Introduction/Objectives Therapeutic alliance (TA) is an integral part of building a patient and clinician relationship. TA begins at the initial encounter; however, the specific TA behavioural practices that are most impactful and linked to pain reduction and improved function remain unclear. The primary objective of this study was to explore physical therapist behaviours and interactions during the initial physical therapy evaluation and how they related to the patient's perception of TA. A secondary objective was to explore the relationship between TA, pain intensity, and function. Methods A mixed methods study was conducted. Pain intensity, TA and self‐reported function were assessed at three time points. Spearman's Rho (ρ) was used to quantify if there was an association between increased TA and function and reduced pain intensity, while a checklist of TA themes and behavioural practices was used for the qualitative analysis. Results There was a statistically significant negative correlation between patient‐perceived TA and pain intensity immediately after the initial evaluation (ρ = −0.39 [p = 0.048]). Behavioural practices associated with higher TA included information gathering, pausing to listen, using humour and transitions, and use of clarifying questions. Behavioural practices associated with patient‐perceived lower TA interactions were lack of touch, the absence of pain neuroscience education, and not restating what the patient said during the interview. Conclusion This study highlights a relationship between TA and reduction of pain intensity after the initial evaluation and identifies key behavioural practices that could positively and negatively impact TA during the clinical encounter.

The physical and mental health of our populace is trending in the wrong direction. Deaths related to noncommunicable disease (NCD) now make up the majority of global deaths each year, yet NCDs are mostly preventable through lifestyle, behavioural, and environmental interventions (Bezner, 2015; Global strategy on diet et al., 1134). We are seeing a rise in depression, anxiety, and other mental health issues across the lifespan. Furthermore, healthcare professionals (Spieler & Baum, 2022;Sullivan et al., 2022) and healthcare students have higher rates of anxiety, depression, sleep disorders, and burnout compared to the general population, since the COVID-19 pandemic (Macauley et al., 2018). For those called to musculoskeletal care, this is an unacceptable state.At this time surrounding global pandemic, when the interrelationship of unhealthy living behaviours, COVID-19 (Bennett et al., 2021;Poly et al., 2021;Tartof et al., 2020), and NCD is clear, the need for increased healthy living (HL) behaviours is an imperative societal requirement (Arena et al., 2021). According to the Dietary Guidelines for Americans 2020-2025 from the United States Department of Agriculture, up to 60% of adults are living with 1 or more diet-related chronic diseases (Global strategy on diet et al., 1134). It is well established that individuals need a minimum of 7 hours of sleep, yet nearly 30% of Americans sleep 7 hours or less (Ford et al., 2015). One of the most powerful behaviours in HL is

Objective: Determine reproducibility of resistance exercise regimens in trials for CLBP and determine if recently available checklists are effective.Methods: Four databases (Medline, PubMed, Cochrane and CINAHL) were searched for keywords related to back pain and resistance exercise. Reproducibility was assessed using two checklists, the 12-item Template for Intervention Description and Replication (TIDieR) and the 19-item Consensus on Exercise Reporting Template (CERT). The proportion reporting was analysed, with additional comparison of trials pre-and post-availability of each checklist. A generalised linear regression was conducted with checklist items as the dependent variable and year of publication as the independent (PROSPERO ID = #CRD42020186036).Results: Overall, details that facilitate reproducibility were under-reported. No trials reported all checklist items, while only 18 trials (35.5%) and 5 trials (9.8%) reported 75%+ of checklist items for the TIDieR and CERT, respectively. A median of 8 (IQR 2) of 12 TIDieR criteria were reported and a median of 9 (IQR 7) of 19 criteria were reported for the CERT. There was no difference pre/post checklist publication (TIDieR median before = 8 (IQR 2), after = 8 (IQR 2.25); CERT mean before = 9 (IQR 5.25), after = 9 (IQR 7)). Regression failed to support improved reporting over time. The majority of studies (86.3%) were scored as having an elevated risk of bias.Conclusions: Reproducibility of resistance exercise in CLBP trials appears questionable due to low levels of reporting. The publication reporting checklists have not resulted in improvement. Real-world reproducibility is questionable. There is a need to improve reporting to maximise reproducibility. Impact statement:The present results reveal a demand in improved reporting to ensure both enhanced clinical translation in the real-world and replicability to enhance knowledge of best-practice for resistance exercise in the CLBP population.