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van Veen MM, Ten Hoope BWT, Bruins TE, Stewart RE, Werker PMN, Dijkstra PU. Therapists' perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study. Physiother Theory Pract 2021; 38:2062-2072. [PMID: 33890851 DOI: 10.1080/09593985.2021.1920074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Facial palsy rehabilitation therapy plays an essential role in treating facial palsy.Purpose: This study aimed to gain insight into therapists' perceptions and attitudes toward facial palsy rehabilitation therapy and to examine whether therapists could be categorized into distinct groups based on these attitudes and perceptions.Methods: Thirteen semi-structured, in-depth interviews were conducted in a purposive sample of therapists. Interviews were analyzed using thematic analysis. Next, a questionnaire containing questions about therapists' characteristics and perceptions and attitudes toward facial palsy rehabilitation therapy was sent to all facial palsy rehabilitation therapists in the Netherlands and Flanders (n = 292). Latent class analysis (LCA) was performed to identify and analyze distinct groups of therapists.Results: Seven themes were derived from the interviews: treatment goals, therapy content, indications, measurement instruments, factors influencing success, emotional support, and cooperation with colleagues. The questionnaire was filled out by 127 therapists. A 2-group structure consisting of a positive class and a negative class was found to fit the questionnaire data best. No distinction could be made regarding therapists' characteristics.Conclusion: Considerable variation in stated treatment practices was present among therapists. Therapists could be classified into 2 groups. This study raises several hypotheses that require further study.
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Affiliation(s)
- Martinus M van Veen
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Britt W T Ten Hoope
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Tessa E Bruins
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
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152
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Alodaibi F, Beneciuk J, Holmes R, Kareha S, Hayes D, Fritz J. The Relationship of the Therapeutic Alliance to Patient Characteristics and Functional Outcome During an Episode of Physical Therapy Care for Patients With Low Back Pain: An Observational Study. Phys Ther 2021; 101:6123370. [PMID: 33513231 DOI: 10.1093/ptj/pzab026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/22/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research supports the relevance of the therapeutic alliance (TA) between patients and physical therapists on outcomes, but the impact of TA during routine physical therapist practice has not been quantified. The primary objective of this study was to examine the relationship between TA assessed during a physical therapy episode of care for patients with low back pain and functional outcome at the conclusion of care. The secondary objective was to examine psychometric properties of the Working Alliance Inventory-Short Revised (WAI-SR) form, a patient-reported TA measure. METHODS This study was a retrospective analysis of prospectively collected data from 676 patients (mean [SD] age = 55.6 [16.1] y; 55.9% female) receiving physical therapy for low back pain in 45 outpatient clinics from 1 health system in the United States. Participating clinics routinely collect patient-reported data at initial, interim, and final visits. The lumbar computer-adapted test (LCAT) was used to evaluate functional outcome. The TA was assessed from the patient's perspective at interim assessments using the WAI-SR, bivariate correlations were examined, and regression models were examined if interim WAI-SR scores explained outcome variance beyond a previously validated multivariate prediction model. Internal consistency and ceiling effects for the WAI-SR were examined. RESULTS Interim WAI-SR scores were not correlated with patient characteristics or initial LCAT, but they were correlated with final LCAT and LCAT change from initial to final assessment. WAI-SR total score (adjusted R2 = 0.36), and Task (adjusted R2 = 0.38) and Goal subscales (adjusted R2 = 0.35) explained additional variance in outcome beyond the base model (adjusted R2 = 0.33). Internal consistency was higher for WAI-SR total score (α = .88) than for subscales (α = .76-.82). Substantial ceiling effects were observed for all WAI-SR scores (27.2%-63.6%). CONCLUSION Findings support the importance of TA in physical therapist practice. Measurement challenges were identified, most notably ceiling effects. IMPACT This study supports the impact of the patient-physical therapist alliance on functional outcome. Results extend similar findings from controlled studies into a typical physical therapist practice setting. Better understanding of the role of contextual factors including the therapeutic alliance might be key to improving the magnitude of treatment effect for discrete physical therapist interventions and enhancing clinical outcomes of physical therapy episodes of care.
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Affiliation(s)
- Faris Alodaibi
- Rehabilitation Science Department, King Saud University, Riyadh, Saudi Arabia
| | - Jason Beneciuk
- University of Florida Department of Physical Therapy, Gainesville, Florida, USA
| | - Rett Holmes
- Physical Therapy at St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Stephen Kareha
- Physical Therapy at St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Deanna Hayes
- Focus on Therapeutic Outcomes, Inc, Knoxville, Tennessee, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, 383 Colorow Drive, Room 391, Salt Lake City, UT 84108, USA
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153
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Linares-Fernández MT, La Touche R, Pardo-Montero J. Development and validation of the therapeutic alliance in physiotherapy questionnaire for patients with chronic musculoskeletal pain. PATIENT EDUCATION AND COUNSELING 2021; 104:524-531. [PMID: 33004233 DOI: 10.1016/j.pec.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study is to present the development and analysis of the factorial structure and psychometric properties of a new self-administered questionnaire (Therapeutic Alliance in Physiotherapy Questionnaire-Patients [CAF-P]) designed to measure therapeutic alliance in physiotherapy. METHODS The sample included 204 patients with chronic pain attending nine primary care centres. The CAF-P was developed and validated using standard methodology, which included developing items, cognitive debriefing and psychometric validation. RESULTS CAF-P has excellent internal consistency, with Cronbach's α of 0.91 and an intraclass correlation coefficient (ICC) of 0.87. We propose a structure of two factors that explain 55.80 % of the variance. The convergent validity showed a moderate positive correlation with the probability of recommending treatment and with the level of satisfaction. CONCLUSIONS The CAF-P appears to be a valid and reliable instrument for measuring the therapeutic alliance perceived by patients in physiotherapy. PRACTICE IMPLICATIONS The results of the present study leads to further research to identify the differences in the therapeutic alliance construct between different settings or professions.
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Affiliation(s)
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Institut of Neuroscience and Sciences of Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Institut of Neuroscience and Sciences of Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
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154
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Hay ME, Connelly DM. The Process of Creating and Disseminating Exercise Programs by Physical Therapists for Older Adults With Chronic Back Pain. Phys Ther 2021; 101:6006698. [PMID: 33245127 DOI: 10.1093/ptj/pzaa202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to enhance the understanding of the process that physical therapists undertake when creating and disseminating exercise programs for older adults with chronic backpain. METHODS Constructivist grounded theory methodology was used as an accessible mode of researching pragmatic clinical practices. Physical therapists from outpatient, ambulatory care clinic settings participated in in-depth, individual interviews (n = 9) and in-clinic observations (n = 5). Data collection and analysis were iterative processes. Codes were generated based on recurrent themes, and constant comparative analysis was used to compare data. Analysis and data collection were concluded when theoretical sufficiency was reached. RESULTS Physical therapist participants described the process of creating and implementing exercise plans as involving listening to the patient's story, determining function, physical therapy care, supported integration, and, ultimately, returning back to living and life with chronic back pain. Participants worked through the 5 phases at different rates, often recurrently, when treating older adults with chronic back pain. The phases are positioned within a shared alliance between physical therapy provider and patient, with a transfer of responsibility occurring throughout treatment and follow-up sessions, progressing toward patient independence. This transfer of responsibility served as the core category for the process herein. CONCLUSIONS This research highlights the importance of listening to patients' stories when engaging in physical therapy care. Focusing on function, providing education and exercise as components of care, and supporting integration of exercise into everyday life are considerations for providing care for older adults with chronic back pain in physical therapist practice and, ultimately, for returning tolife. IMPACT With aging populations and with the increasing prevalence of chronic conditions, this research offers insight into a process for physical therapists to enact exercise engagement for improved health and quality of life for older adults with chronic backpain.
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Affiliation(s)
- Melissa E Hay
- School of Physical Therapy, Western University, 1151 Richmond St, London, Ontario, Canada N6A 3K7
| | - Denise M Connelly
- School of Physical Therapy, Western University, 1151 Richmond St, London, Ontario, Canada N6A 3K7
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155
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Horton A, Hebson G, Holman D. A longitudinal study of the turning points and trajectories of therapeutic relationship development in occupational and physical therapy. BMC Health Serv Res 2021; 21:97. [PMID: 33509181 PMCID: PMC7845106 DOI: 10.1186/s12913-021-06095-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/18/2021] [Indexed: 01/09/2023] Open
Abstract
Background The importance of the therapeutic relationship is widely recognised across healthcare professions. Despite the importance of therapeutic relationships, there are significant gaps in the knowledge base on how these relationships develop. To address these gaps, this study explores relationship dynamics by identifying relational turning points and trajectories in therapeutic relationships between occupational therapists and physical therapists and their patients. The implications for how a focus on these relational aspects can enhance clinical practice will be discussed. Methods Data collection was based on the Retrospective Interview Technique and consisted of two phases. In the first phase patients and therapists were asked to tell the story of their therapeutic relationship development and as part of this, identify the turning points that occurred. In the second phase, therapists-patient dyads were observed from their first interaction to their last to identify potential turning points and at the end of the relationship a participant verification interview was conducted with both dyadic partners individually. Template analysis was used to analyse the data. Results Therapists identified 6 distinct categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Patients, Interpersonal Problems with Patients, Positive Feedback, and Negative Feedback. Patients identified 5 categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Therapists, Agreement with Therapist and Change in Treatment. These turning points varied regarding their impact on the trajectory of the therapeutic relationship. The trajectory patterns identified were stable, upward, downward, and multidirectional. Conclusion This study makes an important contribution to our understanding of therapeutic relationship dynamics in the occupational and physical therapy context. The results expose the challenges that therapists and patients face in building high-quality therapeutic relationships, the diversity of therapeutic relationships, and how these relationships develop over time. This is the first study to use a turning point analysis in research on therapeutic relationships.
