Miciak Maxi, Mayan Maria, Brown Cary, Joyce Anthony S, Gross Douglas P
1Alberta Innovates, 1500, 10104 - 103 Avenue NW, Edmonton, AB T5J 0H8 Canada.
2Faculty of Extension, University of Alberta, 10230 - Jasper Ave, Edmonton, AB T5J 4P6 Canada.
Arch Physiother. 2018 Feb 17;8:3. doi: 10.1186/s40945-018-0044-1. eCollection 2018.
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. 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.
Interpretive 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.
Four conditions were identified as necessary for establishing a therapeutic relationship: , , , and . 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.
These 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.
患者与物理治疗师之间的治疗关系是以患者为中心的护理的核心组成部分，并且与更好的物理治疗临床结果呈正相关。尽管其具有影响力，但我们并不清楚哪些条件能够使物理治疗师和患者建立并维持治疗关系。这一知识对于临床医生如何与患者进行互动以及开发准确反映治疗关系本质的评估工具具有重要意义。因此，本研究的目的是识别并深入描述物理治疗师与患者之间治疗关系建立所需的必要条件。
诠释性描述是用于识别和描述反映并与临床实践实际相关的条件的定性方法导向。从加拿大埃德蒙顿的私人执业诊所中，有目的地抽取了11名具有至少5年临床经验的物理治疗师和7名患有肌肉骨骼疾病的成年患者。面对面的半结构化访谈在参与者选择的地点完成，并进行了录音和转录。采用定性内容分析法对文本数据进行分析，并整合持续比较技术以完善类别和子类别。在整个研究过程中使用的严谨策略包括同行汇报、访谈笔记、反思日记、记备忘录、成员反思、审计跟踪和外部审计。
确定了建立治疗关系所需的四个条件： ， ， 和 。这些条件代表了参与临床互动的物理治疗师和患者的意图和态度。尽管各不相同，但这些条件似乎相互关联，因为在场和接纳为真诚和投入奠定了基础。
物理治疗师和患者要“处于”治疗关系中，需要这些参与条件。虽然沟通技巧对于提升治疗师的关系能力很重要，但意图和态度的意识与整合对于塑造发展治疗关系的行为至关重要。这些发现还表明存在物理治疗特有的治疗关系特征。因此，应谨慎使用来自其他背景（如心理治疗）的理论来指导物理治疗实践和研究。
