Therapeutic alliances in stroke rehabilitation: A meta-ethnography (2025)

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Influence of the Therapeutic Alliance on the Rehabilitation of Stroke: A Systematic Review of Qualitative Studies

Juan Antonio Armenta Peinado

Journal of Clinical Medicine

The therapeutic alliance is a fundamental component of rehabilitation in order to achieve effective outcomes. However, what develops, maintains or hinders this relationship has not been sufficiently explored. The aim of this systematic review is to recognize the role of the therapeutic alliance in the neurological rehabilitation process. A search for articles was carried out in the databases PubMed, Web of Science, SCOPUS, CINAHL, APA PsycInfo, OTseeker and Dialnet. They were selected according to the eligibility criteria. Internal quality assessment of the articles was measured with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The systematic review was registered in PROSPERO (ID 346523). The search in the databases identified 1596 articles, from which 9 different studies were finally included in the systematic review, reflecting the limitations of studies in this field. All studies are qualitative, from the point of view of the patients themselves, their re...

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Intersection of the elements of evidence-based practice in interdisciplinary stroke rehabilitation: A qualitative study

Catherine Vingerhoets

New Zealand Journal of Physiotherapy, 2020

Evidence-based practice (EBP) is a foundational approach to clinical decision-making that integrates scientific research; clinical expertise; and patient preferences, values and circumstances. The purpose of this study was to explore the intersection of the three elements of EBP among an interdisciplinary stroke rehabilitation team. An exploratory qualitative descriptive design was used to examine the intersection of elements through a focus group with the allied health members of an interdisciplinary stroke rehabilitation team. Thematic analysis was applied to the data. Three main themes were developed: the patient as the driver, EBP as a fluid process, and EBP as a collaborative team process. While all three elements intersected during care planning, patient preferences, values, and circumstances were the dominant influence in decision-making. EBP was a dynamic process changing over time and context. Collaboration with the patient and between health professionals was an integral p...

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The perspectives of allied health clinicians on the working alliance with people with stroke-related communication impairment

Jacinta Douglas

Neuropsychological Rehabilitation, 2020

The processes by which working alliances develop in stroke rehabilitation are not well understood. The aim of this study was to explore the ways in which experienced allied health clinicians establish and maintain alliances with people with stroke-related communication impairment, and to identify factors that may influence the strength of these alliances. In-depth interviews were completed with 11 clinicians from the disciplines of occupational therapy, speech-language pathology and physiotherapy. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory. Participants described processes that were captured by the themes of enabling interaction, being responsive, building relational capital and building credibility. Practices that supported communication and emphasized responding, both within an interaction and over time, aligned with examples of strong alliances. Professional credibility and relational practices such as everyday conversations and the use of humour were viewed as important. Difficulty accessing a shared mode of communication due to stroke-related communication impairment altered relational processes and influenced perceptions of the alliance, although examples of strong alliances were present. In this study, reflections on challenging alliances highlighted potentially helpful practices. A responsive approach to rehabilitation, supported by reflective practice, may assist clinicians to better navigate their working alliances with this population.

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Addressing inactivity after stroke: The Collaborative Rehabilitation in Acute Stroke (CREATE) study

Stephanie Honey

International Journal of Stroke, 2020

Background Stroke patients are often inactive outside of structured therapy sessions – an enduring international challenge despite large scale organizational changes, national guidelines and performance targets. We examined whether experienced-based co-design (EBCD) – an improvement methodology – could address inactivity in stroke units. Aims To evaluate the feasibility and impact of patients, carers, and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles. Methods Mixed-methods case comparison in four stroke units in England. Results Interviews were held with 156 patients, staff, and carers in total; ethnographic observations for 364 hours, behavioral mapping of 68 patients, and self-report surveys from 179 patients, pre- and post-implementation of EBCD improvement cycles. Three priority areas emerged: (1) ‘Space’ (environment); (2) ‘Activity oppor...

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Three different points of view in stroke rehabilitation: patient, caregiver, and physiotherapist

Nezehat UNLUER

Topics in stroke rehabilitation, 2015

The similarities or differences of the threesome (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation. The aim of this qualitative study was to investigate the perspectives of the threesome, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you? The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices. One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physi...

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Therapeutic alliance in post-acute brain injury rehabilitation: Predictors of strength of alliance and impact of alliance on outcome

Mark Sherer

Brain Injury, 2007

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Stroke Rehabilitation A Collaborative Approach

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sj-pdf-3-cre-10.1177_02692155211012324 – Supplemental material for Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

Dayna Halls

2021

Supplemental material, sj-pdf-3-cre-10.1177_02692155211012324 for Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies by Dayna Halls, Carolyn Murray and Ben Sellar in Clinical Rehabilitation

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sj-pdf-2-cre-10.1177_02692155211012324 – Supplemental material for Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

Dayna Halls

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Supplemental material, sj-pdf-2-cre-10.1177_02692155211012324 for Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies by Dayna Halls, Carolyn Murray and Ben Sellar in Clinical Rehabilitation

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sj-pdf-1-cre-10.1177_02692155211012324 – Supplemental material for Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

Dayna Halls

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Supplemental material, sj-pdf-1-cre-10.1177_02692155211012324 for Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies by Dayna Halls, Carolyn Murray and Ben Sellar in Clinical Rehabilitation

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Therapeutic alliances in stroke rehabilitation: A meta-ethnography (2025)

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