Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature

Source country of study

 Australia

22 (16.9)

18

2

2

 Brazil

1 (0.7)

1

-

-

 Canada

8 (6.2)

6

2

-

 Germany

3 (2)

2

-

1

 Hong Kong

2 (1.5)

2

-

-

 Iceland

2 (1.5)

1

1

-

 Ireland

2 (1.5)

2

-

-

 Netherland

4 (3.1)

4

-

-

 New Zealand

8 (6.2)

6

-

2

 Norway

2 (1.5)

2

-

-

 Spain

3 (2.3)

3

-

-

 Switzerland

2 (1.5)

1

-

1

 Sweden

12 (9.2)

8

3

1

 Turkey

1 (0.7))

1

-

-

 United Kingdom

27 (20.8)

23

2

2

 USA

31 (23.8)

12

11

8

Study design

 Quantitative methods

43 (33.1)

32

6

5

 Qualitative methods

51 (39.2)

41

8

2

 Mixed methods

8 (6.2)

4

2

2

 Narrative review articles/discussion papers

24 (18.5)

11

5

8

 Systematic reviews

4 (3.1)

4

-

-

Setting

 Community

11 (10)

10

1

-

 Long term care

1 (3)

-

1

-

 Outpatient

25 (21)

19

3

1

 Occupational Health

3 (4)

3

-

1

 Primary care

41 (34)

33

5

3

 Private practice

17 (18)

14

3

-

 Rehabilitation

15 (10)

8

5

2

 Various (multiple settings)

7 (6)

4

3

-

Conditions

 Spinal disorders

33 (25.3)

32

-

1

 Degenerative disease

27 (20.7)

22

-

2

 General Various

19 (14.6)

17

-

2

 Wrist/Hand

10 (7.6)

10

-

-

 Traumatic injury

9 (6.9)

8

1

-

 Upper Limb

15 (11.5)

12

2

1

 Workplace injury

2 (1.5)

2

-

-

Chan et al., 2009 (10s)

^aWhitlock et al. 5A’s framework of behaviour change

Existing literature on the self-determined motivation and engagement in health-promoting behavior.

^bSelf-determination theory

A. CONNECT

1. Partnership

Communication style and exercise compliance in physiotherapy

2. Congruence

Levy et al., 2008 (30s)

^cPhysiotherapist Psychological

3. Communication

4. Personalized therapy

Murray et al., 2015 (33 s)

Support

B. Ask, Advise, Agree, Assist, Arrange

Chen et al., 1999 (13 s)

^aCompliance and satisfaction with exercise

Existing literature and empirical study on compliance to home exercise in upper extremity rehabilitation

^cModel of Human Occupation

1. Input

1. Communication

2. Output

2. Connectedness

^cHealth locus of control

3. Environment

3. Partnership

4. The open system

4. Influencing factors

^cHealth belief model

Gorenberg et al., 2014 (109 s)

^aTherapeutic use of self

Conceptual practice model for occupational therapy focused on understanding therapeutic use of self.

^cThe Intentional Relationship Model

1. Client

1. Connectedness

2. Interpersonal events

2. Roles and responsibilities

3. Practitioner

3. Partnership

4. Occupational engagement

4. Congruence

Harman et al., 2012 (63 s)

^aBuilding blocks of health behavior change

Existing literature on, empirical studies about behaviour change and low back pain rehabilitation

^cTranstheoretical model

1. Need for action

1. Connectedness

2. Solutions

2. Partnership

3. Support

^cMotivational model of patient self-management

3. Reducing threat

4. Partnership

5. Congruence

Hinman et al., 2015 (65 s)

^cModel of Health Change

Existing literature on motivational interviewing, solution-focused coaching and cognitive behavioural therapy.

^cDimensions of health service delivery

1. Practice principles,

1. Connectedness

2. Essential techniques

2. Congruence

3. Step framework

Hurley et al., 2007 (66 s)

^aUnderstanding of illness

Parallel processing framework with one arm dedicated to cognitive processing of internal and external stimulus and the processing of emotional aspects of that stimulus.

