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Cited by 48Psychotherapy Techniques and ApplicationsMusculoskeletal pain and rehabilitationPsychometric Methodologies and Testing

Assessment of the therapeutic alliance in physical rehabilitation: a RASCH analysis

Hall, Amanda Marie, Ferreira, Manuela L., Clemson, Lindy, Ferreira, Paulo, Latimer, Jane, Maher, Chris G.·2012·Disability and Rehabilitation
DOI 10.3109/09638288.2011.606344
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Abstract

Purpose: To investigate the psychometric properties of the Working Alliance Inventory Theory of Change Inventory (WATOCI) in physical rehabilitation. Methods: RASCH analysis was used to examine the validity, internal consistency, reliability and discriminative properties of the 16-item WATOCI. Data was obtained from a randomized controlled trial, which employed the WATOCI to measure the alliance between physical therapists and patients with chronic low back pain. Results: The results indicated that 7 items on the 16-item WATOCI should need to be improved for use in physiotherapy settings. The resulting 9-item version of the WATOCI was found to be a uni-dimensional tool for measuring alliance, however, demonstrated a ceiling effect. Conclusions: There are several items in the WATOCI that require re-wording and/or re-contextualization prior to its use in clinical practice. Specifically, items relating more to the element social interaction did not discriminate well in this population and one solution may be to provide a therapy-specific context. Items regarding how well the patient understood the purpose of the treatment discriminated best between patients and this area is recommended for further development in the tool’s assessment. It is recommended that future research address these issues prior to its use in clinical settings.Implications for RehabilitationChronic low back pain is defined as a condition in which pain has persisted for greater than 12 weeks. It is considered a complex condition as many forms of treatment only provide small to moderate effects for pain relief.The relationship between a patient and therapist that develops during the course of treatment has been found to influence treatment effects in various settings including for patients with chronic low back pain undergoing physiotherapy. However, current tools for assessing the patient-therapist relationship have been developed for use in psychotherapy settings, and have not been validated for use in other rehabilitation settings.In a sample of chronic low back pain, patients undergoing physiotherapy in primary care in Australia, the WATOCI, a common assessment tool of the patient-therapist relationship was used. A RASCH analysis of the WATOCI in this population revealed that many of the items were not assessing the construct and in most cases need to be re-contextualized to suit a physical-rehabilitation setting.Previous research has highlighted that the patient-therapist relationship is an important concept that appears to influence treatment effects; however, this research shows that it is proving difficult to measure this concept in clinical research and practice. Further development of this construct through focus groups and expert opinion is needed to fully assess the construct underlying the patient-therapist relationship in physical rehabilitation.

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  • A handful of studies suggest that the working alliance statistically mediates the positive effects of rehabilitative treatments in people with musculoskeletal pain.

    “A handful of studies suggest that an index of the therapeutic relationship (i.e., the working alliance) statistically mediates the positive effects of rehabilitative treatments among people with musculoskeletal pain 141–145.”

    From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [142]

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Authors
Hall, A. M., Ferreira, M. L., Clemson, L., Ferreira, P., Latimer, J., & Maher, C. G.
Affiliations
  • The George Institute for Global Health (GB)
  • The George Institute for Global Health (AU)
  • The University of Sydney (AU)
Corresponding author
Hall, Amanda Marie
ORCID
Venue
Disability and Rehabilitation
Publisher
Informa UK Limited
Published
2011-12-16
Volume
34
Issue
3
Pages
257-266
ISSN
  • 0963-8288 (ISSN-L)
  • 1464-5165
DOI
10.3109/09638288.2011.606344
OpenAlex
W2077807367
Cited by
48
References
13
Citations by year
2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 7 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 2 · 2012: 2
FWCI
1.72
Type
journal article
Language
en
Open access
closed
Locations
  • Disability and Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords
therapeutic relationship, chronic low back pain, physical rehabilitation, psychometric validation, Rasch analysis, ceiling effect, primary care physiotherapy
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Australia, Chronic Disease, Female, Humans, Male, Middle Aged, Patient Compliance, Professional-Patient Relations, Psychometrics, Surveys and Questionnaires, Reproducibility of Results, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain, Principal Component Analysis, Young Adult, Physical Therapists

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