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Affiliation(s)
| | - Gail Hebson
- Work and Equalities Institute, University of Manchester, Manchester, England
| | - David Holman
- Alliance Manchester Business School, University of Manchester, Manchester, England
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156
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Rodríguez-Herrera A, Reyes-Andrade J, Rubio-Escudero C. Rationale for Timing of Follow-Up Visits to Assess Gluten-Free Diet in Celiac Disease Patients Based on Data Mining. Nutrients 2021; 13:nu13020357. [PMID: 33503952 PMCID: PMC7912674 DOI: 10.3390/nu13020357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 01/21/2023] Open
Abstract
The assessment of compliance of gluten-free diet (GFD) is a keystone in the supervision of celiac disease (CD) patients. Few data are available documenting evidence-based follow-up frequency for CD patients. In this work we aim at creating a criterion for timing of clinical follow-up for CD patients using data mining. We have applied data mining to a dataset with 188 CD patients on GFD (75% of them are children below 14 years old), evaluating the presence of gluten immunogenic peptides (GIP) in stools as an adherence to diet marker. The variables considered are gender, age, years following GFD and adherence to the GFD by fecal GIP. The results identify patients on GFD for more than two years (41.5% of the patients) as more prone to poor compliance and so needing more frequent follow-up than patients with less than 2 years on GFD. This is against the usual clinical practice of following less patients on long term GFD, as they are supposed to perform better. Our results support different timing follow-up frequency taking into consideration the number of years on GFD, age and gender. Patients on long term GFD should have a more frequent monitoring as they show a higher level of gluten exposure. A gender perspective should also be considered as non-compliance is partially linked to gender in our results: Males tend to get more gluten exposure, at least in the cultural context where our study was carried out. Children tend to perform better than teenagers or adults.
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Affiliation(s)
| | - Joaquín Reyes-Andrade
- Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, 41013 Seville, Spain;
| | - Cristina Rubio-Escudero
- Department of Computer Languages and Systems, University of Seville, 41013 Seville, Spain
- Correspondence: ; Tel.: +34-955421018
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157
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Dragesund T, Øien AM. Developing self-care in an interdependent therapeutic relationship: patients' experiences from Norwegian psychomotor physiotherapy. Physiother Theory Pract 2021; 38:1656-1666. [PMID: 33461377 DOI: 10.1080/09593985.2021.1875524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Factors causing and sustaining long-lasting musculoskeletal pain differ between patients, but must be identified in order to target treatment. During physiotherapy, there are multiple factors influencing the treatment outcome. The focus in the present study was to grasp patients' experiences of how social burdens influence the development and persistence of symptoms of muscle pain, and how the relationship with the physiotherapist influences the process of change during Norwegian Psychomotor Physiotherapy. A phenomenological, descriptive, and retrospective design was chosen. Data were collected through focus-group interviews. Eleven patients participated. They ranged in age from 34 to 67 years. The analysis was inspired by Giorgi's phenomenological method. The results identified a general, overarching structure; "Caring for others and developing self-care" and the two interwoven themes "Emerging awareness of overload" and "Receiving care from the physiotherapist." These themes describe the essence of the experiences from the treatment process. To be recognized by the physiotherapist, both through the hands-on treatment and verbal communication, appears to be crucial for patients to develop an awareness of the factors causing and sustaining their pain problems. This awareness seemed necessary for the process of change to take place and for the patients to take more responsibility for their own care.
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Affiliation(s)
- Tove Dragesund
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Aud Marie Øien
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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158
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Lawford BJ, Bennell KL, Campbell PK, Kasza J, Hinman RS. Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial. JMIR Rehabil Assist Technol 2021; 8:e23386. [PMID: 33459601 PMCID: PMC7850906 DOI: 10.2196/23386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/29/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The therapeutic alliance between patients and physical therapists has been shown to influence clinical outcomes in patients with chronic low back pain when consulting in-person. However, no studies have examined whether the therapeutic alliance developed between patients with knee osteoarthritis and physical therapists during telephonic consultations influences clinical outcomes. OBJECTIVE This study aims to investigate whether the therapeutic alliance between patients with knee osteoarthritis and physical therapists measured after the second consultation is associated with outcomes following telephone-delivered exercise and advice. METHODS Secondary analysis of 87 patients in the intervention arm of a randomized controlled trial allocated to receive 5 to 10 telephone consultations with one of 8 physical therapists over a period of 6 months, involving education and prescription of a strengthening and physical activity program. Separate regression models investigated the association between patient and therapist ratings of therapeutic alliance (measured after the second consultation using the Working Alliance Inventory Short Form) and outcomes (pain, function, self-efficacy, quality of life, global change, adherence to prescribed exercise, physical activity) at 6 and 12 months, with relevant covariates included. RESULTS There was some evidence of a weak association between patient ratings of the alliance and some outcomes at 6 months (improvements in average knee pain: regression coefficient -0.10, 95% CI -0.16 to -0.03; self-efficacy: 0.16, 0.04-0.28; global improvement in function: odds ratio 1.26, 95% CI 1.04-1.39, and overall improvement: odds ratio 1.26, 95% CI 1.06-1.51; but also with worsening in fear of movement: regression coefficient -0.13, 95% CI -0.23 to -0.04). In addition, there was some evidence of a weak association between patient ratings of the alliance and some outcomes at 12 months (improvements in self-efficacy: regression coefficient 0.15, 95% CI 0.03-0.27; global improvement in both function, odds ratio 1.19, 95% CI 0.03-1.37; and pain, odds ratio 1.14, 95% CI 1.01-1.30; and overall improvement: odds ratio 1.21, 95% CI 1.02-1.42). The data suggest that associations between therapist ratings of therapeutic alliance and outcomes were not strong, except for improved quality of life at 12 months (regression coefficient 0.01, 95% CI 0.0003-0.01). CONCLUSIONS Higher patient ratings, but not higher therapist ratings, of the therapeutic alliance were weakly associated with improvements in some clinical outcomes and with worsening in one outcome. Although the findings suggest that patients who perceive a stronger alliance with their therapist may achieve better clinical outcomes, the observed relationships were generally weak and unlikely to be clinically significant. The limitations include the fact that measures of therapeutic alliance have not been validated for use in musculoskeletal physical therapy settings. There was a risk of type 1 error; however, findings were interpreted on the basis of clinical significance rather than statistical significance alone. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000054415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369204.
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Affiliation(s)
- Belinda Joan Lawford
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Penny K Campbell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
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159
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McCabe E, Miciak M, Roduta Roberts M, Sun H(L, Kleiner MJ, Holt CJ, Gross DP. Development of the Physiotherapy Therapeutic Relationship Measure. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1868572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | | | - Douglas P. Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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160
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Missed Physical Therapy Treatments in the Acute Hospital: Toward a More Complete Understanding. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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161
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Krasovsky T, Lubetzky AV, Archambault PS, Wright WG. Will virtual rehabilitation replace clinicians: a contemporary debate about technological versus human obsolescence. J Neuroeng Rehabil 2020; 17:163. [PMID: 33298128 PMCID: PMC7724440 DOI: 10.1186/s12984-020-00769-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
This article is inspired by a pseudo Oxford-style debate, which was held in Tel Aviv University, Israel at the International Conference on Virtual Rehabilitation (ICVR) 2019, which is the official conference of the International Society for Virtual Rehabilitation. The debate, between two 2-person teams with a moderator, was organized by the ICVR Program committee to address the question "Will virtual rehabilitation replace clinicians?" It brought together five academics with technical, research, and/or clinical backgrounds-Gerry Fluet, Tal Krasovsky, Anat Lubetzky, Philippe Archambault, W. Geoffrey Wright-to debate the pros and cons of using virtual reality (VR) and related technologies to help assess, diagnose, treat, and track recovery, and more specifically investigate the likelihood that advanced technology will ultimately replace human clinicians. Both teams were assigned a side to defend, whether it represented their own viewpoint or not, and to take whatever positions necessary to make a persuasive argument and win the debate. In this paper we present a recapitulation of the arguments presented by both sides, and further include an in-depth consideration of the question. We attempt to judiciously lay out a number of arguments that fall along a spectrum from moderate to extreme; the most extreme and/or indefensible positions are presented for rhetorical and demonstrative purposes. Although there may not be a clear answer today, this paper raises questions which are related to the basic nature of the rehabilitation profession, and to the current and potential role of technology within it.
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Affiliation(s)
- Tal Krasovsky
- Department of Physical Therapy, University of Haifa, Haifa, Israel
- Pediatric Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel
| | - Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Philippe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
- CRIR - Centre de Recherche Interdisciplinaire en réadaptation, Montreal, Canada
| | - W Geoffrey Wright
- Neuromotor Sciences Program, Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA.
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162
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Bright FAS, Reeves B. Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke. Disabil Rehabil 2020; 44:2670-2682. [PMID: 33226864 DOI: 10.1080/09638288.2020.1849419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Communication between patients and clinicians influences the development of therapeutic relationships. Communication is disrupted when the patient has communication impairments after stroke. However, how these communication disruptions influence therapeutic relationships is not well-understood. This qualitative metasynthesis explores the perspectives of people with communication impairment to understand how interpersonal communication influences therapeutic relationships. MATERIAL AND METHODS Four databases were searched for qualitative studies which discussed how communication influenced therapeutic relationships from the perspectives of people with aphasia, dysarthria or apraxia of speech. Additional papers were identified through citation searching and subject experts. Nineteen eligible papers were included and analysed using thematic analysis. RESULTS Four themes were constructed from the analysis: (1) Relationships provide the foundation for rehabilitation; (2) Different relational possibilities arise from "reading" the clinician; (3) Creating therapeutic relationships through validating interactions and connections; and (4) Creating therapeutic disconnections through invalidating, exclusionary interactions. CONCLUSIONS A therapeutic relationship develops, at least in part, in response to the clinician's communication and how this is received and experienced by the patient. Understanding the characteristics of relationship-fostering communication and knowing how communication influences relationships can help clinicians critically reflect on their communication and better develop therapeutic relationships with people with communication impairment.IMPLICATIONS FOR REHABILITATIONPractitioner-patient communication can facilitate therapeutic relationships or create therapeutic disconnections.Communication patterns that are commonly evident when a patient has communication impairments can impede therapeutic relationships.Clinicians need to attend to how their communication is received and how it influences people's sense of self.Communication partner training should address the existential and relational needs of people with communication impairment after stroke.