^cLevanthal’s self-regulation model of illness

1. Identity

1. Connectedness

2. Timeline

2. Partnership

3. Consequence

3. Influencing factors

4. Cause

5. Control and cure

6. Illness coherence

Jackson et al., 2012 (25 s)

^aTripartite efficacy framework in client-therapist rehabilitation interactions

Existing literature and empirical studies on efficacy beliefs

^cTripartite efficacy model

1. Client-related factors

1. Connectedness

2. Role and responsibilities

2. Therapist related factors

^bSelf-efficacy theory; relation-inferred self-efficacy

3. Personalized therapy

4. Emotional support

5. Communication

Jensen and Lorish, 1994 (26 s)

^aBehavioral theory- based strategies for enhancing patient treatment cooperation and patient beliefs

Existing literature on compliance, decision-making, cognitive behavioral therapy and the explanatory model of exercise and mailed surveys to PTs

^cProcess Model of collaboration

1. Therapeutic relationship

1. Connectedness

2. Problem solving

3. Negotiation

4. Mutual enquiry

Kidd et al., 2011 (68 s)

^aPatient centred care

Existing literature and empirical studies on patient-centred care

^cBiopsychosocial model

1. Ability to communicate

1. Connectedness

2. Understanding of people and ability to relate

2. Partnership

^cPatients perception of a good physiotherapist

3. Knowledge and expertise

3. Influencing factors

4. Confidence

4. Communication

5. Transparent focus on progress and outcome

5. Role and responsibility

Knight et al., 2010 (29 s)

^aClient Satisfaction

Existing literature on satisfaction, and physiotherapy and empirical study on patient satisfaction.

^cConsumer model

1. Service

1. connectedness

2. Satisfaction

2. Influencing factors

3. Dissatisfaction

3. Partnership

4. Quality

4. Congruence

5. Reasons for seeking therapy

5. Communication

Neuman et al., 2009 (116 s)

^cEffect model of empathic communication in clinical encounter

Existing literature and hypothesis on clinical empathy

^cModel of empathic understanding and adherence to treatment regimens (nature)

1. Cognitive action oriented effects

1. Communication

2. Affective oriented effects

2. Partnership

Niederman et al., 2011 (34 s)

^aPictorial Representation of Illness and Self Measure

Existing literature on stress, coping strategies and resource utilization

^cHobfil’s resource conservation model

1. Self

1. Activating resources

^bSocial learning theory

2. Resource

2. Treatment goals

3. Separation

^cSelf management

Norby and Bellner, 1994 (76 s)

^aDimensions of helping

Existing literature and empirical study on basic assumptions of occupational therapy

^cTentative model of the helping encounter

1. Basic Professional-Oriented helping

1. Connectedness

2. Understanding-Oriented helping

2. Partnership

3. Action-Oriented helping

3. Roles and responsibilities

Radomski, 2011 (118 s)

^cEcological model for adherence in rehabilitation

Existing literature on adherence and occupational therapy

^cTranstheoretical model of change

1. Person factors

1. Congruence

2. Provider factors

2. Connectedness

3. Intervention factors

3. Communication

^bSelf-determination theory

4. Technology

4. Influencing factors

5. Social

6. Environmental

Schoster et al., 2005 (100 s)

^cInformation

Existing literature and empirical studies on predicting HIV-preventive behaviour

^cInformation-Motivation-Behavioural skills model

1. Exercise information

1. Connectedness

Motivation and Behavioural model

2. Exercise motivation

2. Roles and responsibilities

3. Exercise behavioural skills

3. Influencing factors.

4. Barriers

4. Partnership

5. Exercise behaviour

Szybek et al., 2000 (121 s)

^cModel of Physiotherapist-patient interactions

Existing literature on Psycho-therapeutic encounters, working alliance, transference and real relationships

