Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis: Secondary Analyses From a Randomized Controlled Trial.
Belinda Joan Lawford, Kim L Bennell, Penny K Campbell and 2 others
PMID 33459601WHAT IT FOUND
In people with knee osteoarthritis receiving telephone-delivered physical therapy, a stronger alliance rated by the patient was weakly linked to better pain and function scores.
However, these statistical links were so small they are unlikely to matter clinically. Therapist ratings of the alliance showed no such association.
Key findings
01Patient-rated therapeutic alliance was weakly associated with some improvements in pain, self-efficacy, and global function at 6 and 12 months, but the effect sizes were very small.
02Physical therapist ratings of the therapeutic alliance were generally not associated with clinical outcomes, suggesting the patient's perception of the relationship is more relevant than the therapist's.
03The observed associations were considered too weak to be clinically significant, with a one-unit increase in alliance score corresponding to only a 0.10-unit improvement in pain on an 11-point scale.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study is a secondary analysis of a single trial's intervention arm, which limits generalizability and statistical power. The physical therapists involved had specific training in person-centered care and behavior change, which may not reflect the training of therapists in the broader community. The measure used for therapeutic alliance (WAI) has not been validated specifically for musculoskeletal physical therapy and may suffer from a ceiling effect, as scores were uniformly high. All outcomes were self-reported, which introduces potential bias compared to objective performance measures. The sample size (87 patients) is relatively small for detecting subtle associations across multiple outcomes.
Declared interests
The funders played no role in the design, conduct, or reporting of this study. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that therapeutic alliance is unimportant. The study found that patient-perceived alliance was statistically associated with outcomes, even if the effect size was clinically negligible. The lack of association with therapist-perceived alliance suggests that how the patient experiences the relationship matters more than how the therapist rates it.