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Affiliation(s)
- F A S Bright
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - B Reeves
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
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163
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Conde M, Hendry GJ, Woodburn J, Skelton DA. ´Feet are second class citizens`: exploring the perceptions of Scottish and Portuguese older adults about feet, falls and exercise- a qualitative study. J Foot Ankle Res 2020; 13:66. [PMID: 33176825 PMCID: PMC7659063 DOI: 10.1186/s13047-020-00434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Foot problems are likely to contribute to falls risk in older adults. Foot and ankle exercises may be beneficial, but uptake may be influenced by cultural factors. Few studies have explored the views of older adults from different cultural backgrounds about foot-specific falls risk factors, and foot and ankle falls prevention exercises. Objectives To explore the views of Scottish and Portuguese community-dwelling older adults who have experienced a fall, about any foot risk factors for falls, and foot and ankle exercises. Methods Cross-cultural qualitative study with (n = 6) focus groups exploring the perceptions of Scottish (n = 10, mean age 76 yrs) and Portuguese older adults (n = 14, mean age 66 years) aged, applying thematic analysis. Results One main theme `evolving awareness about feet and falls prevention´ and three subthemes; (i) Feet are often forgotten, (ii) the important role of footwear, (iii) need to look at my feet and do the exercises were identified. Scottish participants had more experience of falls prevention but there was a lack of knowledge surrounding foot-specific falls risk factors, and the role of ankle and foot exercise in the prevention of falls. Portuguese participants exhibited a fatalistic approach to falls. Conclusions Older adults from both nations had little knowledge of foot-specific falls risk factors, being initially unaware of the functional status of their feet and of the role of exercise in foot care and falls management. There were differences between national groups that should be accounted for when developing culturally adequate interventions.
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Affiliation(s)
- Monserrat Conde
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK.
| | - Gordon J Hendry
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Jim Woodburn
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
| | - Dawn A Skelton
- School of health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, G4 0BA, Glasgow, Scotland, UK
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164
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Rodríguez-Nogueira Ó, Morera Balaguer J, Nogueira López A, Roldán Merino J, Botella-Rico JM, Del Río-Medina S, Moreno Poyato AR. The psychometric properties of the person-centered therapeutic relationship in physiotherapy scale. PLoS One 2020; 15:e0241010. [PMID: 33156867 PMCID: PMC7647106 DOI: 10.1371/journal.pone.0241010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the psychometric properties of the Person-Centered Therapeutic Relationship in Physiotherapy Scale (PCTR-PT) in order to find the most appropriate fit for the tool. METHODS Patients who had received treatment at the physiotherapy service of nine hospitals in Spain were invited to complete the 31 items of the PCTR-PT scale. To select the most appropriate items of the PCTR-PT, an exploratory factorial analysis (EFA) was performed using the maximum likelihood and oblique rotation (promin) methods. Factor validity, goodness-of-fit and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent (CFA) and discriminant validity were calculated. Internal consistency was verified using the Cronbach's alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability. RESULTS 366 patients over 18 years old who had received, at least, 15 physiotherapy treatment sessions completed the questionnaire. The results of the exploratory factor analysis revealed a tool with 15 items in four factors [Relational Bond (N items = 4); Individualized Partnership (N items = 4); Professional Empowerment (N items = 3) and Therapeutic Communication (N items = 4)], explaining 78.4% of the variance of the total variables of this tool. The confirmatory factor analysis further confirmed the four-structure model. Reliability of the tool was approved by Cronbach's alpha in all four dimensions, as all were above .70, ranging from .84 (Individualized Partnership) to .91 (Professional Empowerment). = 0.94. Test-retest was performed with two-week intervals, indicating an appropriate stability for the scale (ICC = 0.900). CONCLUSION The Person-Centered Therapeutic Relationship in Physiotherapy Scale (PCTR-PT) is a useful, valid and applicable instrument to evaluate the person-centered therapeutic relationship during physiotherapy interventions. It would be interesting to investigate the predictive capacity (sensitivity and specificity) of the PCTR-PT scale.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- Department of Nursing and Physiotherapy, SALBIS Research Group, Campus de Ponferrada, Universidad de León, Ponferrada, León, Spain
| | - Jaume Morera Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Elche, Alicante
| | - Abel Nogueira López
- European University of the Atlantic, Santander, Spain
- International Ibero-American University, Campeche, Mexico
- Department of Sport, International University of Cuanza, Cuito, Angola
| | - Juan Roldán Merino
- Campus Docent, Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, and Researcher, Research Group GIES (Grupo de investigación en Enfermerıía, Educación y Sociedad), Barcelona, Spain
- Research Group GEIMAC (Consolidated Group 2017–1681: Group of Studies of Invarianza of the Instruments of Measurement and Analysis of Change in the Social and Health Areas), Barcelona, Spain
| | - José-Martín Botella-Rico
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Elche, Alicante
| | - Sonia Del Río-Medina
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Elche, Alicante
| | - Antonio R. Moreno Poyato
- Escola d´Infermeria Departament d'Infermeria de Salut Pública, Salut Mental i MaternoInfantil Facultat de Medicina i Ciències de la Salut, Campus de Bellvitge, Universitat de Barcelona, Pavelló de Govern, Barcelona, Spain
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165
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Senicola CA, Smith JB, Wilson K. COVID-19 Has Changed Patient-Clinician Communication: What Can Rehabilitation Professionals Do to Enhance It? HSS J 2020; 16:141-145. [PMID: 33223976 PMCID: PMC7664167 DOI: 10.1007/s11420-020-09802-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Cara Ann Senicola
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, 535 E. 70th St, New York, NY USA
| | - Jerome Brent Smith
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, 535 E. 70th St, New York, NY USA
| | - Katherine Wilson
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, 535 E. 70th St, New York, NY USA
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166
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Rowlands L, Coetzer R, Turnbull OH. Building the bond: Predictors of the alliance in neurorehabilitation. NeuroRehabilitation 2020; 46:271-285. [PMID: 32310195 DOI: 10.3233/nre-193005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurorehabilitation services are often delivered through group psycho-education programmes. However, little is known about the therapeutic process at work during such sessions. The present study is the first to gain insight into the therapeutic alliance, during a seven-session group programme. In addition, cognitive, emotional, and demographic predictors of the alliance, and participants' feelings towards their group members, were investigated, together with predictors of patient engagement. METHODS Forty-five participants with an acquired brain injury completed a series of questionnaires, and neuropsychological assessment, following group psycho-education. The group facilitator completed a parallel therapeutic alliance questionnaire, and rated participants' engagement. RESULTS Results demonstrated that a strong alliance can be formed in seven group sessions. Notably, no demographic or cognitive factors appear to pose a barrier to developing a therapeutic alliance, nor to group attraction. CONCLUSION High levels of depression, however, may be a challenge, and clinicians may need to tailor their clinical skills to ensure a good therapeutic relationship with such patients. To promote engagement, clinicians may also need to provide additional support to patients with lower levels of education, working memory, and episodic memory impairment.
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Affiliation(s)
- Leanne Rowlands
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
| | - Rudi Coetzer
- School of Psychology, Bangor University, Bangor, UK.,The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, Colwyn Bay, UK
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167
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Nurre ER, Smith AW, Rodriguez MG, Modi AC. Patient, Caregiver, and Provider Perceptions of Transition Readiness and Therapeutic Alliance during Transition from Pediatric to Adult Care in Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractTransition from pediatric to adult health care is a time of high risk for adolescents and young adults (AYAs) with epilepsy. Our aims are to examine patient, caregiver, and provider perceptions of transition readiness and the influence of patient-provider alliance in the context of transition readiness. Our cross-sectional study included 82 AYAs with epilepsy prior to transition. Patients, caregivers, and providers completed questionnaires (e.g., transition readiness and working alliance). Statistical analyses included independent samples and paired t-tests. Participants were 17.3 ± 2.8 years on average, 54% were females, 84% were White (non-Hispanic), and 38% had generalized epilepsy. Caregivers reported significantly higher transition readiness than their AYAs (t (72) = −10.6, p < 0.001). AYAs and providers reported similar alliance scores. Providers who felt patients were ready to transition had higher patient-reported transition readiness and provider-reported alliance scores. These data suggest that patients and providers are well aligned in the transition process, and providers appropriately perceive key areas necessary for transition. Caregivers and patients had discrepant perceptions of transition readiness, highlighting the importance of assessing both unique transition perspectives. Dedicated transition programs are likely to be beneficial in improving transition readiness and increase alignment across patients, caregivers, and providers.
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Affiliation(s)
- Emily R. Nurre
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Aimee W. Smith
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States
| | - Marie G. Rodriguez
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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168
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What symptoms tell us: A multiple case study of oncology consultations. Palliat Support Care 2020; 19:421-436. [PMID: 32912373 DOI: 10.1017/s1478951520000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES While patients' symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach. METHODS Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature. RESULTS Patients' symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential. SIGNIFICANCE OF RESULTS Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.