^cGelso and Carter model

1. Interactions

1. Partnership

2. Non-insight oriented therapist

2. Congruence

3. Insight oriented therapist

Verkaaik et al., 2010 (123 s)

^aProductive partnership (P2) framework

Existing literature on power distribution in partnerships

^cIndependent living movement model

1. Context

1. Partnership

2. Predicted characteristics

^cConsumer direction model

3. Autonomy

4. Knowledge

Congruence

Agreement on goals

32 (24.6)

Problem identification

19 (14.6)

Agreement on tasks

27 (20.7)

Connectedness

Perceived good relationship

14 (8.7)

Friendliness

21 (20.3)

Empathy

16 (9.7)

Caring

15 (15.5)

Warmth

13 (10)

Genuine interest/concern^a

14 (10.7)

Therapist faith/belief^a in patient

8 (7.7)

Honesty^a

2 (1.5)

Courtesy^a

4 (3.0)

Communication

Nonverbal

24 (18.4)

Listening skills

39 (30)

Visual aids

7 (5.3)

Clear explanation and information^a

26 (20)

Positive feedback^a

9 (6.9)

Expectation

Therapy

25 (19.2)

Outcomes

22 (16.9)

Individualized therapy

Responsiveness

9 (6.9)

Holistic practice

8 (7.7)

Influencing factors

 External factors

Structures, processes and environment

17 (13.1)

 Therapist prerequisite

Skill and competence and experience

30 (23.1)

Personal characteristics

13 (10)

Humor

7 (5.3)

Life experiences

7 (5.3)

Emotional intelligence^a

3 (2.3)

 Patient prerequisite

Personal characteristics

6 (4.6)

Existing resources

10 (7.7)

Life experiences

11 (8.4)

Willingness to engage

11 (8.4)

Partnership

Trust/dependability

23 (17.6)

Respect

19 (14)

Mutual understanding

24 (18.4)

Knowledge exchange

19 (14.6)

Power balance

6 (4.6)

Active involvement/engagement

28 (21.5)

Roles and responsibilities

Activating patient’s resources

17 (13.1)

Motivator/Encourager^a

26 (20)

Professional manner

13 (10)

Educator/Adviser^a/Guide^a

11 (8.4)

Active follow-up^a

5 (3.8)

Autonomy support^a

3 (2.3)

Adamson et al., 1994 (1 s)

Attitude scale (19-item)

X

X

X

X

X

Yes^a

Stenmar and Nordholm, 1994 (101 s)

Baker et al., 2001 (4 s)

Participation Method Assessment Instrument (21-item)

X

X

X

X

Yes^b

Beattie et al., 2005 (6 s)

MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MR-12) (12-item)

X

X

X

X

Yes^a

Besley et al., 2010 (7 s)

Health Alliance Questionnaire (HAQ) (19-item)

X

X

X

X

X

Yes^a

Bliss, 2010 (8 s)

Working Alliance Inventory (WAI-12) (12-item)

X

X

X

Yes^a

Besley et al., 2010 (7 s)

Burns et al., 1999 (9 s)

Morrison, 2013 (98 s)

Chan and Can, 2010 (10 s)

Self-developed questionnaire (5-item)

X

X

No

Cole and McLean, 2003 (14 s)

Self-developed questionnaire (10-item)

X

X

X

X

X

No

Eklund et al., 2015 (17 s)

Working Relationship Questionnaire (HAqII) (19-item)

X

X

X

X

X

X

X

Yes^a

Farin et al., 2011 (57 s)

KOPRA questionnaire (32-item)

X

X

X

X

Yes^a

Ferreira et al., 2013 (18 s)

Working Alliance Theory of Change Inventory (WATOCI) (16-item)

X

X

X

X

X

Yes^b

Hall et al., 2012 (23 s)

Yes^a

Cheing et al., 2010 (12 s)

Pain Rehabilitation Scale (PRES) (54-item)

X

X

X

X

X

X

X

X

Yes^a

Fuentes et al., 2014 (20 s)

