Lucas Lauren, Peters Sarah, Cotterill Sarah, Bowen Audrey
Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK.
Northern Care Alliance NHS Trust, Greater Manchester, UK.
Clin Rehabil. 2025 Sep;39(9):1254-1265. doi: 10.1177/02692155251358457. Epub 2025 Jul 21.
ObjectiveTo understand healthcare professionals' experiences of developing therapeutic alliances (working relationships) with stroke survivors, and their views on how alliance relates to self-management in community settings.DesignQualitative study.SettingCommunity.ParticipantsHealthcare professionals recruited purposively from four National Health Service community stroke teams in England.Main measuresSemi-structured, one-to-one qualitative interviews, transcribed verbatim and analysed using Braun and Clarke's reflexive thematic analysis.ResultsNineteen clinicians (six physiotherapists, four occupational therapists, two speech and language therapists, two nurses, one psychologist and four people in assistant/trainee roles) were included in the study. Three main themes were developed from the data. (1) : alliances were shaped by the time-limited nature of community rehabilitation and relied on trust, buy-in, and clearly defined roles and expectations. (2) : whilst alliances supported motivation and engagement, complicated power dynamics sometimes undermined self-management. (3) : participants often equated self-management with self-directed rehabilitation and described a lack of clarity, confidence and training in supporting emotional and long-term adjustment needs. Strong alliances were viewed as essential for self-management, but formal support strategies were rarely used.ConclusionsCommunity-based healthcare professionals consider therapeutic alliance to be the foundation for stroke self-management in the community. However, a limited understanding of self-management among clinicians, combined with unbalanced power dynamics, may restrict patient autonomy. Relationship-based training (e.g. Bridges) and the development of self-management champion roles within organisations may enhance clinicians' confidence and consistency in delivering self-management support in the community.
目的
了解医疗保健专业人员与中风幸存者建立治疗联盟（工作关系）的经历，以及他们对联盟与社区环境中自我管理之间关系的看法。
设计
定性研究。
背景
社区。
参与者
从英国四个国民保健服务社区中风团队中有意招募的医疗保健专业人员。
主要措施
进行半结构化一对一的定性访谈，逐字转录并使用布劳恩和克拉克的反思性主题分析法进行分析。
结果
19名临床医生（6名物理治疗师、4名职业治疗师、2名言语和语言治疗师、2名护士、1名心理学家以及4名助理/实习人员）参与了该研究。从数据中得出了三个主要主题。（1）：联盟受社区康复限时性的影响，依赖信任、认同以及明确的角色和期望。（2）：虽然联盟支持积极性和参与度，但复杂的权力动态有时会破坏自我管理。（3）：参与者常常将自我管理等同于自我导向的康复，并表示在支持情感和长期调整需求方面缺乏清晰度、信心和培训。强大的联盟被视为自我管理的关键，但很少使用正式的支持策略。
结论
社区医疗保健专业人员认为治疗联盟是社区中风自我管理的基础。然而，临床医生对自我管理的理解有限，再加上权力动态不平衡，可能会限制患者的自主权。基于关系的培训（如“桥梁”培训）以及在组织内设立自我管理倡导者角色可能会增强临床医生在社区提供自我管理支持时的信心和一致性。