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169
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Moran ME, Hodgson JL, Jensen JF, Wood TL. Musculoskeletal injury survivors' resiliency: A systematic review. Disabil Health J 2020; 14:100987. [PMID: 32888877 DOI: 10.1016/j.dhjo.2020.100987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/29/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Musculoskeletal traumas are on the rise in the United States; however, limited studies are available to help trauma providers assess and treat concerns beyond the physical impact. Little is understood about the psychological, social, and spiritual factors that protect patients from adverse effects after a physical trauma or their experiences with each factor afterward. OBJECTIVE This systematic review was conducted to investigate and review advancements in research related to risk and resiliency factors experienced by survivors of traumatic musculoskeletal injuries. The use of biopsychosocial-spiritual (BPS-S) framework and resiliency theory guided the analysis. METHODS Researchers reviewed 1003 articles, but only seven met the search criteria. Due to the complexity and uniqueness of traumatic brain injuries, studies on that target population were excluded. RESULTS Of the seven articles reviewed, three identified psychological protective factors that protect against negative health outcomes; three identified negative psychological, social, or spiritual outcomes; and none investigated social or spiritual health. CONCLUSIONS There are significant gaps in the literature surrounding risk and resiliency factors related to the BPS-S health of musculoskeletal injury survivors.
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Affiliation(s)
- Mary E Moran
- Division of Trauma, Department of Surgery, Summa Health System - Akron Campus, 525 East Market, Akron, OH, 44304, USA.
| | - Jennifer L Hodgson
- Department of Human Development and Family Science, East Carolina University, E. 5th Street, Greenville, NC, 27858, USA
| | - Jakob F Jensen
- Department of Human Development and Family Science, East Carolina University, E. 5th Street, Greenville, NC, 27858, USA
| | - Teresa L Wood
- Nursing Research, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH, 43214, USA
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170
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Supp G, Schoch W, Baumstark MW, May S. Do patients with low back pain remember physiotherapists' advice? A mixed-methods study on patient-therapist communication. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1868. [PMID: 32776654 DOI: 10.1002/pri.1868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/17/2020] [Accepted: 07/05/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The primary aim of this study was to determine if the advice physiotherapists think they provide to patients with low back pain (LBP) is what the patients remember and take away from the clinical encounter. The secondary aim was to determine which factors may influence the retention of this advice. METHODS The first component of the study used questionnaires completed by patients and therapists after the initial visit. Related questionnaires of patients and therapists were screened for inconsistencies. The second component of the study involved semi-structured interviews. RESULTS Ninety pairs of questionnaires were completed. Therapists provided patients with one (N = 90), two (N = 85) or three (N = 51) items of advice regarding the management of their LBP. All patients remembered the first item of advice, 92% remembered a second, and 67% remembered the third piece of advice. All items of advice were deemed either 'relevant' or 'very relevant' by 97% of the patients. After the analysis of 14 interviews, data saturation was reached. Four themes emerged from the data analysis of the interviews: (a) Evaluation type, (b) Exercise factors, (c) Patient concerns about their diagnosis, and (d) Patient expectations. DISCUSSION In most cases, patients remembered what therapists told them and considered that the advice provided was relevant. Based on the qualitative data, patients were more likely to remember what therapists said when: (a) shared decision making was used during the initial encounter, (b) prescribed exercises were simple to perform and few in number, (c) patients' concerns about their diagnosis were addressed, and (d) patients' expectations were identified and addressed.
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Affiliation(s)
| | | | - Manfred W Baumstark
- Institute for Exercise- and Occupational Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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171
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Pasternak K, Diaz J, Thibeault SL. Predictors of Voice Therapy Initiation: A Cross-Sectional Cohort Study. J Voice 2020; 36:194-202. [PMID: 32561211 DOI: 10.1016/j.jvoice.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine predictors of voice therapy initiation. STUDY DESIGN Cross-sectional cohort study. METHODS All patients were evaluated in an interdisciplinary model at the University of Wisconsin Voice and Swallow Clinics between June 2016 and October 2017. Patients were eligible if they were diagnosed with a voice disorder and recommended for voice therapy as the only treatment. The dependent variable was attendance in at least once voice therapy session. Independent variables included therapeutic alliance, measured using the Session Rating Scale, and patient- and disease-related factors. These factors included gender, age, distance to the clinic, education level, household composition, occupational voice demand, Voice Handicap Index score, auditory-perceptual dysphonia severity (Grade, Roughness, Breathiness, Asthenia, Strain), and medical voice diagnosis. RESULTS Ninety-five patients were enrolled in the study. Voice therapy initiation rate was 70%. Having fewer school-aged children (5-18 years) in the household was significantly different between the group that initiated voice therapy and the group that did not (P = 0.048). There was no difference between groups for all other factors. CONCLUSIONS This investigation suggests that household composition, specifically having fewer school-aged children in the household, may predict initiation of voice therapy. This study confirms in a prospective fashion the absence of relationship between voice therapy initiation and most patient- and disease-related factors. Therapeutic alliance should be further investigated for its ability to predict voice therapy initiation using a measure that is validated for the population of patients with dysphonia.
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Affiliation(s)
- Kevin Pasternak
- UW Voice and Swallow Clinics, UW Health, Madison, Wisconsin.
| | - Jennylee Diaz
- Division of Speech-Language Pathology, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Susan L Thibeault
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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172
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Stagg K, Douglas J, Iacono T. The perspectives of allied health clinicians on the working alliance with people with stroke-related communication impairment. Neuropsychol Rehabil 2020; 31:1390-1409. [PMID: 32546084 DOI: 10.1080/09602011.2020.1778491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The processes by which working alliances develop in stroke rehabilitation are not well understood. The aim of this study was to explore the ways in which experienced allied health clinicians establish and maintain alliances with people with stroke-related communication impairment, and to identify factors that may influence the strength of these alliances. In-depth interviews were completed with 11 clinicians from the disciplines of occupational therapy, speech-language pathology and physiotherapy. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory. Participants described processes that were captured by the themes of enabling interaction, being responsive, building relational capital and building credibility. Practices that supported communication and emphasized responding, both within an interaction and over time, aligned with examples of strong alliances. Professional credibility and relational practices such as everyday conversations and the use of humour were viewed as important. Difficulty accessing a shared mode of communication due to stroke-related communication impairment altered relational processes and influenced perceptions of the alliance, although examples of strong alliances were present. In this study, reflections on challenging alliances highlighted potentially helpful practices. A responsive approach to rehabilitation, supported by reflective practice, may assist clinicians to better navigate their working alliances with this population.
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Affiliation(s)
- Kellie Stagg
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia.,Summer Foundation, Melbourne, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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173
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Cornish MA, Guyll M, Wade NG, Lannin DG, Madon S, Chason KC. Does Empathy Promotion Necessarily Lead to Greater Forgiveness? An Experimental Examination. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-018-9816-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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174
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Turner J, Malliaras P, Goulis J, Mc Auliffe S. "It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away." A qualitative study exploring individuals' beliefs and experiences of Achilles tendinopathy. PLoS One 2020; 15:e0233459. [PMID: 32469914 PMCID: PMC7259496 DOI: 10.1371/journal.pone.0233459] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Achilles tendinopathy (AT) is a common and often persistent musculoskeletal disorder affecting both athletic and non-athletic populations. Despite the relatively high incidence there is little insight into the impact and perceptions of tendinopathy from the individual’s perspective. Increased awareness of the impact and perceptions around individuals’ experiences with Achilles tendinopathy may provide crucial insights for the management of what is often a complex, persistent, and disabling MSK disorder. Purpose To qualitatively explore the lived experiences of individuals with AT. Design A qualitative, interpretive description design was performed using semi-structured telephone interviews. Methods Semi-structured interviews were conducted on 15 participants (8 male and 7 female) with AT. Thematic analysis was performed using the guidelines laid out by Braun and Clarke. The study has been reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. Results Four main themes were identified from the data: 1) beliefs and perceptions surrounding AT: “If I'm over training or something, I don't really know”, 2) the biopsychosocial impact of AT: “I think it restricts me in a lot of things that I would be able to do”, 3) individuals’ experiences with the management process: “You want it to happen now. You're doing all this stuff and it's just very slow progress”, and 4) future prognosis and outlook in individuals with AT: “I see myself better”. Conclusions This study offers a unique insight into the profound impact and consequences of Achilles tendinopathy in a mixed sample of both athletic and non-athletic individuals. The findings of this study have important clinical implications. Specifically, it highlights the need for clinicians to recognize and adopt treatment approaches to embrace a more biopsychosocial approach for the management of tendinopathy.
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Affiliation(s)
- Jeffrey Turner
- 56 Medical Group, Luke Air Force Base, United States Air Force, Phoenix, AZ, United States of America
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health, Monash University, Melbourne, Australia
| | - Jimmy Goulis
- Department of Physiotherapy, School of Primary and Allied Health, Monash University, Melbourne, Australia
| | - Seán Mc Auliffe
- Department of Physical Therapy and Rehabilitation Sciences, College of Health Sciences, Qatar University, Doha, Qatar
- * E-mail:
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175
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Lilleheie I, Debesay J, Bye A, Bergland A. A qualitative study of old patients' experiences of the quality of the health services in hospital and 30 days after hospitalization. BMC Health Serv Res 2020; 20:446. [PMID: 32434506 PMCID: PMC7238652 DOI: 10.1186/s12913-020-05303-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 05/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background The number of people aged 80 years and above is projected to triple over the next 30 years. People in this age group normally have at least two chronic conditions. The impact of multimorbidity is often significantly greater than expected from the sum of the effects of each condition. The World Health Organization has indicated that healthcare systems must prepare for a change in the focus of clinical care for older people. The World Health Organization (WHO) defines healthcare quality as care that is effective, efficient, integrated, patient centered, equitable and safe. The degree to which healthcare quality can be defined as acceptable is determined by services’ ability to meet the needs of users and adapt to patients’ expectations and perceptions. Method We took a phenomenological perspective to explore older patients’ subjective experiences and conducted semistructured individual interviews. Eighteen patients (aged from 82 to 100 years) were interviewed twice after discharge from hospital. The interview transcriptions were analyzed thematically. Results The patients found their meetings with the health service to be complex and demanding. They reported attempting to restore a sense of security and meaning in everyday life, balancing their own needs against external requirements. Five overarching themes emerged from the interviews: hospital stay and the person behind the diagnosis, poor communication and coordination, life after discharge, relationship with their next of kin, and organizational and systemic determinants. Conclusion According to the WHO, to deliver quality healthcare, services must include all six of the dimensions listed above. Our findings show that they do not. Healthcare focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, where they struggled to find balance in their everyday life. Further work must be done to ensure that integrated services are provided without a financial burden, centered on the needs and rights of older people.