Vong et al., 2011 (42 s)

Gorenberg and Taylor, 2013 (109 s)

Clinical Assessment of 5 Modes Scale (23-item)

X

X

X

X

X

Yes^a

Taylor et al., 2011 (39 s)

Grannis et al., 1981 (22 s)

Q sort questionnaire (28-item)

X

X

X

X

No

Hills and Kitchen, 2007 (24 s)

Physiotherapy Outpatient Satisfaction Questionnaire (38-item)

X

X

X

X

Yes^a

Jackson et al., 2012 (25 s)

Relationship Assessment Scale (RAS) (16-item)

X

X

X

X

X

X

Yes^a

Kersten et al., 2012 (27 s)

Consultation and Relational Empathy (CARE) (10-item)

X

X

X

X

Yes^a

Kerssens et al., 1999 (28 s)

Self-developed questionnaire (11-item)

X

X

X

X

No

Knight et al., 2010 (29 s)

Service dimension questionnaire (12-item)

X

X

X

X

X

Yes^a

Lysack et al., 2005 (31 s)

Self-developed questionnaire (3-item)

X

X

X

X

No

Medina-Mirapeix et al., 2015 (32 s)

Patient Experience in Post-Acute Outpatient Physical Therapy (PEPAP-Q)

X

X

X

X

X

X

X

Yes^a

Murray et al., 2015 (33 s)

Health Care Climate Questionnaire (HCCQ) (6-items)

X

X

X

X

Yes^a

Chan et al., 2009 (10 s)

Levy et al., 2008 (30 s)

Roberts and Bucksey, 2007 (36 s)

Medical Communication Behaviour System (23-item)

X

X

X

Yes^a

Roberts et al., 2013

Thomson et al., 1997 (40 s)

Barrett-Lennard Relationship Inventory (BLRI) (64-item)

X

X

X

X

No

Thomson et al., 1997 (40 s)

Truax Accurate Empathy Scale (TAES) (8-item)

X

No

Tousignant, 2011 (41 s)

Health Care Satisfaction questionnaire (26-item)

X

X

Yes^a

Sluijs et al., 1991 (37 s), 1993 (38 s)

Patient Education checklist (5-item)

X

Yes^a

Wright et al., 2013 (43 s)

Medical Interview Satisfaction Scale (26-item)

X

X

X

X

X

Yes^a

Bliss, 2010 (8 s)

To examine psychosocial variables like attachment style, depression and the working alliance as predictors of treatment outcomes

Chronic knee pain (n = 59)

Correlational study

Working Alliance Inventory

5-item self-report measure of treatment compliance (α = 0.83)

The transformed WAI scores were significantly positively correlated to pain interference and severity, patient compliance and satisfaction. The transformed WAI accounted for 24% of the variance in patient compliance

Campbell et al., 2001 (48 s)

To understand reasons for compliance and non-compliance with a home-based exercise regimen

Knee osteoarthritis (n = 20)

Grounded theory with thematic analysis

Interviews

Interviews

Compliance were apparent initially when attending PT sessions and later when a number of factors combined to determine continued and long term compliance (or non-compliance). Continued compliance depends on a person’s perception of their symptoms, the effectiveness of the intervention, their ability to incorporate it into everyday life and support from physiotherapists.

A model of continued compliance was developed.

Chan and Can 2010 (11 s)

To evaluate patients’ adherence to home exercise programs in clinical practice and understand factors that affect patients’ adherence to home exercises.

Orthopaedic, sports injury, hand therapy, rheumatology (n = 82)

Cross-sectional survey study

25 item questionnaire

5-item exercise performance questionnaire.

Motivation, role of exercise, patients’ understanding of exercises, verbal and visual explanation and satisfaction with PT were found to have a strong effect on patient’s performance of home exercises.

