Araujo Amanda Costa, Filho Rúben Negrão, Oliveira Crystian B, Ferreira Paulo H, Pinto Rafael Z
Physiotherapy Department, Faculty of Science and Technology, São Paulo State University, Presidente Prudente, São Paulo, Brazil.
Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
J Back Musculoskelet Rehabil. 2017;30(4):879-887. doi: 10.3233/BMR-160563.
In the low back pain (LBP) field, therapeutic alliance is considered a non-specific factor of interventions associated with improvements in clinical outcomes. However, there is a paucity of studies aimed to evaluate measurement properties of tools used to objectively quantify the alliance between therapist and patients, such as the Working Alliance Inventory (WAI) and Session Rating Scale (SRS).
To translate and cross-culturally adapt the short-form version of WAI - therapist and SRS into Brazilian Portuguese; to investigate the measurement properties, of the WAI-Patient, WAI-Therapist and SRS in patients with LBP and their physical therapists, respectively.
One hundred patients with LBP and 18 physical therapists were recruited from physical therapy clinics in Brazil. Therapeutic alliance measures were collected at the initial assessment, prior to the second session, and at 2-month follow-up. The measurement properties investigated were reproducibility, internal consistency, ceiling/floor effects and responsiveness.
Although WAI-Patient, WAI-Therapist and SRS were considered to have acceptable test-retest reliability (ICC2,1 > 0.70), these questionnaires showed problems with other measurement properties. WAI-Patient showed problems with internal consistency (i.e. Cronbach's alpha < 0.70 for all subscales). Presence of ceiling effect (i.e. > 15% of participants with the maximum score) and poor internal responsiveness were found for the WAI-Patient (Effect size = 0.15; 84% CI: 0.04 to 0.29) and for the SRS (Effect size = 0.05; 84% CI: -0.22 to 0.11). The WAI-Therapist revealed slightly better measurement properties.
We identified psychometric limitations with most measurement properties of the WAI questionnaires and SRS. Future studies are needed to refine these tools.
在腰痛（LBP）领域，治疗联盟被认为是与临床结局改善相关的干预措施的非特异性因素。然而，旨在评估用于客观量化治疗师与患者之间联盟的工具（如工作联盟量表（WAI）和治疗过程评定量表（SRS））测量特性的研究较少。
将WAI治疗师简版和SRS翻译成巴西葡萄牙语并进行跨文化调适；分别调查WAI患者版、WAI治疗师版和SRS在腰痛患者及其物理治疗师中的测量特性。
从巴西的物理治疗诊所招募了100名腰痛患者和18名物理治疗师。在初始评估、第二次治疗前以及2个月随访时收集治疗联盟测量指标。所调查的测量特性包括可重复性、内部一致性、天花板/地板效应和反应性。
尽管WAI患者版、WAI治疗师版和SRS被认为具有可接受的重测信度（ICC2,1>0.70），但这些问卷在其他测量特性方面存在问题。WAI患者版在内部一致性方面存在问题（即所有子量表的Cronbach'sα<0.70）。WAI患者版（效应量=0.15；84%CI：0.04至0.29）和SRS（效应量=0.05；84%CI：-0.22至0.11）存在天花板效应（即>15%的参与者得最高分）且内部反应性较差。WAI治疗师版显示出稍好的测量特性。
我们发现WAI问卷和SRS的大多数测量特性存在心理测量学局限性。未来需要开展研究来完善这些工具。
