Language Discordance and Telephone Interpretation Complicates Pain Neuroscience Education in Physical Therapy Management of a Patient with Acute Low Back Pain

Abstract

Purpose: Pain neuroscience education (PNE) is an intervention used for musculoskeletal pain to improve understanding of pain processes; PNE can decrease pain levels, improve function, and lower disability. Clear communication between the patient and provider is important for PNE to be an effective intervention. There is a lack of research on how a language discordance may impact that communication, and therefore the effectiveness of PNE. Purposes: 1) describe the physical therapist management of a Spanish speaking patient with acute low back pain (LBP) while using an off-site telephone interpreting service and 2) examine how PNE treatment was impacted by a language discordance. Methods: A female in her early 40’s presented with LBP two months after a motor vehicle accident. A systems review revealed comorbidities of class 1 obesity and prediabetes and a language discordance between the provider and patient, necessitating the use of a telephone interpreter. While acute LBP is usually self-limiting, the language discordance and comorbidities were expected to negatively impact her functional prognosis. Intervention included PNE, strengthening, directional preference exercises, graded exposure, and body mechanics training. Results: Within 5 weeks, the patient’s self-perceived disability as reported by the Spanish translated and culturally adapted Oswestry Disability Index, thoracolumbo-pelvic hip range of motion, and perceived levels of pain improved significantly. Conclusion: The link between clarity of communication while utilizing PNE and patient comprehension, outcomes, and satisfaction is unclear. While more time consuming, PNE delivered via translations services appears to be an effective physical therapy intervention. However, further research is needed and it is important for physical therapy providers to consider how language discordance could impact the effectiveness of PNE.