Chan et al., 2009 (11 s)

To investigate the impact of PT’s autonomy-supportive behaviors on patients’ motivation and rehabilitation adherence

Anterior cruciate ligament injury (n = 115)

Correlational study

Healthcare Climate Questionnaire 15-item

Sport Injury Rehabilitation Adherence Scale (SIRAS)

Autonomous treatment motivation was associated positively with autonomy support but the relationship between autonomy support and controlled treatment motivation was not significant. Autonomous treatment motivation fully mediated the effect of physiotherapists’ autonomy-supportive behaviours on patients’ adherence.

Patient self-report home-based exercise adherence

Crook et al., 1998 (15 s)

To report the problem experienced with patient engagement in PT-led groups undertaking either an aerobic exercise or a stretching and relaxation program.

MSK disorders (n = 228)

Mixed methods study (quasi randomized controlled trial, interviews, checklist)

Individual interviews

Home exercise diary for exercise activity

PTs and patients acknowledge that listening was an importance part of the therapeutic relationship that improved adherence.

LBP [52], Neck pain [30];

Lower limb pain [25], Shoulder pain [12]

Escolar-Reina et al., 2010 (56 s)

To explore perceptions of people pain about the characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises.

Chronic neck or low back pain (n = 34)

Grounded theory approach

Interviews

NA

Patient adherence to home-based exercise is more likely to happen when care providers’ style (clinical knowledge, feedback, giving reminders, monitoring adherence and promoting exercise feedback and the content of exercise programme) are positively experienced.

Freene et al., 2014 (96 s)

To compare a PT-led home-based PA program to usual practice of community group exercise program to determine effectiveness in middle-aged adults for increasing physical activity levels over the short and long term.

Sedentary community dwelling adults (n = 37)

Mixed methods study (quasi randomized trial, focus groups)

Interviews

Self-report on Active Australia Survey

Most participants agreed the physiotherapist was an enabling factor for the home-based intervention, although others did not think this was important. Participants reported a good interaction with the PT and felt they were expert and knowledgeable.

Reliable and valid national measure.

Advice and support and individually tailored program from the PT and a good relationship with the instructor was important for continued participation in physical activity at home.

Gleeson et al., 1991 (21 s)

To develop policies and procedures about management of patient non-attendance in OT.

Hand injuries, burns, rheumatology (n = 100)

Cross-sectional survey study

Survey instrument

Patient and therapist comment on non-adherence

28% of patients believed that poor communication with the therapist was the reason for non-adherence.

PTs felt that non- attendance affected continuity of care due to difficulty in evaluating the overall effectiveness of treatment, unmet goals, inability to establish ongoing plans, and concern regarding discharge. PTs saw non-compliance as the result of a need to develop personal skills (empathy, warmth, concern), demonstrating a feeling of responsibility for non-attendance.

Harman et al., 2012 (63 s)

To describe the approach used by a PT during a rehab programme for injured members of the military designed to enhance self-efficacy and self-management skills.

Chronic low back pain (n = 12)

Qualitative study with interpretive paradigm

Interviews

NA

Trusting the physiotherapist helped patients continue with their programme despite it getting harder, challenging their confidence, and not showing immediate results.

Hinman et al., 2015 (65 s)

To explore how patients, PTs and telephone coaches experienced, and made sense of an integrated program of PT-supervised exercise and telephone coaching.

Knee osteoarthritis (n = 6)

Grounded theory with symbolic interactionism

Interviews

Interviews

Patients felt accountable and responsible for meeting goals when perceived attention from PT was individualized and genuine.

PTs appreciated providing clear information and monitoring progress, incorporation of exercise into daily routine. PTs recognized that collaboration, mutual understanding and emphasising the same treatment with the client as the central character were important.

Hurley et al., 2010 (66 s)

To explore the health beliefs, experiences, treatment expectations of people with chronic knee pain, and investigate if, how and why these change after taking part on an integrated exercise-based rehabilitation programme

Chronic knee pain (n = 29

Grounded Theory with thematic analysis

Interview

Attendance

The care, support and guidance participants received during the informal discussions helped build a trusting, collaborative partnership between patient and PT. This increased participant’ confidence and trust in the PT and belief in the rehabilitation programme. The interpersonal qualities and professional skills of the supervising PT were considered as important to the success of the programme as the content of the programme itself.