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Affiliation(s)
- Ingvild Lilleheie
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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176
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Zadro JR, Ferreira G. Has physical therapists' management of musculoskeletal conditions improved over time? Braz J Phys Ther 2020; 24:458-462. [PMID: 32387047 DOI: 10.1016/j.bjpt.2020.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Our 2019 systematic review found that up to 63% of physical therapists provided recommended care for musculoskeletal conditions, up to 43% provided non-recommended care, and up to 81% provided care of unknown value. We included studies published as early as 1993 and as recent as 2017. OBJECTIVE To determine whether physical therapists' treatment choices for musculoskeletal conditions have improved over time. METHODS For the original review, we included studies (until April 2018) that quantified physical therapy treatment choices for musculoskeletal conditions through surveys of physical therapists, audits of clinical notes, and other methods (e.g. clinical observation). Using medians and interquartile ranges, we summarised the percentage of physical therapists who provided treatments that were recommended, not recommended, and of unknown value. For this analysis, we stratified the findings from the above systematic review by decade (1990-1999, 2000-2009, 2010-2018). RESULTS The median percentage of physical therapists who provided recommended treatments (40% from 1990 to 1999, 50% from 2000 to 2009, and 35% from 2010 to 2018) and non-recommended treatments (41%, 28%, and 39% respectively) has not changed over time. However, more physical therapists seem to be providing treatments of unknown value (41% from 1990 to 1999, 55% from 2000 to 2009, and 70% from 2010 to 2018). CONCLUSION Possible explanations for this trend include the growing need for clinical innovation, challenge of keeping up to date with evidence, increased exposure to treatments of unknown value, belief that evidence is not relevant to practice, and possible limitations of the data. Strategies to help physical therapists replace non-recommended care with recommended care are discussed.
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Affiliation(s)
- Joshua R Zadro
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
| | - Giovanni Ferreira
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
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177
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Chavez Arana C, Catroppa C, Yáñez-Téllez G, Prieto-Corona B, de León MA, García A, Gómez-Raygoza R, Hearps SJC, Anderson V. A Parenting Program to Reduce Disruptive Behavior in Hispanic Children with Acquired Brain Injury: A Randomized Controlled Trial Conducted in Mexico. Dev Neurorehabil 2020; 23:218-230. [PMID: 31345088 DOI: 10.1080/17518423.2019.1645224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral self-regulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation.
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Affiliation(s)
- Clara Chavez Arana
- Universiteit Leiden, Faculteit der Sociale Wetenschappen, Instituut Psychologie, Netherlands.,The University of Melbourne, Melbourne, Victoria, Australia.,Universidad Nacional Autónoma de México, FES Iztacala, Mexico City, Mexico
| | - Cathy Catroppa
- The University of Melbourne, Melbourne, Victoria, Australia.,Child Neuropsychology, Murdoch Childrens Research Institute, Melbourne, Australia.,Royal Children´s Hospital, Melbourne, Australia
| | | | | | - Miguel A de León
- Iskalti Centre of Psychological and Educational Support S.C., Mexico City, Mexico
| | - Antonio García
- Unit of High Specialty "La Raza" IMSS, Mexico City, Mexico
| | | | - Stephen J C Hearps
- Universidad Nacional Autónoma de México, FES Iztacala, Mexico City, Mexico
| | - Vicki Anderson
- Universidad Nacional Autónoma de México, FES Iztacala, Mexico City, Mexico.,Child Neuropsychology, Murdoch Childrens Research Institute, Melbourne, Australia.,Royal Children´s Hospital, Melbourne, Australia
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Lawrason SVC, Todd KR, Shaw RB, Martin Ginis KA. Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review. Spinal Cord 2020; 58:735-745. [DOI: 10.1038/s41393-020-0460-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/27/2022]
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179
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Eklund A, Hagberg J, Jensen I, Leboeuf-Yde C, Kongsted A, Lövgren P, Jonsson M, Petersen-Klingberg J, Calvert C, Axén I. The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain - a secondary analysis of a pragmatic randomized controlled trial. Chiropr Man Therap 2020; 28:19. [PMID: 32316995 PMCID: PMC7171853 DOI: 10.1186/s12998-020-00309-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background A recent study showed that chiropractic patients had fewer days with bothersome (activity-limiting) low back pain (LBP) when receiving care at regular pre-planned intervals regardless of symptoms (‘maintenance care’, MC) compared to receiving treatment only with a new episode of LBP. Benefit varied across psychological subgroups. The aims of this study were to investigate 1) pain trajectories around treatments, 2) recurrence of new episodes of LBP, and 3) length of consecutive pain-free periods and total number of pain-free weeks, for all study participants as well as for each psychological subgroup. Methods A secondary analysis of data from a randomized controlled trial of patients (n = 319) seeking chiropractic care for recurrent or persistent LBP used 52 weekly estimates of days with bothersome (activity-limiting) LBP. First, a generalized estimating equations analysis was used to compare the pain trajectory before and after the initial treatment in every new treatment period. Thereafter, a time-to-event analysis (using Cox regression) estimated time to/risk of a new LBP episode. The analyses were performed on i) all study participants and ii) separately for each psychological sub-group (named adaptive copers, interpersonally distressed and dysfunctional) classified by the West Haven-Yale Multidimensional Pain Inventory. Results Patients receiving MC had flat pain trajectories around each new treatment period and reported fewer days with pain compared to patients receiving the control intervention. The entire effect was attributed to the dysfunctional subgroup who reported fewer days with activity limiting pain within each new LBP episode as well as longer total pain-free periods between episodes with a difference of 9.8 weeks (CI 95% 3.3, 16.3) compared to the control group. There were no differences in the time to/risk of a new episode of LBP in either of the subgroups. Conclusion Data support the use of MC in a stratified care model targeting dysfunctional patients for MC. For a carefully selected group of patients with recurrent and persistent LBP the clinical course becomes more stable and the number of pain-free weeks between episodes increases when receiving MC. Understanding how subgroups of patients are likely to be affected by MC may help align patients’ and clinicians’ expectations based on realistic outcomes. Trial registration Clinical trials.gov; NCT01539863; February 22, 2012.
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Affiliation(s)
- Andreas Eklund
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden.
| | - Jan Hagberg
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Irene Jensen
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Charlotte Leboeuf-Yde
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | - Iben Axén
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
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180
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Søndenå P, Dalusio-King G, Hebron C. Conceptualisation of the therapeutic alliance in physiotherapy: is it adequate? Musculoskelet Sci Pract 2020; 46:102131. [PMID: 32217276 DOI: 10.1016/j.msksp.2020.102131] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Therapeutic Alliance (TA) is an emerging concept within physiotherapy practice, reflecting the ongoing paradigm shift from a biomedical- (BMM) towards a biopsychosocial model (BPSM) of care. Current conceptual understanding of the TA is commonly based on Bordin's (1979) definition, developed within a psychotherapy context. A concept analysis was conducted in order to provide conceptual clarity of the TA within physiotherapy literature. METHOD An evolutionary method of concept analysis was followed. An extensive literature search was conducted, and eligible articles were submitted to inductive, semantic thematic analysis. FINDINGS A total of 14 articles were included within this concept analysis. 5 master attribute themes, and 4 corresponding sub-themes were identified following thematic analysis. The master attribute themes were: 'Seeing the person', 'Sharing the journey', 'Communication', 'Therapeutic space' and 'Fostering autonomy'. The 4 Sub-themes were: 'Giving of self', 'Legitimising the experience', 'Physiotherapist characteristics matter' and 'Interpersonal collaboration'. CONCLUSION A heuristic interpretation of the TA within a physiotherapy context is offered. The TA is a dynamic construct within the clinical encounter and is influenced reciprocally between the person seeking care and the physiotherapist by biological, social and psychological contributing factors. 'Communication' may act as a catalyst in operationalising the TA in a physiotherapy context. Continued efforts are needed in physiotherapy education and training in both enhancing theoretical awareness of the role of the TA within physiotherapy practice, as well as guidance on its implementation in clinical practice.
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Affiliation(s)
- Petter Søndenå
- University of Brighton, School of Health Sciences, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom
| | - Georgi Dalusio-King
- University of Brighton, School of Health Sciences, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom
| | - Clair Hebron
- University of Brighton, School of Health Sciences, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom.
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181
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Vestøl I, Debesay J, Pajalic Z, Bergland A. The importance of a good therapeutic alliance in promoting exercise motivation in a group of older Norwegians in the subacute phase of hip fracture; a qualitative study. BMC Geriatr 2020; 20:118. [PMID: 32228477 PMCID: PMC7106840 DOI: 10.1186/s12877-020-01518-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background Hip fractures represent a global public health issue that demands high cost both from the patient and from the society. Functional exercise in the subacute phase of a hip fracture is essential in reducing these costs. To the best of our knowledge, no qualitative study has explored the patients’ experiences in participating in an exercise program during the first month after surgery. Thus, this study aims to explore how older people who had participated in an evidence-based exercise intervention describe their relationship with their therapists and how this relationship might contribute to their motivation for exercise. Methods Thirteen women and six men, who all had experienced a hip fracture and were staying in the same short-term rehabilitation unit, were interviewed by the last author. The interviews lasted from 30 to 70 min. The participants’ mean age was 86 years and they had all participated in a High Intensity Functional Exercise (HIFE) program in one-on-one sessions for 2 weeks, a total of 10 sessions. The recruitment was done by therapists involved in an RCT evaluating the HIFE-program with the attempt to obtain maximum variation. Data were analyzed through systematic text condensation in collaboration between all authors. Results The analysis yielded three main themes integrated in the core theme “Therapeutic alliance is an interpretative filter for the participants’ experiences.” The three themes were “The feeling of mutuality and respect in the alliance”; “A trusting and motivating relationship” and “Tailoring of the instruction and program to make the task understandable”. These themes concerned basic needs in the relationship between the participants and the therapists which brought forward a feeling of mutual respect. The most prominent finding was the experience of trust in the therapists’ abilities, and how this contributed to the participants’ motivation to fulfil the program and achieve meaningful changes. Conclusion Our findings suggest that therapeutic alliance is an indispensable aspect of a therapy, and relational knowledge and competence are prerequisites in the transfer of professional knowledge in a therapy. Our findings can be useful to therapists involved in clinical practice, especially to those working with vulnerable groups.
