Predictors and impact of the working alliance in the neuropsychological rehabilitation of patients with multiple sclerosis

Abstract

BackgroundThere is preliminary evidence of positive effects of neuropsychological rehabilitation in multiple sclerosis (MS). However, whether a working alliance affects rehabilitation outcome has not been studied. ObjectiveThe aim of this study was to evaluate the effects of the baseline patient-related (cognitive, mood and fatigue symptoms, cognitive status, demographic factors) and illness-related factors (duration and severity of the disease) on the alliance, as well as the effects of the alliance on rehabilitation outcome in neuropsychological rehabilitation among MS patients. MethodsFifty-six patients with relapsing–remitting MS received multimodal neuropsychological intervention (attention retraining, learning strategies, psychoeducation, psychological support, homework assignments) conducted once a week in 60-minute sessions for thirteen consecutive weeks. After the intervention, both patients and therapists evaluated the alliance with the short form of the Working Alliance Inventory. ResultsNone of the baseline factors was related to the alliance. Better patient-evaluated alliance was associated with a more prominent decrease in fatigue symptoms and greater achievement of rehabilitation goals. Better therapist-evaluated alliance was associated with greater benefit from the intervention as evaluated by therapists. ConclusionA positive patient–therapist alliance may relate to positive neuropsychological rehabilitation outcome in MS.