The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review
Abstract
Background: The working alliance, or collaborative bond, between client and psychotherapist has been found to be related to outcome in psychotherapy. Purpose: The purpose of this study was to investigate whether the working alliance is related to outcome in physical rehabilitation settings. Data Sources: A sensitive search of 6 databases identified a total of 1,600 titles. Study Selection: Prospective studies of patients undergoing physical rehabilitation were selected for this systematic review. Data Extraction: For each included study, descriptive data regarding participants, interventions, and measures of alliance and outcome—as well as correlation data for alliance and outcomes—were extracted. Data Synthesis: Thirteen studies including patients with brain injury, musculoskeletal conditions, cardiac conditions, or multiple pathologies were retrieved. Various outcomes were measured, including pain, disability, quality of life, depression, adherence, and satisfaction with treatment. The alliance was most commonly measured with the Working Alliance Inventory, which was rated by both patient and therapist during the third or fourth treatment session. The results indicate that the alliance is positively associated with: (1) treatment adherence in patients with brain injury and patients with multiple pathologies seeking physical therapy, (2) depressive symptoms in patients with cardiac conditions and those with brain injury, (3) treatment satisfaction in patients with musculoskeletal conditions, and (4) physical function in geriatric patients and those with chronic low back pain. Limitations: Among homogenous studies, there were insufficient reported data to allow pooling of results. Conclusions: From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
During psychotherapeutic treatment, establishing a sound patient-therapist relationship is crucial for good outcomes.
“During psychotherapeutic treatment, for example, establishing a sound therapeutic relationship between patient and therapist is crucial for producing good outcomes 140.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [140]
Cites
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040296 · Cited by 23,020 · see citing works
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & Initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010 · Cited by 17,796 · see citing works
Foundations of Clinical Research: Applications to Practice,
(2002) · Survey of Ophthalmology · doi:10.1016/s0039-6257(02)00362-4 · Cited by 9,485 · see citing works
The generalizability of the psychoanalytic concept of the working alliance.
Bordin, E. S. (1979) · Psychotherapy: Theory, Research & Practice · doi:10.1037/h0085885 · Cited by 5,238 · see citing works
Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review
Martin, D. J., Garske, J. P., & Davis, M. K. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.3.438 · Cited by 3,355 · see citing works
Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease
Kaplan, S. H., Greenfield, S., & Ware, J. E. (1989) · Medical Care · doi:10.1097/00005650-198903001-00010 · Cited by 2,043 · see citing works
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007) · Epidemiology · doi:10.1097/ede.0b013e3181577654 · Cited by 1,991 · see citing works
Sanderson, S., Tatt, I. D., & Higgins, J. P. (2007) · International Journal of Epidemiology · doi:10.1093/ije/dym018 · Cited by 1,531 · see citing works
Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?
Hall, M. A., Dugan, E., Zheng, B., & Mishra, A. K. (2001) · Milbank Quarterly · doi:10.1111/1468-0009.00223 · Cited by 1,491 · see citing works
The Technique and Practice of Psychoanalysis, Volume 1
Greenson, R. R. (1967) · Medical Entomology and Zoology · Cited by 1,086 · see citing works
Acute low back pain: systematic review of its prognosis
Pengel, L. H. M., Herbert, R., Maher, C. G., & Refshauge, K. M. (2003) · BMJ · doi:10.1136/bmj.327.7410.323 · Cited by 867 · see citing works
Self-citationThe Dynamics of the Transference
Laufer, M. E. (2018) · Yale University Press eBooks · doi:10.2307/j.ctt211qwc2.16 · Cited by 695 · see citing works
Correlates of Exercise Compliance in Physical Therapy
Sluijs, E. M., Kok, G. J., & van der Zee, J. (1993) · Physical Therapy · doi:10.1093/ptj/73.11.771 · Cited by 551 · see citing works
The conceptualization and measurement of therapeutic alliance: An empirical review
Elvins, R., & Green, J. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.04.002 · Cited by 534 · see citing works
The Relationship Between Method of Physician Payment and Patient Trust
Kao, A. C. (1998) · JAMA · doi:10.1001/jama.280.19.1708 · Cited by 380 · see citing works
Alliance predicts patients' outcome beyond in-treatment change in symptoms.
