Relationships between patient- and therapist-rated working alliance with physical rehabilitation outcomes among patients with Parkinson’s disease

Katsuyuki Kobayashi, Keiko Nakamura, Tomomi Kinoshita, Kimito Momose, Kazumi Sakurai, Daiki Usuda, Keita Sue
Purpose:

This study aimed to reveal relationships between patient- and therapist-rated WA with physical rehabilitation outcomes in patients with PD.

Methods:

Study Design: Observational study. Subjects: Twenty patients with PD (Hohen & Yahr stage 2-3) aged 70.3 ±7.1 admitted for the 4-days × 4 weeks amplitude-specific Lee Silverman Voice Treatment BIG therapy and 6 physical therapists with 19.2 ±8.1 years of experience were included. Measurements: Both patient- and therapist-rated WA were assessed using the Working Alliance Inventory (WAI) after completion of the fifth training session. The total WAI scores were divided into three sub-scores; task, goal, and bond scores. Rehabilitation outcomes included comfortable and maximal gait speed during 10-meter walking test (10-MWT) and Timed Up & Go (TUG) test before and after the program. The rate of change in these tests was calculated using the following formula: (pre-program assessment - post-program assessment) / pre-program assessment × 100. Statistical analysis: Correlations between each WAI sub-score, as rated by both patients and therapists and the rate of change in each test were calculated using Pearson’s product’s moment correlation coefficient.

Results:

No significant correlations were found between each therapist-rated WA sub-score and the rate of change in gait tests. A significant correlation was found between patient-rated task score and the rate of change in comfortable gait speed during 10-MWT (r= 0.529, p=0.016) and significant correlations between patient-rated task score, bond score, and goal score with the rate of change in maximal gait speed during 10-MWT were r=0.487 (p=0.029), r=0.447 (p=0.048), and r=0.685 (p=0.001), respectively. 

Conclusion(s):

Patient-rated WA was moderately correlated with the rate of changes in gait tests among patients with PD, while therapist-rated WA had no significant correlations with improvement of those tests. Our results indicated patients' perceived WA might influence the improvement of physical performance in people with PD.

Implications:

Patients’ perceived WA may influence physical rehabilitation outcomes in patients with PD even when undergoing the same rehabilitation program, and this factor should not be ignored in daily practice.

Funding acknowledgements:
No funding to declare.
Keywords:
parkinson's disease
working alliance
performance test
Primary topic:
Neurology: Parkinson's disease
Second topic:
Disability and rehabilitation
Third topic:
Neurology
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The medical ethics committee of Kakeyu Hospital
Provide the ethics approval number:
2022001
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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