Measuring connection and collaboration in rehabilitation: Developing a measure of therapeutic relationship

Abstract

The therapeutic relationship may be critical to rehabilitation outcome. However, knowledge advance is hampered by existing measures, which were not designed for use in the rehabilitation context and fail to capture essential elements. Drawing on a conceptual framework developed through prior research, we aimed to develop a robust measure of therapeutic relationship, tailored to the rehabilitation context. A measure development study drawing on steps proposed by Prior et al., 2011. We undertook a literature search to identify existing measures of therapeutic relationship. All items were extracted and mapped against our conceptual framework. We removed duplicate and conceptually incongruent items, and developed new items for aspects not already captured. We reworded items to ensure consistency in item scoring direction and language. A preliminary pool of 68 items were then piloted with rehabilitation clients using cognitive interviewing methods to determine their comprehensibility, acceptability, relevance and answerability. The research team met to examine the data and identified items for deletion or revision. Clients ( n = 13) were drawn from a diversity of contexts and included people with neurological ( n = 5), long-term chronic ( n = 4), and acute ( n = 4) conditions. We deleted 32 and reworded eight items in response to feedback. Reasons for deletion included overlap with other items ( n = 22), not relevant across populations/context ( n = 5), ambiguous ( n = 4), or too global ( n = 1). A 36-item scale was derived aiming to measure therapeutic relationship in rehabilitation. This measure is now being pilot tested with a larger cohort of clients to further refine the measure using Rasch analysis.