Barber, J. P., Connolly, M. B., Crits-Christoph, P. F., Gladis, L., & Siqueland, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.6.1027 · Cited by 348 · see citing works
Patients’ trust in their physicians
Kao, A. C., Green, D. C., Davis, N., Koplan, J. P., & Cleary, P. D. (1998) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1998.00204.x · Cited by 343 · see citing works
Patient trust in the physician: relationship to patient requests
Thom, D. H. (2002) · Family Practice · doi:10.1093/fampra/19.5.476 · Cited by 335 · see citing works
Course and prognostic factors of whiplash: A systematic review and meta-analysis ☆
Kamper, S. J., Rebbeck, T. J., Maher, C. G., McAuley, J. H., & Sterling, M. M. (2008) · Pain · doi:10.1016/j.pain.2008.02.019 · Cited by 324 · see citing works
Self-citationThe effects of trust in physician on self-efficacy, adherence and diabetes outcomes
Lee, Y.-Y., & Lin, J. L. (2009) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.12.033 · Cited by 285 · see citing works
Switching doctors: predictors of voluntary disenrollment from a primary physician's practice.
Safran, D. G., Montgomery, J. E., Chang, H., Murphy, J., & Rogers, W. H. (2001) · PubMed · Cited by 274 · see citing works
Horvath, A. O. (2001) · Psychotherapy · doi:10.1037/0033-3204.38.4.365 · Cited by 249 · see citing works
Interventions for improving patients' trust in doctors and groups of doctors
Rolfe, A., Cash‐Gibson, L., Car, J., Sheikh, A., & McKinstry, B. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004134.pub3 · Cited by 241 · see citing works
Physical therapists' nonverbal communication predicts geriatric patients' health outcomes.
Ambady, N., Koo, J., Rosenthal, R., & Winograd, C. H. (2002) · Psychology and Aging · doi:10.1037/0882-7974.17.3.443 · Cited by 229 · see citing works
Alliance predicts patients' outcome beyond in-treatment change in symptoms.
Barber, J. P., Connolly, M. B., Crits-Christoph, P. F., Gladis, L., & Siqueland, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.6.1027 · Cited by 229 · see citing works
Teasdale, T. W., Christensen, A., Willmes, K., Deloche, G., Braga, L. W., Stachowiak, F.-J., Vendrell, J. M., Castro‐Caldas, A., Laaksonen, R. K., & Leclercq, M. (1997) · Brain Injury · doi:10.1080/026990597123250 · Cited by 155 · see citing works
Etchegoyen, R. H. (2018) · Routledge eBooks · doi:10.4324/9780429481864-8 · Cited by 144 · see citing works
Bachelor, A. (1991) · Psychotherapy · doi:10.1037/0033-3204.28.4.534 · Cited by 133 · see citing works
Persons, J. B., & Burns, D. D. (1985) · Cognitive Therapy and Research · doi:10.1007/bf01173007 · Cited by 129 · see citing works
Préau, M., Leport, C., Salmon, D., Carrieri, P., Portier, H., Chêne, G., Spire, B., Choutet, P., Raffi, F., Morin, M., et al. (2004) · AIDS Care · doi:10.1080/09540120410001716441 · Cited by 120 · see citing works
Beattie, P., Turner, C., Dowda, M. C., Michener, L. A., & Nelson, R. M. (2005) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2005.35.1.24 · Cited by 107 · see citing works
(1989) · Elsevier eBooks · doi:10.1016/b978-0-08-088582-7.50001-6 · Cited by 100 · see citing works
Resolving decisional conflict by Gestalt two-chair dialogue: Relating process to outcome.
