The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review

Background Nonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clinician-patient alliance and communication on adherence in mental health, identifying the specific mechanisms that mobilise patient engagement. Methods In December 2010, a systematic search was conducted in Pubmed, PsychInfo, Web of Science, Cochrane Library, Embase and Cinahl and yielded 6672 titles. A secondary hand search was performed in relevant journals, grey literature and reference. Results 23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. 17 studies reported positive associations with adherence, only four of which employed intervention designs. 10 studies examined the association between clinician-patient alliance and adherence. Subjective ratings of clinical communication styles and messages were assessed in 12 studies. 1 study examined the association between objectively rated communication and adherence. Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis. Conclusions Clinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice. Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine

Four weeks of sprint interval training improves 5-km run performance

Sprint interval training (SIT) rapidly improves cardiorespiratory fitness but demands less training time and volume than traditional endurance training. Although the health and fitness benefits caused by SIT have received considerable research focus, the effect of short-term SIT on 5-km run performance is unknown. Thirty healthy untrained participants (aged 18-25 years) were allocated to a control (n = 10) or a SIT (n = 20) group. Sprint interval training involved 3-8 sprints at maximal intensity, 3 times a week for 4 weeks. Sprints were progressed to 8 by the 12th session. All participants completed a 5-km time trial on a public running track and an incremental treadmill test in an exercise physiology laboratory to determine 5-km run performance and maximum oxygen uptake, respectively, before and after the 4-week intervention. Relative to the controls, sprint interval-trained participants improved 5-km run performance by 4.5% (p < 0.001), and this was accompanied by improvements in absolute and relative maximum oxygen uptake (4.9%, p 0.04 and 4.5%, p = 0.045, respectively). Therefore, short-term SIT significantly improves 5-km run performance in untrained young men. We believe that SIT is a time-efficient means of improving cardiorespiratory fitness and 5-km endurance performance

A changed reality: Experience of an acceptance and commitment therapy (ACT) group after stroke

Copious research on the utility of Acceptance and Commitment Therapy (ACT) in long-term conditions has demonstrated promising results. However, little research has been conducted on ACT within stroke, particularly studies that are qualitative in nature. The aim of this paper was to gain insight into stroke survivors’ experiences of ACT and to explore what processes help facilitate adjustment in living with residual disability. Interviews with thirteen stroke survivors following their attendance at a stroke-adapted ACT group were analysed using a grounded theory approach. Stroke survivors varied in age, severity of stroke, limitations and duration since stroke. Interviews revealed a main difficulty of “accepting a changed reality” following stroke. Survivors’ narratives regarding their experiences of ACT revealed insight into which processes helped facilitate movement towards accepting symptoms and a changed reality and into helpful and less helpful aspects of the intervention. Stroke survivors find ACT helpful in adjusting to stroke limitations. ACT appears to have potential as a psychological intervention for stroke survivors experiencing psychological distress. Amendments to the format of the intervention to enhance the impact of ACT impact are identified