Therapeutic alliance between stroke survivors and physiotherapists in inpatient stroke rehabilitation

Introduction: Exploration of therapeutic alliance is an emerging field within physiotherapy (Babatunde et al., 2017). Research has highlighted the positive association between a strong alliance in physiotherapy and outcome (Kinney et al., 2020). Previous research suggests establishing a therapeutic alliance within a stroke rehabilitation context can be a complex process (Stagg et al., 2021). The purpose of my study was to explore how therapeutic relationships are formed, maintained, and closed within the provision of physiotherapy to inpatient stroke survivors. I also sought to understand stroke survivors’ and physiotherapists’ perspectives on therapeutic alliance within stroke rehabilitation and factors which facilitate or impede its’ development. Method: Contextual data, focused observations, and semi-structured interviews were employed to address these aims. A framework approach to analysis was adopted, and 10 participants (5 stroke survivors; 5 physiotherapists) were recruited. Results: Five main themes were developed based on focused observations and semi-structured interviews. These themes are Environmental Influences on Therapeutic Alliance, Goals, Tasks, Bond, and Satisfaction with the Relationship. Themes suggest that the environment sets the context for therapeutic alliance development. Reciprocity was an important interpersonal process, which appears to underpin alliance development. Discussion: My findings highlight several key learning points for physiotherapists, which could help them build stronger therapeutic alliances with stroke survivors. Future research could develop targeted interventions based on these results.