The George Institute for International Health, Faculty of Medicine, The University of Sydney, PO Box M201, Missenden Road, Sydney, New South Wales, 2050 Australia.
Phys Ther. 2010 Aug;90(8):1099-110. doi: 10.2522/ptj.20090245. Epub 2010 Jun 24.
The working alliance, or collaborative bond, between client and psychotherapist has been found to be related to outcome in psychotherapy.
The purpose of this study was to investigate whether the working alliance is related to outcome in physical rehabilitation settings.
A sensitive search of 6 databases identified a total of 1,600 titles.
Prospective studies of patients undergoing physical rehabilitation were selected for this systematic review.
For each included study, descriptive data regarding participants, interventions, and measures of alliance and outcome-as well as correlation data for alliance and outcomes-were extracted.
Thirteen studies including patients with brain injury, musculoskeletal conditions, cardiac conditions, or multiple pathologies were retrieved. Various outcomes were measured, including pain, disability, quality of life, depression, adherence, and satisfaction with treatment. The alliance was most commonly measured with the Working Alliance Inventory, which was rated by both patient and therapist during the third or fourth treatment session. The results indicate that the alliance is positively associated with: (1) treatment adherence in patients with brain injury and patients with multiple pathologies seeking physical therapy, (2) depressive symptoms in patients with cardiac conditions and those with brain injury, (3) treatment satisfaction in patients with musculoskeletal conditions, and (4) physical function in geriatric patients and those with chronic low back pain.
Among homogenous studies, there were insufficient reported data to allow pooling of results.
From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.
患者与心理治疗师之间的工作联盟（或协作关系）已被发现与心理治疗的结果有关。
本研究旨在调查工作联盟是否与物理康复环境中的结果有关。
对 6 个数据库进行了敏感搜索，共确定了 1600 个标题。
选择了正在接受物理康复的患者的前瞻性研究进行这项系统评价。
对于每一项纳入的研究，都提取了参与者、干预措施以及联盟和结果测量的描述性数据，以及联盟和结果的相关数据。
共检索到 13 项研究，包括脑损伤、肌肉骨骼疾病、心脏疾病或多种疾病的患者。测量了各种结果，包括疼痛、残疾、生活质量、抑郁、治疗依从性和对治疗的满意度。联盟最常用工作联盟量表（Working Alliance Inventory）进行测量，由患者和治疗师在第三次或第四次治疗期间进行评分。结果表明，联盟与以下方面呈正相关：（1）脑损伤和寻求物理治疗的多种疾病患者的治疗依从性，（2）心脏疾病和脑损伤患者的抑郁症状，（3）肌肉骨骼疾病患者的治疗满意度，以及（4）老年患者和慢性下腰痛患者的身体功能。
在同质研究中，没有足够的报告数据来进行结果的汇总。
从本综述来看，治疗师和患者之间的联盟似乎对物理康复环境中的治疗结果有积极影响；然而，需要进一步的研究来确定这种关联的强度。
