Miciak M1, Mayan M2, Brown C3, Joyce AS4, Gross DP5
1University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada, 2University of Alberta, Faculty of Extension-Extension Academics, Edmonton, Canada, 3University of Alberta, Department of Occupational Therapy, Edmonton, Canada, 4University of Alberta, Department of Psychiatry, Edmonton, Canada, 5University of Alberta, Department of Physical Therapy, Edmonton, Canada

Background: The therapeutic relationship between practitioner and patient is a contextual factor that increasingly appears to be critical for understanding successful clinical interactions. Positive therapeutic relationships in rehabilitation have been associated with increased patient satisfaction, treatment adherence, and improved clinical outcomes. Despite its link to important clinical metrics, there has been little research clarifying the key components of the therapeutic relationship in physiotherapy. However, the “bond”, or the positive affective attachment between practitioner and patient, has consistently been discussed across disciplines as being characteristic of the therapeutic relationship. Despite its relevance, research characterizing the bond in physiotherapy is limited.

Purpose: We aimed to identify and conceptually describe the elements of the bond in physiotherapy.

Methods: Interpretive description was the qualitative methodological approach used to inductively explore the bond from a practice perspective. Eleven physiotherapists practicing a minimum of 5 years and 7 adult patients with musculoskeletal conditions from private practice clinics in Edmonton, Canada participated. Purposive and convenience sampling were used to identify participants. Factors including treatment specializations (e.g., acupuncture) and areas of clinical interest (e.g., chronic pain) were considered to broaden physiotherapists' philosophical perspectives and practical experiences. Data generation and analysis were iterative. One-on-one semi-structured interviews, audio-recorded and lasting 40-90 minutes, generated rich descriptions of participant experiences of the therapeutic relationship in general and bonds specifically. Data were collected until a meaningful description of clinical reality was achieved. Qualitative content analysis involved iteratively coding and developing categories and sub-categories. The analysis was refined using constant comparison principles. Trustworthiness of results was strengthened by triangulation of data sources, peer debrief, a reflexivity strategy, and external audit.

Results: We identified and conceptually described four elements of the physiotherapy bond characterized by mutuality and professional/personal dimensions, with the body as central point of connection. Nature of the rapport hinged on physiotherapists' duty of care and therapists' and patients' friendly ease of interacting. Respect was the reciprocal acknowledgement of patients' and physiotherapists' value as people and how each contributed to rehabilitation. Trust was described as patients' confidence in therapists' professional intentions and credibility as well as their personal qualities, while therapists also needed to trust patients' intentions and actions. Caring was conveyed as therapists' clinical and personal concern for patients combined with patients' reciprocal affinity for therapists.

Conclusion(s): Rapport, respect, trust, and caring appear to be bond elements common across disciplines; however, we clarified characteristics that are important in physiotherapy. Notably, rapport and respect appear more complex than previously acknowledged in the literature. The results also indicate personal aspects of the relationship may require more attention than otherwise considered.

Implications: Physiotherapy researchers often borrow psychotherapy tools to assess the therapeutic relationship. These results highlight the need and provide direction for developing an assessment tool for physiotherapy with particular consideration of the personal dimension. Knowledge of the bond's professional and personal dimensions could inform clinical decisions (e.g., use of touch to build trust) and policy regarding patient-centred care. The conceptual quality of these results enhances their transferability to other settings and disciplines.

Keywords: working alliance, patient-provider interaction, patient-centred care

Funding acknowledgements: Thesis Operating Grant, Department of Physical Therapy, University of Alberta; Canadian Institutes of Health Research Banting and Best Graduate Scholarship

Topic: Musculoskeletal; Musculoskeletal; Pain & pain management

Ethics approval required: Yes
Institution: University of Alberta
Ethics committee: Health Research Ethics Board
Ethics number: Pro00021472

All authors, affiliations and abstracts have been published as submitted.

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