Jackson et al., 2012 (25 s)

To (i). explore potential relationship s between clients’ “tripartite” efficacy constructs, relationship quality with the therapist, and engagement in exercise and, (ii) model actor and partner effects or clients’ and therapists’ efficacy beliefs in relation to relationship quality

Osteoarthritis, osteoporosis, bursitis (n = 68)

Descriptive and Correlational study.

5-items from the 7-item Relation-ship adherence scale

3-item Engagement instrument

Increase in perception of relationship quality were directly related to improvements in engagement scores, accounting for 18% of the variance in engagement ratings.

Jensen et al., 1994 (26 s)

To integrate concepts from research, theory, and practice are integrated into a Process Model for Patient-Practitioner Collaboration for use in clinical practice

Rheumatoid arthritis.

Correlational survey study

Interview

NA

Pleasing the therapist was a reason for adherence to exercises prescribed.

Osteoarthritis, low back pain (n = 305)

PTs (n = 568).

Karnad and McLean, 2011 (67 s)

To explore PT’s perception of exercise adherence and interventions used in clinical practice.

Chronic MSK conditions

Interpretative Phenomenology

Interviews

Interviews

Most PTs believe that clear communication, faith in the PT, realistic treatment plans, shared goals and pain education are important for adhering to exercise.

PTS (n = 5)

Kingston et al., 2014 (97 s)

To determine whether compliance and understanding of a home exercise program is improved when patients are provided with a DVD.

Traumatic hand injury (n = 53)

Randomized controlled trial

Follow up survey

Compliance measures; diary recording of exercise, checklist for correctness and understanding of exercises, weekly attendance

No significant differences were found in the overall mean exercise compliance score between the groups.

All participants reported that the instructions provided were easy to use (100%). All respondents (100%) felt that their appointment with their hand therapist was moderately to extremely important and 90.6% felt their appointment was moderate to extremely important in motivating them to do theirexercises.

Levy et al., 2008 (30 s)

To investigate the relationship between perceived autonomy support, age, and rehabilitation adherence among sports-related injuries

Tendon related injuries ankle, knee, shoulder, elbow) (n = 70)

Prospective correlational study

Healthcare Climate Questionnaire 15-item

Sport Injury Rehabilitation Adherence Scale (SIRAS)

High autonomy support provided by the physical therapist was related to better clinic-based adherence and attendance but not to home-based adherence. Age was related to all adherence indices and moderated the relationship between perceived autonomy support and clinic-based rehabilitation adherence.

Clinic attendance

Home exercise adherence

Liddle et al., 2007 (71 s)

To explore the experiences, opinions and treatment expectations of chronic low back pain patients to identify what components of treatment they consider as being of most value.

Chronic low back pain (n = 18)

Narrative study using focus group

Interviews

NA

Lack of faith in practitioner resulted in participants ignoring advice and failing to adhere to home exercises programs and continuing bad postural habits. Follow-up support and reassurance about correct exercise instructions and assistance with appropriate treatment progression improved exercise adherence.

Littlewood et al., 2014 (72 s)

To increase knowledge and understanding of the experience of exercising and determine perception of facilitators and barriers to exercise.

Rotator cuff tendinopathy (n = 6)

Phenomenology with framework analysis

Interviews

NA

PTs and patients agreed that ongoing support in the form of providing feedback, proactive follow-up and stimulating further engagement with the self-managed exercise programs when progress was slow were influential on successful outcomes

Lysack et al., 2005 (31 s)

To compare computer-assisted video instruction and routine rehabilitation practice on compliance and satisfaction with home exercise.

