Abstract
BackgroundThe therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study’s aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients.MethodsInterpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and seven adult patients with musculoskeletal disorders were purposively sampled from private practice clinics in Edmonton, Canada. The in-person, semi-structured interviews were completed in a location of the participant’s choice and were audio recorded and transcribed. Qualitative content analysis was used to analyze the textual data and constant comparison techniques were integrated to refine the categories and sub-categories. Rigour strategies used throughout the study were peer debrief, interview notes, reflexive journaling, memoing, member reflections, audit trail, and external audit.ResultsFour conditions were identified as necessary for establishing a therapeutic relationship: present, receptive, genuine, and committed. These conditions represent the intentions and attitudes of physiotherapists and patients engaging in the clinical interaction. Although distinct, the conditions appear related as being present and receptive create a foundation for being genuine and committed.ConclusionsThese conditions of engagement are needed for physiotherapist and patient to “be” in a therapeutic relationship. Although communication skills are important for advancing therapists’ relational abilities, awareness and integration of intentions and attitudes are essential for shaping behaviors that develop the therapeutic relationship. These findings also suggest there are characteristics of the therapeutic relationship specific to physiotherapy. Therefore, theories from other contexts (e.g., psychotherapy) should be used judiciously to guide physiotherapy practice and research.
Highlights
The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes
The therapeutic relationship between patient and provider is considered a central component of patientcentred care [1, 2] and patient engagement [3, 4]
Study of the therapeutic relationship in physiotherapy is in its infancy, especially when compared to theoretical development and empirical investigation in the psychotherapy context
Summary
The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Physiotherapy researchers have used Bordin’s theory of the working alliance [14], while educators reference Freudian [15, 16] and Rogerian principles [15] Of these theories, Rogers’ [17] “necessary and sufficient conditions” of genuineness (freedom to be one’s self), empathic understanding (understanding of the patient’s feelings and meanings combined with congruent interactional behaviours) and unconditional positive regard (accepting attitude) have contributed, implicitly or explicitly, to the understanding of the therapeutic relationship in psychotherapy [18]. Meta-analyses have demonstrated that empathy [20] and positive regard [21] are moderately associated with clinical outcomes in psychotherapy
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