Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: A scoping review of the literature

© 2017 The Author(s). Background: Most conventional treatment for musculoskeletal conditions continue to show moderate effects, prompting calls for ways to increase effectiveness, including drawing from strategies used across other health conditions. Therapeutic alliance refers to the relational processes at play in treatment which can act in combination or independently of specific interventions. Current evidence guiding the use of therapeutic alliance in health care arises largely from psychotherapy and medicine literature. The objective of this review was to map out the available literature on therapeutic alliance conceptual frameworks, themes, measures and determinants in musculoskeletal rehabilitation across physiotherapy and occupational therapy disciplines. Methods: A scoping review of the literature published in English since inception to July 2015 was conducted using Medline, EMBASE, PsychINFO, PEDro, SportDISCUS, AMED, OTSeeker, AMED and the grey literature. A key search term strategy was employed using physiotherapy , occupational therapy , therapeutic alliance , and musculoskeletal to identify relevant studies. All searches were performed between December 2014 and July 2015 with an updated search on January 2017. Two investigators screened article title, abstract and full text review for articles meeting the inclusion criteria and extracted therapeutic alliance data and details of each study. Results: One hundred and thirty articles met the inclusion criteria including quantitative (33%), qualitative (39%), mixed methods (7%) and reviews and discussions (23%) and most data came from the USA (23%). Randomized trials and systematic reviews were 4.6 and 2.3% respectively. Low back pain condition (22%) and primary care (30.7%) were the most reported condition and setting respectively. One theory, 9 frameworks, 26 models, 8 themes and 42 subthemes of therapeutic alliance were identified. Twenty-six measures were identified; the Working Alliance Inventory (WAI) was the most utilized measure (13%). Most of the therapeutic alliance themes extracted were from patient perspectives. The relationship between adherence and therapeutic alliance was examined by 26 articles of which 57% showed some correlation between therapeutic alliance and adherence. Age moderated the relationship between therapeutic alliance and adherence with younger individuals and an autonomy support environment reporting improved adherence. Prioritized goals, autonomy support and motivation were facilitators of therapeutic alliance. Conclusion: Therapeutic Alliance has been studied in a limited extent in the rehabilitation literature with conflicting frameworks and findings. Potential benefits described for enhancing therapeutic alliance might include better exercise adherence. Several knowledge gaps have been identified with a potential for generating future research priorities for therapeutic alliance in musculoskeletal rehabilitation

Under-Five Mortality in High Focus States in India: A District Level Geospatial Analysis

<div><h3>Background</h3><p>This paper examines if, when controlling for biophysical and geographical variables (including rainfall, productivity of agricultural lands, topography/temperature, and market access through road networks), socioeconomic and health care indicators help to explain variations in the under-five mortality rate across districts from nine high focus states in India. The literature on this subject is inconclusive because the survey data, upon which most studies of child mortality rely, rarely include variables that measure these factors. This paper introduces these variables into an analysis of 284 districts from nine high focus states in India.</p> <h3>Methodology/Principal Findings</h3><p>Information on the mortality indicator was accessed from the recently conducted Annual Health Survey of 2011 and other socioeconomic and geographic variables from Census 2011, District Level Household and Facility Survey (2007–08), Department of Economics and Statistics Divisions of the concerned states. Displaying high spatial dependence (spatial autocorrelation) in the mortality indicator (outcome variable) and its possible predictors used in the analysis, the paper uses the Spatial-Error Model in an effort to negate or reduce the spatial dependence in model parameters. The results evince that the coverage gap index (a mixed indicator of district wise coverage of reproductive and child health services), female literacy, urbanization, economic status, the number of newborn care provided in Primary Health Centers in the district transpired as significant correlates of under-five mortality in the nine high focus states in India. The study identifies three clusters with high under-five mortality rate including 30 districts, and advocates urgent attention.</p> <h3>Conclusion</h3><p>Even after controlling the possible biophysical and geographical variables, the study reveals that the health program initiatives have a major role to play in reducing under-five mortality rate in the high focus states in India.</p> </div

Some solar radiation ratios and their interpretations with regards to radiation transfer in the atmospher

Ratios of some radiation fluxes such as global (total) solar radiation, H, direct solar radiation, Hb, diffuse solar radiation, Hd, and extraterrestrial radiation, Ho were proposed to define radiation coefficients related to radiation transfer in the atmosphere and solar radiation measurement on the ground surface. The irradiative transfer interpretations and applications in radiation measurement of the ratios were explained. Examples of such ratios are H/Ho and Hd/H. These are used to define the “clearness index” and “cloudiness index” of the atmosphere respectively, and are already in common knowledge and use. H/Ho and Hd/H for example, were found, from experimentation, to add up practically to unity, i.e. H/Ho + Hd/H =1. Based on this result, an empirical expression for predicting the direct solar radiation was developed in a previous work. Other ratios are Hb/H, Hb/Ho, Hd/Ho, Hr/Ho and sub>a/Ho. They were proposed to define relevant radiation coefficients, and were used to develop equations for estimating the reflection of the earth's surface and the absorption of the earth's atmosphere. Keywords: solar radiation, radiation transfer, clearness index Nigeria Journal of Pure and Applied Physics Vol. 4(1) 2005: 41-4

Theoretical study of thermodynamic properties and ordering in sulphur-tellurium alloy

Quasi-lattice model has been used to explain the concentration dependence of the free energy of mixing, excess entropy of mixing, chemical short-range order parameter and concentration–concentration fluctuation in the long wavelength limit for S-Te molten alloy. Results show that the molten alloy does not form a complex of the form S-Te3 rather, there is phase separation. Keywords: free energy of mixing, chemical short range order and concentration-concentration fluctuation in the long wavelength limit Nigerian Journal of Physics Vol. 17, 2005: 1-

Simulated reflected SW-radiation and its characteristic variation at Ilorin, Nigeria

No Abstract. Nigerian Journal of Physics Vol. 17 (Supplement) 2005: pp. 193-20