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Affiliation(s)
- Irene Vestøl
- Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet, P.O. Box 4 St. Olavs Plass, 0130, Oslo, Norway.
| | - Jonas Debesay
- Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet, P.O. Box 4 St. Olavs Plass, 0130, Oslo, Norway
| | - Zada Pajalic
- Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet, P.O. Box 4 St. Olavs Plass, 0130, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet, P.O. Box 4 St. Olavs Plass, 0130, Oslo, Norway
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182
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Naeemabadi MR, Søndergaard JH, Klastrup A, Schlünsen AP, Lauritsen REK, Hansen J, Madsen NK, Simonsen O, Andersen OK, Kim KK, Dinesen B. Development of an individualized asynchronous sensor-based telerehabilitation program for patients undergoing total knee replacement: Participatory design. Health Informatics J 2020; 26:2492-2511. [DOI: 10.1177/1460458220909779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Telerehabilitation programs can be employed to establish communication between patients and healthcare professionals and empower patients performing their training remotely. This study aimed to identify patients’ requirements after a total knee replacement following a self-training rehabilitation program, leading to the design and development of a telerehabilitation program that can meet the stakeholders’ actual needs. System design, development, and testing were conducted in five iterations based on a participatory design approach. Data collection was performed using interviews, observations, prototyping, and questionnaires. It was found that the main barriers facing the existing rehabilitation program were a lack of clear communication, lack of relevant information, and healthcare professional’s feedback. The participants emphasized the main themes of communication, information, training, and motivation in the process of design and development. In using the telerehabilitation program, the patients reported a high level of user-friendliness, flexibility, and a sense of security. This study has identified obstacles in the current rehabilitation program and revealed the potential effectiveness of using asynchronous communication and sensor-based technologies by employing participatory design and development. A higher level of portability and flexibility were observed. However, future studies and development are required to investigate the overall usability and reliability of the telerehabilitation program.
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183
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Rodríguez Nogueira O, Botella-Rico J, Martínez González MC, Leal Clavel M, Morera-Balaguer J, Moreno-Poyato AR. Construction and content validation of a measurement tool to evaluate person-centered therapeutic relationships in physiotherapy services. PLoS One 2020; 15:e0228916. [PMID: 32119676 PMCID: PMC7051061 DOI: 10.1371/journal.pone.0228916] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study sought to develop a tool for evaluating person-centered therapeutic relationships within physiotherapy services, and to examine the content validity of the same. METHODS A mixed qualitative and quantitative study was performed in three distinct phases: 1) the items were generated based on a literature review and a content analysis of focus groups of patients and physiotherapists; 2) an e-Delphi survey process was performed based on three rounds to select and refine the proposed questionnaire; 3) two rounds of cognitive interviews were conducted to evaluate the comprehension of items, the clarity of language and the appropriateness and relevance of content. RESULTS Thirty-one items were generated based on the seven domains identified after the analysis of four focus groups of physiotherapists and four patient focus groups. Nine experts participated in the e-Delphi survey. Fifty-five patients participated in the two rounds of the cognitive pre-tests. Participating patients were from public and private physical therapy services. Based on the participants' suggestions, four items were removed, and four were added, whereas 16 were reworded. CONCLUSIONS The final tool comprised 31 items divided into seven domains. The response format was based on a 5-point Likert frequency scale. The response options ranged from "strongly agree" to "strongly disagree".
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Affiliation(s)
- O. Rodríguez Nogueira
- University of León, Health Sciences School, Nursing and Physical Therapy Department, Ponferrada León, Spain
| | - J. Botella-Rico
- Universidad Cardenal Herrera-CEU, CEU Universities, Physical Therapy Department, Plaza Reyes Católicos, Elche, Alicante, Spain
| | - M. C. Martínez González
- Universidad Cardenal Herrera-CEU, CEU Universities, Medicine Department, Plaza Reyes Católicos, Elche, Alicante, Spain
| | - M. Leal Clavel
- Universidad Cardenal Herrera-CEU, CEU Universities, Nursing Department, Plaza Reyes Católicos, Elche, Alicante, Spain
| | - J Morera-Balaguer
- Universidad Cardenal Herrera-CEU, CEU Universities, Physical Therapy Department, Plaza Reyes Católicos, Elche, Alicante, Spain
- * E-mail:
| | - A. R. Moreno-Poyato
- Universitat de Barcelona, Escola d'Infermeria, Departament d'Infermeria de Salut Pública, Salut Mental i MaternoInfantil, Facultat de Medicina i Ciències de la Salut, Campus Bellvitge Pavelló de Govern, c/ Feixa Llarga, L'Hospitalet de Llobregat Barcelona, Spain
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184
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Abrosimoff M, Rajendran D. ‘Tell me your story’ - How osteopaths apply the BPS model when managing low back pain - A qualitative study. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2019.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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185
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Louw A, Goldrick S, Bernstetter A, Van Gelder LH, Parr A, Zimney K, Cox T. Evaluation is treatment for low back pain. J Man Manip Ther 2020; 29:4-13. [PMID: 32091317 DOI: 10.1080/10669817.2020.1730056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: To investigate the effect of the examination process (history taking and physical examination) on pain and function. Methods: An observational cohort trial of patients presenting to outpatient physical therapy clinics for the first time with low back pain (n = 34, 57.7 ± 18.7 years, 53% female). A blinded investigator measured participants prior to the beginning of the initial evaluation and after each component of evaluation (history taking and physical examination). Another physical therapist provided normal history taking and physical examination as the patient case presented itself. Primary outcome measure was numeric pain rating scale (NPRS) for the low back and leg. Secondary outcomes and time during examination process and connection between PT and patient were also measured as potential confounders. Results: Participants showed a significant reduction in pain through just the history taking and physical exam for both the back with an NPRS reduction of 1.23 and the leg showing a 0.95 NPRS reduction. The most significant reduction occurs after history taking. Discussion: The evaluation process produced small, but significant, therapeutic effects related to pain, fear-avoidance, pain catastrophization, and functional measures of mobility and sensitivity. The therapist's report of connection with the patient did not alter the patient outcome.
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Affiliation(s)
- Adriaan Louw
- International Spine Pain Institute , Story City, IA, USA.,Department of Physical Therapy, St. Ambrose University , Davenport, IA, USA.,Pain Science Fellowship, Evidence in Motion , San Antonio, TX, USA
| | - Steve Goldrick
- International Spine Pain Institute , Story City, IA, USA.,Pain Science Fellowship, Evidence in Motion , San Antonio, TX, USA.,Kitsap Physical Therapy , Silverdale, WA, USA
| | | | | | - Aaron Parr
- ProActive Physical Therapy , Tucson, AZ, USA
| | - Kory Zimney
- International Spine Pain Institute , Story City, IA, USA.,Pain Science Fellowship, Evidence in Motion , San Antonio, TX, USA.,Department of Physical Therapy, University of South Dakota , Vermillion, SD, USA
| | - Terry Cox
- International Spine Pain Institute , Story City, IA, USA.,Department of Physical Therapy, Southwest Baptist University , Bolivar, MO, USA
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186
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Do therapist effects determine outcome in patients with shoulder pain in a primary care physiotherapy setting? Physiotherapy 2020; 107:111-117. [PMID: 32026811 DOI: 10.1016/j.physio.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore whether a therapist effect exists in physiotherapists treating patients with shoulder pain and to identify if personality traits of the physiotherapist influences patients outcome. DESIGN Observational cohort study. SETTING Primary care physiotherapy practices. PARTICIPANTS Data on patients with shoulder complaints that started and finished treatment between 2009 and 2012 were derived from the NIVEL Primary Care Database. Personality traits of the physiotherapist were identified using the Big Five Inventory. Data of 2814 patients and 56 physiotherapists were analysed using multi level linear regression. MAIN OUTCOME MEASURE Severity of complaint was measured on a 10-point Likert scale at the start and end of treatment. Change score is used as outcome. RESULTS A therapist effect exists in the rehabilitation of patients with shoulder complaints in a physiotherapy setting; the physiotherapist explained 12% of variance and the personality trait extraversion showed a significant association (P=0.03) with change in treatment outcome. CONCLUSION Current explorative study suggests that patients who were treated by therapists that tend to be more outgoing and energetic achieved better treatment results. Additional studies are needed to unravel the interplay between personality traits and other variables of importance, like patients' personality traits or psychological factors, in treating patients with shoulder complaints.
