between physical therapist and patients, but there has been little investigation into how reciprocity is enacted in physical therapy, its value, and how to improve it if required. This study investigates forms of reciprocity during physical therapist-patient interactions in low back pain (LBP) care with the aim of enhancing patient-centered approaches.

The qualitative design involved (1) ethnographic observations at a fee-for-service practice in Australia, and (2) reflexive discussions between researchers and participating clinicians. To understand reciprocity, the analysis drew from the concepts of "accepting'"(or "blocking") "offers" that have been previously applied to physical therapy interactions. The analysis is a sub-study using a larger dataset and analyses in which we partnered with physical therapists and people living with LBP.

Forty-nine observations and 13 reflexive discussions were undertaken with 42 people with LBP and 10 physical therapists. Analysis developed 3 themes suggesting that forms of reciprocity depended on physical therapists accepting or blocking patients' offers, inviting patients to make an offer, and offering personal stories. These elements of reciprocity are relevant to power-sharing during interactions and may impact patient-centered care.

Our results suggest that attending to forms of reciprocity can help physical therapists shift power in clinical interactions. By inviting and accepting "offers," physical therapists may build collaborative interactions, support individuals to guide the treatment narrative, and shift away from biomedically centered management approaches. Such recommendations create reciprocal environments that might enhance patient-centered care.

This is one of the few studies to explore how reciprocity is enacted in interactions between physical therapists and s with LBP. Our findings highlight how engaging with the concept of reciprocity could assist with sharing power, improving physical therapist-patient relationships, and enhancing patient-centered care.