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Bedside Matters: A Conceptual Framework of the Therapeutic Relationship in Physiotherapy Open Access


Other title
Therapeutic Alliance
Patient-practitioner Relationship
Physical Therapy
Working Alliance
Patient-centred Care
Conceptual Framework
Client-centred Care
Therapeutic Relationship
Patient-therapist Relationship
Type of item
Degree grantor
University of Alberta
Author or creator
Miciak, Maxi A
Supervisor and department
Mayan, Maria (Extension)
Gross, Douglas (Physical Therapy)
Examining committee member and department
Manns, Patricia (Physical Therapy)
Brown, Cary (Occupational Therapy)
Joyce, Anthony (Psychiatry)
George, Steven (Physical Therapy)
Faculty of Rehabilitation Medicine
Rehabilitation Science
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Background The therapeutic relationship (TR) in physiotherapy, sometimes described as the rapport or the alliance between physiotherapist and patient, is an important aspect of clinical interactions. Physiotherapists are expected attend to the TR as a standard of patient-centred practice. Recent research that illustrates that better quality TRs can positively impact health outcomes, patient satisfaction with services, and patient adherence to treatment plans. However, a lack of conceptual development limits how the TR is addressed in research, clinical practice, and education. A specific definition of the TR and conceptual framework is needed to provide a foundation to understand and apply the TR in these 3 areas. This dissertation aimed to identify and conceptually describe the key components of the TR. Methods and Results The study design was interpretive description, a qualitative method. One-on-one interviews were completed with 11 physiotherapists and 7 patients managing musculoskeletal conditions in private practice clinics in Edmonton, Canada. Textual data was analyzed using qualitative content analysis, augmented by principles of constant comparison. Three components were identified and conceptually described: the necessary conditions of engagement, ways of establishing connections, and elements of the bond. This dissertation details each component in separate papers. The first paper (Chapter 4), “The necessary conditions of engagement for the therapeutic relationship in physiotherapy,” provides a detailed account of the circumstances that underlie development of the TR. The second paper (Chapter 5), “A framework for establishing connections in physiotherapy practice” reviews the various ways that physiotherapists and patients can develop meaningful attachments based on common ground and acknowledgement of personal and professional factors between them. The third paper, “The defining elements of the bond between physiotherapists and patients,” illustrates the nature of the affective resonance between physiotherapist and patient. Conclusion Findings provide an overarching conceptual framework that could advance the way the TR is approached in research, clinical practice, and education. Together, these 3 components illustrate that the nature and development of the TR in physiotherapy involves multiple factors. Moreover, the findings clarify that the TR is a mutual endeavour involving a complex mix of professional and personal factors that can vary between clinical situations.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Miciak, M. (2015, May) Developing the therapeutic relationship: Ways of establishing connections with patients. ‘Physiotherapy Alberta Webinar Series’ 2015-2016.Miciak, M. (2013, December) Bedside matters: Understanding the therapeutic relationship in physical therapy. ‘CPA Clinical Teleconference Program’, Canadian Physiotherapy Association.

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