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

A qualitative investigation into the rehabilitation experience of patients following wrist fracture

Introduction. Fractures of the wrist are often highly traumatic, leading to significant pain and reduction in an individual’s home, work and leisure roles for a considerable time. Among the studies on wrist fracture, there is limited evidence which qualitatively explores the patient’s rehabilitation experiences of this condition, and the impact they feel it has on their daily lives. The aim of this study was therefore to explore the experiences of working age people with dominant side wrist fracture in terms of the impact on their lives from the resulting loss of hand function, and the role that hand therapy plays in the rehabilitation process. Method. Using a qualitative approach, semistructured interviews were carried out with six participants who were current or previous patients of an outpatient occupational therapy department and who had sustained wrist fracture. Three key themes equated to the impact the fracture had on their lives: ‘functional ability’, ‘attitudes and expectations of self and others’ and ‘assessment and treatment in occupational therapy’. Results. The main findings showed that the impact of reduced ability evoked negative reactions and dependence on others. Lack of information on application and removal of plaster cast contributed towards early anxieties about the appearance and function of the hand. Patients’ attitudes generally reflected taking some responsibility for their own progress. Occupational therapy input increased motivation, and particularly for those who attended rehabilitation sessions in the department, the therapy was valued. Discussion. The recommendations from this study are that early and continued patient education is provided by the therapist, engaging relatives where appropriate, to alleviate patient and family anxieties and to help determine realistic expectations of recovery. While patients generally engage with objective measurements, making assessment and treatment relevant to their activities of daily living is essential to ensure they are motivated for therapy

‘It's a New Way of Life’: An Exploration of the Occupational Transition of Retirement

Introduction: The aim of this study was to explore the work to retirement transition, from an occupational perspective. Participants' personal reports of experiences relating to the occupational transition of retirement, and its impact on health and wellbeing, were examined. Method: Eight participants who had recently retired were recruited purposively. They were interviewed using semi-structured interviews, focusing on the areas of previous employment, experience of the retirement transition, occupational balance and reflection on the impact on health and wellbeing. The research used interpretative phenomenological analysis to guide data collection and analysis. Findings and conclusion: Three superordinate themes emerged: the process of retirement; purpose, doing and wellbeing; and retirement as a new life stage. These themes suggested that the retirement transition was a period of significant readjustment and that there was a close relationship between participants' engagement in occupation and their perceived health and wellbeing. </jats:sec