A mix of interpersonal, clinical, and organizational factors are perceived to influence patient-therapist interactions, although research is needed to identify which of these factors actually influence patient-therapist interactions. Physical therapists' awareness of these factors could enhance patient interactions and treatment outcomes. Mechanisms to best enhance these factors in clinical practice warrant further study.

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Non-specific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioural interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy and ergonomics. Behavioural and/or psychologically informed interventions aim to enhance behaviours, cognitions or mood by using methods such as relaxation and cognitive behavioural therapy (CBT). Combined interventions aim to target both physical and behavioural and/or psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programmes. Since it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioural and/or psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Nine electronic databases were searched for randomised controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (e.g. if the study compared two physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioural and/or psychologically informed, and combined interventions were assessed using meta-analyses. 24 studies were included. No clinically significant differences were found for pain and disability between physical, behavioural and/or psychologically informed and combined interventions. The simple categorisation of interventions into physical, behavioural and/or psychologically informed and combined could be considered a limitation of this review, as these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring Perspective: In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioural and/or psychologically informed and combined interventions.

Background Persistent strength deficits secondary to Achilles tendinopathy (AT) have been postulated to account for difficulty engaging in tendon-loading movements, such as running and jumping, and may contribute to the increased risk of recurrence. To date, little consensus exists on the presence of strength deficits in AT. Consequently, researchers are uncertain about the appropriate methods of assessment that may inform rehabilitation in clinical practice. Objective To evaluate and synthesize the literature investigating plantar-flexion (PF) strength in individuals with AT. Study Selection Two independent reviewers searched 9 electronic databases using an agreed-upon set of key words. Data Extraction Data were extracted from studies comparing strength measures (maximal, reactive, and explosive strength) between individuals with AT and healthy control participants or between the injured and uninjured sides of people with AT. The Critical Appraisal Skills Programme Case-Control Study Checklist was used to assess the risk of bias for the included studies. Data Synthesis A total of 19 studies were eligible. Pooled meta-analyses for isokinetic dynamometry demonstrated reductions in maximal strength (concentric PF peak torque [PT] slow [Hedges g = 0.52, 44% deficit], concentric PF PT fast [Hedges g = 0.61, 38% deficit], and eccentric PF PT slow [Hedges g = 0.26, 18% deficit]). Reactive strength, particularly during hopping, was also reduced (Hedges g range = 0.32–2.61, 16%–35% deficit). For explosive strength, reductions in the rate of force development (Hedges g range = 0.31–1.73, 10%–21% deficit) were observed, whereas the findings for ground reaction force varied but were not consistently altered. Conclusions Individuals with AT demonstrated strength deficits compared with the uninjured side or with asymptomatic control participants. Deficits were reported across the strength spectrum for maximal, reactive, and explosive strength. Clinicians and researchers may need to adapt their assessment of Achilles tendon function, which may ultimately help to optimize rehabilitation outcomes.