Abstract
BackgroundThe therapeutic alliance (TA) is the bond between a patient and a physiotherapist during collaboration on recovery or training. Previous studies focused on the TA between physiotherapists and patients of the general population. Little information exists on whether this is similar in the demanding environment of elite athletes. The aim of this study was to investigate the components of TA between elite athletes and physiotherapists.MethodsTen elite athletes and ten physiotherapists were interviewed using one-on-one semi-structured interviews between June 2020 and October 2020. Athletes were included if they competed at national or international championships. Physiotherapists had to treat elite athletes on a regular basis. Interview questions were based on TA components of the general physiotherapy population. The interviews were transcribed and coded using inductive thematic analysis.ResultsThe analysis resulted in an elite athlete TA framework which consists of nine themes and ten subthemes that could influence the TA. The nine themes are trust, communication, professional bond, social bond, elite athlete, physiotherapist, time, pressure and adversity, and external factors. This showed that the TA consists of bonds on different social levels, depends on the traits of both elite athletes and physiotherapists, and can be positively and negatively influenced by the external environment. The influences from the external environment seem to be more present in the elite athlete TA compared to the TA in the general physiotherapy setting. Multiple relations between themes were discovered. Trust is regarded as the main connecting theme.ConclusionThis study provides a framework to better understand the complex reality of the TA between elite athletes and physiotherapists. Compared to the general physiotherapy setting, new themes emerged. The created framework can help elite athletes and physiotherapists to reflect and improve their TA and subsequently improve treatment outcomes.
Highlights
Introduction by the interviewer on the purpose of the interview, including creation of a safe atmosphere
Twenty interviews were conducted with ten elite athletes and ten physiotherapists (Table 2)
Two more elite athletes and two more physiotherapists participated in a discussion on the final framework (Table 3)
Summary
Introduction by the interviewer on the purpose of the interview, including creation of a safe atmosphere. What do you think as elite athlete/physiotherapist that is important for a strong TA?. What is your view on the importance of agreement between you and your elite athlete/physiotherapist and what influences the agreement process?. Which factors do you think contribute to a proper communication between a physiotherapist and an elite athlete?. Previous studies focused on the TA between physiotherapists and patients of the general population. The aim of this study was to investigate the components of TA between elite athletes and physiotherapists. A gap of knowledge exists on the components of the TA in an elite athlete setting. In 1979, Bordin defined three main components which contributed to the TA: agreement on treatment goals, agreement on intervention, and an affective bond between patient and therapist [7]. A partial explanation of this phenomenon could be the positive correlation between the TA and therapy adherence [5, 12]
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