Poor rehabilitation adherence may lead to sub-optimal treatment outcomes, reduced clinic efficiency and increased cost of care. But despite this knowledge, research indicates that attendance at physiotherapy departments is within 54%-94% and can be as low as 40%. Several studies confirm that adherence to a clinic-based exercise protocol is often around the 50% mark and may be particularly poor for unsupervised home exercise programs.
In order to develop an in-depth understanding of the factors influencing attendance (AA), in-clinic adherence (ICA) and home exercise adherence (HEA), my PhD research involved a multi-phase mixed methods study which included an initial systematic review and meta-ethnography, followed by a prospective cohort study and qualitative exploration of emerging factors through interviews with patients and reception staff and focus groups with physiotherapists and clinical managers. Finally a triangulation protocol was used to integrate and conceptualise the findings from all these stages. While a wide variety of themes were identified from over 136 different factors which were analysed, a positive therapeutic relationship emerged as the sole factor which influenced all three aspects of rehabilitation adherence (AA, ICA, HEA).
The concept of therapeutic relationship was first highlighted by Freud (1913) within the domain of mental health. He suggested that “The first aim of the treatment consists in attaching [the patient] to the treatment and the person of the physician”. Since then, therapeutic relationship and its impact on patient adherence and satisfaction have been well documented across medical literature.
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