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187
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Patient and family experience of physical rehabilitation on the intensive care unit: a qualitative exploration. Physiotherapy 2020; 109:102-110. [PMID: 32317118 DOI: 10.1016/j.physio.2020.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To explore the experience of physical rehabilitation in the intensive care unit (ICU), from the perspective of patients and relatives. DESIGN Exploratory, qualitative study. PARTICIPANTS Five former ICU patients and five family members of former ICU patients recruited from ICU support groups across the UK. INTERVENTIONS Semi-structured interviews. MAIN OUTCOME MEASURES Participants' experiences of physical rehabilitation in the ICU. Data were analysed using an iterative thematic approach. RESULTS Four main themes were identified: Trust and Rapport, Necessity (of treatment), Psychological Benefit, and Goal Setting: Whose goal is it anyway? Despite a lack of enjoyment, patients tend to comply with physical rehabilitation, due in part to a positive patient-therapist relationship. There was agreement across participants that physical rehabilitation should be started as soon as possible after admission to ICU and exhaustion was highlighted as the biggest challenge to participation. In addition to aiding physical recovery, physical rehabilitation in the ICU may also provide psychological support for both patients and relatives. Finally, participants described a desire for therapists to direct goal setting in the early stages of recovery as they felt unable to engage in the process due to other priorities. CONCLUSIONS The experience of physical rehabilitation on ICU may be influenced by key aspects of person-centred care. This study suggests that patients and relatives are keen for physical rehabilitation to start as soon as possible, which is a crucial new finding to support the practice of early rehabilitation in the ICU.
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188
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White J, Auliffe SM, Jepson M, Burstein F, Hopman R, Morrissey D, Haines T, Malliaras P. 'There is a very distinct need for education' among people with rotator cuff tendinopathy: An exploration of health professionals' attitudes. Musculoskelet Sci Pract 2020; 45:102103. [PMID: 32056827 DOI: 10.1016/j.msksp.2019.102103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/15/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical practice guidelines recommend non-surgical care in the management of rotator cuff tendinopathy prior to considering imaging or surgery. However, this requires effective education to promote adherence to treatment. OBJECTIVES To explore expert shoulder clinician's experiences with managing rotator cuff tendinopathy including practice beliefs towards providing education. DESIGN An in-depth qualitative study. METHOD We conducted interviews (n = 8) with an international sample of expert shoulder clinician-researchers. Data were analysed using an inductive thematic approach with constant comparison. RESULTS Three key themes emerged: (1) The need for early, focused education: "Some beliefs can be detrimental to rehabilitation options", (2) Developing therapeutic alliance: "If a patients trust you then you are generally going to get much better results" and (3) What is required moving forward in current day RT management: "Maybe we can get better." CONCLUSIONS Our findings highlight the importance of education to alleviate potential barriers to effective conservative care (including exercise) and self-management for rotator cuff tendinopathy. We also identified actionable ways to promote a collaborative therapeutic alliance however, this hinges on sufficient clinical time to educate patients adequately, which may be a barrier in busy clinical settings. Further, there is need for targeted education to facilitate development of clinical skills required to implement effective patient education strategies.
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Affiliation(s)
| | - Sean Mc Auliffe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Megan Jepson
- Department of Community Emergency Health and Paramedic Practice, Monash University, Australia
| | - Frada Burstein
- Centre for Organisational and Social Informatics, Faculty of Information Technology, Australia
| | - Ruben Hopman
- Department of Physiotherapy, School of Primary and Allied Health, Monash University, Australia
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, UK
| | - Terence Haines
- School of Primary and Allied Health, Monash University, Australia
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health, Monash University, Australia
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189
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Lawton M, Haddock G, Conroy P, Serrant L, Sage K. People with aphasia's perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:59-69. [PMID: 30987440 DOI: 10.1080/17549507.2019.1585949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 10/17/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke.Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis.Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me.Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population.
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Affiliation(s)
- Michelle Lawton
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Gillian Haddock
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Paul Conroy
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Laura Serrant
- Faculty of Health and Wellbeing, Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Karen Sage
- Faculty of Health and Wellbeing, Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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190
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Mallows A, Jackson J, Littlewood C, Debenham J. The association of working alliance, outcome expectation, adherence and self-efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study). Musculoskeletal Care 2020; 18:169-176. [PMID: 31997555 DOI: 10.1002/msc.1451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This study evaluated the feasibility of a large longitudinal cohort study utilizing an online platform to investigate the association and predictive relationship of working alliance, outcome expectations, adherence and self-efficacy with outcome in Achilles tendinopathy. The objectives were: (1) to determine the recruitment and retention rate and (2) to carry out preliminary data analysis of the selected variables and clinical outcomes. METHODS A multi-centred, longitudinal feasibility cohort study was used. Eligible participants were directed to a bespoke online platform hosting study information and the outcome measures in the form of an online questionnaire. Responses from the online questionnaire were collected on three occasions: at baseline, at 6 and at 12 weeks following completion of the first questionnaire. Feasibility outcomes (recruitment and retention rates) were described using descriptive statistics. RESULTS The website recorded a total 55 views. These 55 views resulted in 24 participants consenting to join the study. The questionnaire at baseline was started 63 times and completed on 60 separate occasions resulting in a 95% conversion rate. Retainment for completion of the questionnaire for a second time was 83.3% and for the third time was 66.6%. All questionnaires were completed fully yielding a missing data indicator of 0%. CONCLUSIONS Feasibility studies ask the question 'can this be done'? Based on the data from recruitment and rates and exploratory correlation analysis a future study can be done; this previously untested online platform appears feasible, but changes could be useful before proceeding to a much larger study.
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Affiliation(s)
- Adrian Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, CO4 3SQ, UK
| | - Jo Jackson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, CO4 3SQ, UK
| | - Chris Littlewood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK
| | - James Debenham
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
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191
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The effect of treatment regimens on salivary cortisol levels in patients with chronic musculoskeletal disorders. J Bodyw Mov Ther 2020; 24:100-108. [PMID: 31987528 DOI: 10.1016/j.jbmt.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Increased levels of circulating cortisol have been associated with pain severity in patients with chronic musculoskeletal disorders (CMD). Little is known about the potential association between pain management and salivary cortisol alterations in CPM patients treated with different regimens. OBJECTIVES This prospective feasibility study aimed to determine the effect of two treatment regimens in comparison with sham therapy on pain intensity and disability and salivary cortisol concentration (SCC) in patients with CMD. METHODS Thirty patients were randomly assigned to 3 groups of 10: two experimental groups (A and B) and a control group (C). The experimental groups followed physiotherapy treatment (A) or acupuncture (B), while the control group (C) followed a sham therapy for 10 sessions. Pain data were collected using the Chronic Pain Grade (CPG) questionnaire and SCC was measured by enzyme-linked immunosorbent assay at pre- and posttreatment. RESULTS Repeated-measures analysis of variance showed that patients treated with acupuncture experienced greater decreases in pain intensity/pain disability (P < 0.05) than the physiotherapy and sham therapy groups. No statistical differences were found between the three groups for the SCC outcome variable. Bonferroni adjustments showed that the mean values of SCC were significantly decreased at posttreatment (P < 0.05) across the three groups. CONCLUSION There was a significant decrease in both pain and cortisol outcomes at posttreatment in patients with CMD. Because of the limitations of this study, we cannot draw conclusions regarding whether the lower SCC could be an indication of pain reduction in patients with CMD.
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192
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Crom A, Paap D, Wijma A, Dijkstra PU, Pool G. Between the Lines: A Qualitative Phenomenological Analysis of the Therapeutic Alliance in Pediatric Physical Therapy. Phys Occup Ther Pediatr 2020; 40:1-14. [PMID: 31057028 DOI: 10.1080/01942638.2019.1610138] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To explore perceptions and preferences of children, parents, and physical therapists regarding the therapeutic alliance in pediatric physical therapy in a rehabilitation setting.Methods: Qualitative phenomenological analysis of interviews with children (n = 10), their parents (n = 10), and physical therapists (n = 10).Results: Three themes were identified: importance of trust in the physical therapist, transparency in sharing information, and negotiation concerning goals and tasks of treatment. Parents considered trust in the therapist's relational skills of greater importance to the therapeutic alliance than the therapist's technical skills. Although the physical therapists showed a strong willingness to meet the needs of children and parents, they seemed unaware of the emotional impact of positional inequality and the differences in roles and tasks of children, parents, and therapists during the treatment.Conclusion: All participants emphasized the importance of the quality of the therapeutic alliance. Nevertheless, positional inequality and differences in roles and tasks appeared to influence negotiation about goals and tasks of treatment. Children and parents are in a dependent relationship with the physical therapist. Physical therapists are challenged to find the right balance between their professional position and input on the one hand, and the emotional needs of child and parents on the other hand.
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Affiliation(s)
- Astrid Crom
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Davy Paap
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Physical Therapy Practice, Inter-Fysio, Groningen, The Netherlands
| | - Amarins Wijma
- Departments of Physiotherapy, and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium.,Transcare, Transdisciplinary Pain Management Center, Groningen, The Netherlands.,Pain in Motion Research Group, Belgium
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Grieteke Pool
- Section Health Psychology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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193
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Miciak M. Confronting Tensions and Challenges to the Therapeutic Alliance is Hard, but Necessary to Make a Difference: A Commentary on "Between the Lines: A Qualitative Phenomenological Analysis of the Therapeutic Alliance in Paediatric Physical Therapy". Phys Occup Ther Pediatr 2020; 40:15-17. [PMID: 31691597 DOI: 10.1080/01942638.2020.1685325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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194
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Moore AJ, Holden MA, Foster NE, Jinks C. Therapeutic alliance facilitates adherence to physiotherapy-led exercise and physical activity for older adults with knee pain: a longitudinal qualitative study. J Physiother 2020; 66:45-53. [PMID: 31843425 DOI: 10.1016/j.jphys.2019.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 07/16/2019] [Accepted: 11/18/2019] [Indexed: 01/19/2023] Open
Abstract
QUESTIONS What are people's experiences and perceived impact of physiotherapist-led exercise interventions for knee pain attributable to osteoarthritis? What barriers and facilitators to change in exercise and physical activity behaviour exist over time? DESIGN A longitudinal qualitative study was undertaken; it involved face-to-face, semi-structured and longitudinal interviews. PARTICIPANTS Interviews were undertaken with older adults with knee pain and who had been randomised to one of three physiotherapist-led exercise intervention arms in the Benefits of Effective Exercise for knee Pain (BEEP) trial. Thirty participants were enrolled in this qualitative study, with interviews scheduled at the end of the trial intervention period and 12 months later. DATA ANALYSIS A 'layered approach' to thematic analysis was used, including open coding (using constant comparison), deductive coding and within-case and cross-case longitudinal analysis of change. RESULTS Different levels of exercise supervision, progression and individualisation emerged, matching the content of the intervention protocols. Barriers to exercise and general physical activity were similar across intervention arms (lack of motivation, time, physical environment, lack of supervision and/or monitoring). Despite individualising exercise programs and specifically targeting exercise, some barriers to adherence remained at 12 months. Factors facilitating longer-term exercise adherence included change in or retained knowledge about the role of exercise for knee pain and the presence and quality of a therapeutic alliance, which was also reflective of the participants' experience of the intervention, regardless of the trial arm. CONCLUSION Despite a focus on individualisation and exercise adherence, barriers remained in the longer term. Strong therapeutic alliance during treatment appeared to facilitate adherence to exercise and general physical activity. The findings highlight ongoing physiotherapy support and therapeutic alliance as targets for future adherence-enhancing interventions for exercise in older adults with knee pain.
