Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Aug 10, 2020
Date Accepted: Dec 19, 2020
Association between therapeutic alliance and outcomes following telephone-delivered exercise by a physical therapist for people with knee osteoarthritis: secondary analyses from a randomised controlled trial
ABSTRACT
Background:
The therapeutic alliance between patients and physiotherapists has been shown to influence clinical outcomes in patients with chronic low back pain when consulting in-person. However, no studies have examined whether the therapeutic alliance developed between patients with knee osteoarthritis and physiotherapists during telephone consultations influences clinical outcomes.
Objective:
Investigate whether the therapeutic alliance between patients with knee osteoarthritis and physical therapists, measured after the second consultation, is associated with outcomes following telephone-delivered exercise and advice.
Methods:
Secondary analysis of 87 patients in the intervention arm of a randomised controlled trial allocated to receive 5-10 telephone consultations with one of 8 physical therapists over 6-months, involving education and prescription of a strengthening and physical activity program. Separate regression models investigated the association between patient and therapist ratings of therapeutic alliance (measured after the second consultation using the Working Alliance Inventory Short Form) and outcomes (pain, function, self-efficacy, quality of life, global change, adherence to prescribed exercise and physical activity) at 6- and 12-months, with relevant covariates included.
Results:
There was some evidence of weak association between patient ratings of the alliance and some outcomes at 6-months (improvements in average knee pain [regression coefficient (95% confidence interval): 0.10 (0.03 to 0.16)], self-efficacy [-0.16 (-0.28 to -0.04)], global improvement in function [odds ratio: 1.26 (1.04 to 1.39)], and overall improvement [odds ratio: 1.26 (1.06 to 1.51)], but also with worsening in fear of movement [regression coefficient: 0.13 (0.04 to 0.23)]). There was also some evidence of weak association between patient ratings of the alliance and some outcomes at 12 months (improvements in self-efficacy [regression coefficient: -0.15 (-0.27 to -0.03)], global improvement in both function [odds ratio: 1.19 (0.03 to 1.37)] and pain [odds ratio: 1.14 (1.01 to 1.30)], and overall improvement [odds ratio: 1.21 (1.02 to 1.42)]). Data suggest associations between therapist ratings of therapeutic alliance and outcomes were not strong, except for improved quality of life at 12-months (regression coefficient: -0.01 (-0.01 to -0.0003)).
Conclusions:
Higher patient, but not therapist, ratings of therapeutic alliance were weakly associated with improvements in some clinical outcomes, but worsening in one. Although findings suggest that patients who perceive a stronger alliance with their therapist may achieve better clinical outcomes, observed relationships were generally weak and of uncertain clinical significance. Clinical Trial: n/a
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