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

  • Author / Creator
    Miciak, Maxi A
  • 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.

  • Subjects / Keywords
  • Graduation date
    2015-11
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R34B2X97W
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Doctoral
  • Department
    • Faculty of Rehabilitation Medicine
  • Specialization
    • Rehabilitation Science
  • Supervisor / co-supervisor and their department(s)
    • Gross, Douglas (Physical Therapy)
    • Mayan, Maria (Extension)
  • Examining committee members and their departments
    • George, Steven (Physical Therapy)
    • Manns, Patricia (Physical Therapy)
    • Joyce, Anthony (Psychiatry)
    • Brown, Cary (Occupational Therapy)