Greenberg, L. S., & Webster, M. C. (1982) · Journal of Counseling Psychology · doi:10.1037/0022-0167.29.5.468 · Cited by 97 · see citing works
Sherer, M., Evans, C. C., Leverenz, J., Stouter, J., Irby, J. W., Lee, J. E., & Yablon, S. A. (2007) · Brain Injury · doi:10.1080/02699050701481589 · Cited by 92 · see citing works
Schönberger, M., Humle, F., & Teasdale, T. W. (2006) · Brain Injury · doi:10.1080/02699050600664772 · Cited by 90 · see citing works
Interventions for improving patients' trust in doctors and groups of doctors
McKinstry, B., Ashcroft, R. E., Car, J., Freeman, G. K., & Sheikh, A. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004134.pub2 · Cited by 84 · see citing works
Schönberger, M., Humle, F., & Teasdale, T. W. (2006) · Brain Injury · doi:10.1080/02699050601049395 · Cited by 70 · see citing works
Schönberger, M., Humle, F., Zeeman, P., & Teasdale, T. W. (2006) · Neuropsychological Rehabilitation · doi:10.1080/09602010500176476 · Cited by 65 · see citing works
Alliance and Technique for Predicting Outcome in Short-and Long-Term Analytic Psychotherapy
Gaston, L., Piper, W. E., Debbané, E. G., Bienvenu, J., & Garant, J. (1994) · Psychotherapy Research · doi:10.1080/10503309412331333952 · Cited by 55 · see citing works
Effectiveness of Traditional Bone Setting in Chronic Neck Pain: Randomized Clinical Trial
Zaproudina, N., Hänninen, O. O. P., & Airaksinen, O. (2007) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2007.05.004 · Cited by 53 · see citing works
Burns, J. W., & Evon, D. M. (2007) · Health Psychology · doi:10.1037/0278-6133.26.6.684 · Cited by 48 · see citing works
Shelton, C., & Shryock, M. (2007) · Brain Injury · doi:10.1080/02699050701716935 · Cited by 40 · see citing works
The Technique and Practice of Psychoanalysis.
GRINKER, R. R. (1967) · Archives of General Psychiatry · doi:10.1001/archpsyc.1967.01730300128026 · Cited by 33 · see citing works
Zaproudina, N., Hietikko, T., Hänninen, O., & Airaksinen, O. (2008) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2008.08.005 · Cited by 30 · see citing works
The Illinois Institute of Technology
Aylward, F. (1960) · Technical Education and Industrial Training · doi:10.1108/eb014834 · Cited by 22 · see citing works
Forman, N. W. (1990) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The role of psychosocial processes in the development and maintenance of chronic pain
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016) · The Journal of Pain · doi:10.1016/j.jpain.2016.01.001 · Cited by 954 · see citing works
Evaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719 · see citing works
Kinney, M., Seider, J., Beaty, A. F., Coughlin, K., Dyal, M., & Clewley, D. (2020) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1516015 · Cited by 290 · see citing works
Slade, S. C., Patel, S., Underwood, M., & Keating, J. L. (2014) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000044 · Cited by 173 · see citing works
Moore, A. J., Holden, M. A., Foster, N. E., & Jinks, C. (2020) · Journal of Physiotherapy · doi:10.1016/j.jphys.2019.11.004 · Cited by 140 · see citing works
Lamb, S. E., Mistry, D., Alleyne, S., Atherton, N., Brown, D., Copsey, B., Dosanjh, S., Finnegan, S., Fordham, B., Griffiths, F., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22280 · Cited by 98 · see citing works
“A good therapeutic alliance must be continually reproduced between the patient and the therapist.(103) Trying to maintain a good therapeutic alliance with participants who have dementia is challenging.”