Total joint arthroplasty (n = 40)

Randomized controlled trial

3-item tool on encouragement, courtesy, and, active involvement

Self-report on exercise performance accuracy, difficulty in remembering exercises, exercise frequency, level of exercise when feeling poorly, and duration of each exercise session

Statistical analysis showed there were no significant differences at follow-up between the video and control groups on any of the exercise compliance items or on any of the patient satisfaction items (p > 0.05 in all cases). Results of this randomized trial suggest that computerized patient education technology may not provide the benefits anticipated.

Hip [21]

Knee [19]

Rating of quality of exercise performance

Petursdottir et al., 2010 (81 s)

To increase knowledge and understanding of the experience of exercising among individuals with osteoarthritis and to determine what they perceive as facilitators and barriers to exercising.

Osteoarthritis (n = 12)

Phenomenology

Facilitator and barrier checklist

NA

Many participants placed emphasis on the fact that the encouragement and understanding they received from their PT were very important.

Hip/knee (n = 10)

Vertebral column (n = 9)

Clear communication and a sense of a positive connection were equally as important as the physical results of the therapy and adherence to exercise in physical therapy. Supervision by the PT facilitated exercise maintenance.

Hands [6]

Other joints [3]

Slade et al., 2009 (86 s)

To understand the factors that participants in exercise programs perceive to be important to engage and participate

Chronic low back pain (n = 18)

Grounded theory with focus groups

Audio-taped interviews

Audio-taped interviews

Helpful and empowering care-provider skills are those of the effective educator, motivator and communicator. Care-seekers are empowered by recognition of their own physical capability, motivators, time-management skills, and assertiveness to adhere to exercise

Sluijs et al., 1993 (38 s)

To investigate whether patent compliance was related to characteristics of the patient’s illness, attitude or physical therapist’s behaviour.

Trauma and postoperative conditions, Radiating back pain, Non-radiating back pain, Neck and shoulder pain (n = 1837)

Correlation study

5-item questionnaire

1-item questionnaire

The 5 forms of PT behavior showed no direct, statistically significant relationship with compliance.

Compliance was significantly related to the positive feedback (therapist satisfaction with and appreciation of exercise performance).

PT (n = 300)

Observers (n = 3)

Stenmar et al., 1994 (101 s)

To find out the kinds of attributions PTs make regarding why PT works and the extent to which attributions are related to background variables.

PTs (n = 140)

Cross-sectional survey study

22 Likert-type items and various demographic variables.

NA

Majority of the respondents believed that the patient’s own resources and the patient-PT relationship rather than the treatment techniques are the most important factors in explaining why PT works. Other background factors had no relationship to the beliefs and attitudes expressed.

Veenhof et al., 2006 (91 s)

To understand why patients who have received a behavioural graded activity program successfully integrate activities into their daily lives.

Osteoarthritis (n = 12)

Grounded theory approach

Interview

Self-report on integrating activities into daily life after discharge

Initial motivation, active involvement in the whole process and that the PT coaching role during intervention facilitated adherence to exercises and activities:

Vong et al., 2011 (42 s)

To examine whether the addition of motivational enhancement therapy (MET) to conventional PT produces better outcomes than PT alone

Chronic low back pain (n = 76)

Randomized, controlled trial

Pain Rehabilitation Expectation Scale (PRES)

Exercise log (frequency)

The MET-plus-PT group produced significantly greater improvements than the PT group in proxy efficacy, working alliance, and treatment expectancy with significantly better performance in lifting capacity, general health and exercise compliance.

Wright et al., 2013 (43 s)

To identify which factors best explain non-adherence to home rehabilitation for patients with musculoskeletal injuries.

Musculoskeletal injuries (n = 87)

Cross-sectional study

Medical Interview Satisfaction Scale (MISS)

Sports Injury Rehabilitation Scale (SIRAS)

Patients are most likely to adhere to HRE when they perceive a positive relationship with their PT. Self-reported adherence is higher when patient perception of behavioural, cognitive and affective elements of the relationship are positive.