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

Concentrations of potentially toxic elements and soil environmental quality evaluation of a typical Prosecco vineyard of the Veneto region (NE Italy)

Purpose The aim of this work was to assess the concentrations of potentially toxic elements and to evaluate the soil quality of a typical Prosecco Denomination of Controlled and Guaranteed Origin vineyard of the Veneto region, NE Italy. Materials and methods Soil samples and leaves of Taraxacum officinale and Vitis vinifera were collected during spring–summer 2014. Element determination (Al, Cd, Cr, Cu, Fe, Mg, Mn, Ni, P, Pb, V, and Zn) were performed with ICP-OES after microwave digestion of samples. Soil quality was assessed via the biological soil quality (BSQ-ar) index. Lipid peroxidation test was performed to evaluate the vegetation oxidative stress, based on malondialdehyde (MDA) content via spectrophotometer. Results and discussion High concentrations of Al,Mg, and P were identified in soil, while high contents of Al, Cu, Fe, and Zn were found in V. vinifera leaves. The high concentrations in soil are probably due to agricultural activities, whereas those in leaves are probably due to atmospheric deposition and repeated use of foliar sprays in viticulture. The bioconcentration factor showed an effective transport of Cu, P, and Zn, from soil to leaf. The BSQ-ar values registered were similar to those obtained in preserved soils; hence, the biological class (VI) of these soils is high. The MDA content in T. officinale and V. vinifera leaves was below the reference value for T. officinale (2.9 ± 0.2 μM), suggesting that the metal content did not stress the vegetation in the investigated site. Conclusions The MDA value for V. vinifera (1.1 ± 0.7 μM) could be adopted as another control value for soil quality, which in our case is of Bgood quality.^ Moreover, our results suggest that high concentrations of elements detected in the analyzed samples do not influence negatively the quality of soil, but a better agronomic management could improve soil quality in the studied area