BackgroundBergman Nordgren, L., Carlbring, P., Linna, E., & Andersson, G. (2013) · JMIR Research Protocols · doi:10.2196/resprot.2292 · Cited by 92 · see citing works
Specific and general therapeutic mechanisms in cognitive behavioral treatment of chronic pain
Burns, J. W., Nielson, W. R., Jensen, M. P., Heapy, A., Czlapinski, R., & Kerns, R. D. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0037208 · Cited by 77 · see citing works
Physiotherapy management of patients with chronic pelvic pain (CPP): a systematic review
Klotz, S. G. R., Schön, M., Ketels, G., Löwe, B., & Brünahl, C. A. (2019) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2018.1455251 · Cited by 66 · see citing works
Mindfulness and Motivational Interviewing: Two candidate methods for promoting self-management
Benzo, R. P. (2013) · Chronic Respiratory Disease · doi:10.1177/1479972313497372 · Cited by 55 · see citing works
“Based on the previous research, we hypothesize that higher working alliance will be associated with better patient outcomes.(9,10)”
MethodJesus, T. S., & Silva, I. L. (2016) · Clinical Rehabilitation · doi:10.1177/0269215515585133 · Cited by 51 · see citing works
Kowatsch, T., Lohse, K.-M., Erb, V., Schittenhelm, L., Galliker, H., Lehner, R., & Huang, E. M. (2021) · Journal of Medical Internet Research · doi:10.2196/23612 · Cited by 39 · see citing works
Pruitt, L. D., Vuletic, S., Smolenski, D. J., Wagner, A., Luxton, D. D., & Gahm, G. A. (2019) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x18784103 · Cited by 22 · see citing works
Mander, J., Neubauer, A. B., Schlarb, A., Teufel, M., Bents, H., Hautzinger, M., Zipfel, S., Wittorf, A., & Sammet, I. (2017) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12131 · Cited by 27 · see citing works
Seo, W., Buyuktur, A. G., Verma, S., Kim, H., Choi, S. W., Sedig, L., & Park, S. Y. (2021) · Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445120 · Cited by 18 · see citing works
Galea Holmes, M. N., Wileman, V., Hassan, S., Denning, J., Critchley, D., Norton, S., McCracken, L. M., & Godfrey, E. (2022) · British Journal of Health Psychology · doi:10.1111/bjhp.12583 · Cited by 13 · see citing works
Wrapson, W., Dorrestein, M., Wrapson, J., Theadom, A., Kayes, N., Snell, D., Rutherford, S., Roche, M., Babbage, D. R., & Siegert, R. J. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2021.1950777 · Cited by 12 · see citing works
- Authors
- Hall, A. M., Ferreira, P. H., Maher, C. G., Latimer, J., & Ferreira, M. L.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Hall, Amanda M.
- Venue
- Physical Therapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-08-01
- Volume
- 90
- Issue
- 8
- Pages
- 1099-1110
- ISSN
- 0031-9023 (ISSN-L)
- 1538-6724
- OpenAlex
- W2134567940
- Cited by
- 641
- References
- 47
- Citations by year
- 2026: 47 · 2025: 44 · 2024: 49 · 2023: 56 · 2022: 65 · 2021: 58 · 2020: 51 · 2019: 49 · 2018: 45 · 2017: 34 · 2016: 41 · 2015: 30 · 2014: 23 · 2013: 23 · 2012: 11
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physical Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- therapeutic relationship, physical rehabilitation, treatment outcomes, medication adherence, treatment satisfaction, depressive symptoms, brain injury, musculoskeletal disorders, cardiac conditions, chronic low back pain, elderly patients, physical function, Working Alliance Inventory
- MeSH terms
- Depression, Disabled Persons, Persons with Disabilities, Humans, Pain Measurement, Patient Compliance, Professional-Patient Relations, Quality of Life, Patient Satisfaction, Outcome Assessment, Health Care, Physical Therapy Specialty
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