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Affiliation(s)
- Andrew J Moore
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom; Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Melanie A Holden
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, United Kingdom
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195
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Friedlander ML, Kangos K, Maestro K, Muetzelfeld H, Wright ST, Silva ND, Kimber J, Helmer DA, McAndrew LM. Introducing the System for Observing Medical Alliances (SOMA): A Tool for Studying Concordance in Patient-Physician Relationships. COUNSELING PSYCHOLOGIST 2019; 47:796-819. [PMID: 32372766 DOI: 10.1177/0011000019891434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We developed the System for Observing Medical Alliances (SOMA) to study relationships between medical providers and patients with medically unexplained symptoms (MUS). Based on literature in health psychology, medicine, and the psychotherapeutic alliance, the SOMA operationalizes three medical alliance dimensions: Engagement in the Consultation Process, Trust in the Provider, and Concordance of Illness Beliefs and Treatment Recommendations. Specific behavioral indicators, tallied as observed by trained judges, are used as the basis for rating each dimension. In a sample of 33 medical consultations with veterans who had MUS, interrater reliabilities ranged from .79 to .94. Notably, the other dimension ratings accounted for 40% of the variability in Concordance, with Trust in the Provider contributing unique variance. In addition to research, psychologists in integrated health settings can use the SOMA to consult and train medical providers on communication skills that enhance concordance.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lisa M McAndrew
- Veterans Affairs New Jersey Health Care System, University at Albany
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196
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Rafiei MH, Kelly KM, Borstad AL, Adeli H, Gauthier LV. Predicting Improved Daily Use of the More Affected Arm Poststroke Following Constraint-Induced Movement Therapy. Phys Ther 2019; 99:1667-1678. [PMID: 31504952 PMCID: PMC7105113 DOI: 10.1093/ptj/pzz121] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/02/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Constraint-induced movement therapy (CI therapy) produces, on average, large and clinically meaningful improvements in the daily use of a more affected upper extremity in individuals with hemiparesis. However, individual responses vary widely. OBJECTIVE The study objective was to investigate the extent to which individual characteristics before treatment predict improved use of the more affected arm following CI therapy. DESIGN This study was a retrospective analysis of 47 people who had chronic (> 6 months) mild to moderate upper extremity hemiparesis and were consecutively enrolled in 2 CI therapy randomized controlled trials. METHODS An enhanced probabilistic neural network model predicted whether individuals showed a low, medium, or high response to CI therapy, as measured with the Motor Activity Log, on the basis of the following baseline assessments: Wolf Motor Function Test, Semmes-Weinstein Monofilament Test of touch threshold, Motor Activity Log, and Montreal Cognitive Assessment. Then, a neural dynamic classification algorithm was applied to improve prognostic accuracy using the most accurate combination obtained in the previous step. RESULTS Motor ability and tactile sense predicted improvement in arm use for daily activities following intensive upper extremity rehabilitation with an accuracy of nearly 100%. Complex patterns of interaction among these predictors were observed. LIMITATIONS The fact that this study was a retrospective analysis with a moderate sample size was a limitation. CONCLUSIONS Advanced machine learning/classification algorithms produce more accurate personalized predictions of rehabilitation outcomes than commonly used general linear models.
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Affiliation(s)
- Mohammad H Rafiei
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Kristina M Kelly
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - Alexandra L Borstad
- Department of Physical Therapy, The College of St Scholastica, Duluth, Minnesota
| | - Hojjat Adeli
- Department of Biomedical Informatics, Department of Neurology, Department of Neuroscience, The Ohio State University
| | - Lynne V Gauthier
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, 3 Solomon Way, Weed Hall 218D, Lowell, MA 01854 (USA)
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197
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Sullivan N, Hebron C, Vuoskoski P. "Selling" chronic pain: physiotherapists' lived experiences of communicating the diagnosis of chronic nonspecific lower back pain to their patients. Physiother Theory Pract 2019; 37:973-992. [PMID: 31744369 DOI: 10.1080/09593985.2019.1672227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians' experiences of communicating their understanding of this diagnosis to their patients.Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences.Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients "on board" (2a. the "selling" process; and 2b. paternalism and the clinician's perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty).Conclusions: Personal conflicts were identified between clinicians' descriptions of their wishes to "sell" their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients' beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients' reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training.
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Affiliation(s)
- Nick Sullivan
- Sutton Health & Care Alliance, Physiotherapy Department, St Helier Hospital, Carshalton, UK
| | - Clair Hebron
- Faculty of Health and Social Science, Department of Physiotherapy, University of Brighton, Eastbourne, UK
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences (Physiotherapy), University of Jyväskylä, Jyväskylä, Finland
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198
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Lilleheie I, Debesay J, Bye A, Bergland A. Experiences of elderly patients regarding participation in their hospital discharge: a qualitative metasummary. BMJ Open 2019; 9:e025789. [PMID: 31685492 PMCID: PMC6858187 DOI: 10.1136/bmjopen-2018-025789] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ageing patients are discharged from the hospital 'quicker and sicker' than before, and hospital discharge is a critical step in patient care. Older patients form a particularly vulnerable group due to multimorbidity and frailty. Patient participation in healthcare is influenced by government policy and an important part of quality improvement of care. There is need for greater insights into the complexity of patient participation for older patients in discharge processes based on aggregated knowledge. OBJECTIVE The aim of this study was to review reported evidence concerning the experiences of older patients aged 65 years and above regarding their participation in the hospital discharge process. METHODS We conducted a qualitative metasummary. Systematic searches of Medline, Embase, Cinahl, PsycINFO and SocINDEX were conducted. Data from 18 studies were included, based on specific selection criteria. All studies explored older patients' experience of participation during the discharge process in hospital, but varied when it came to type of discharge and diagnosis. The data were categorised into themes by using thematic analysis. RESULTS Our analysis indicated that participation in the discharge process varied among elderly patients. Five themes were identified: (1) complexity of the patients state of health, (2) management and hospital routines, (3) the norm and preference of returning home, (4) challenges of mutual communication and asymmetric relationships and (5) the significance of networks. CONCLUSIONS Collaboration between different levels in the health systems and user-friendly information between staff, patient and families are crucial. The complexity of patient participation for this patient group should be recognised to enhance user involvement during discharge from hospital. Interventions or follow-up studies of how healthcare professionals can improve their communication skills and address the tension between client-centred goals and organisational priorities are requested. Organisational structure may need to be restructured to ensure the participation of elderly patients.
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Affiliation(s)
- Ingvild Lilleheie
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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199
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Brunner E, Dankaerts W, O’Sullivan K, Meichtry A, Bauer C, Probst M. Associations between alliance, physiotherapists’ confidence in managing the patient and patient-reported distress in chronic low back pain practice. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1672786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Emanuel Brunner
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Kieran O’Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - André Meichtry
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Christoph Bauer
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Michel Probst
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
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200
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Lawton M, Conroy P, Sage K, Haddock G. Aphasia and stroke therapeutic alliance measure (A-STAM): Development and preliminary psychometric evaluation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:459-469. [PMID: 31416382 DOI: 10.1080/17549507.2019.1648551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: The therapeutic alliance, also known as the therapeutic relationship, may influence treatment process and outcome in aphasia rehabilitation; however, we currently lack a reliable tool to measure this relationship. This study aimed to develop a novel measure of the therapeutic alliance applicable to this population and provide preliminary evidence of the measure's psychometric properties. Method: Statements were generated from the: (1) therapeutic alliance literature, (2) qualitative interviews with stakeholders, and (3) Q methodological insights with people with aphasia (PWA) (n = 455). A representative sample of statements was identified from the data set (n = 57) and reviewed by expert panels (professionals and PWA), culminating in a 42-item clinician and patient version of the aphasia and stroke therapeutic alliance measure (A-STAM). Reliability and validity of both the clinician and patient versions of A-STAM were investigated with 34 Clinician-patient dyads engaging in therapy. Result: Internal consistency and test-retest reliability were excellent for both clinician (α = 92; ICC = 0.93) and patient versions of A-STAM (α = 0.92; ICC = 0.97). In both versions, scores correlated highly with psychotherapeutic measures of therapeutic alliance, indicative of good construct validity (rs = 0.75; rs = 0.77). Conclusion: The findings establish the preliminary reliability and validity of A-STAM and support further investigation into the measure's psychometric properties in larger samples.
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Affiliation(s)
- Michelle Lawton
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester , Manchester , UK
| | - Paul Conroy
- Faculty of Health and Wellbeing, Centre for Health and Social Care Research, Sheffield Hallam University , Sheffield , UK
| | - Karen Sage
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine & Health, The University of Manchester , Manchester , UK
| | - Gillian Haddock
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester , Manchester , UK
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