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Differences between patient- and therapist-rated working alliance and their relationships with physical rehabilitation outcomes in individuals with Parkinson's disease

  • 1Department of Rehabilitation, JA Nagano Kouseiren Kakeyu-Misatyama Rehabilitation Center Kakeyu Hospital, Ueda, Japan.
  • 2Department of Fundamental Physical Therapy, School of Medicine, Shinshu University, Matsumoto, Japan.
  • 3Department of Rehabilitation, JA Nagano Kouseiren Asama Nanroku Komoro Medical Center, Komoro, Japan.
  • 4Department of Neurology, JA Nagano Kouseiren Kakeyu-Misatyama Rehabilitation Center Kakeyu Hospital, Ueda, Japan.
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June 9, 2025

Abstract

Introduction

Working Alliance (WA) significantly influences therapeutic success in psychotherapy or rehabilitation for musculoskeletal problems. The perception of WA often differs between patients and therapists. However, little is known about WA in patients with Parkinson's disease (PD) and its relationship with clinical outcomes following physical rehabilitation. This study aimed to examine the differences in WA between patients and physical therapists in the early phase of a physical rehabilitation program and explore their relationships with improvements in gait-related assessments.

Methods

Twenty-one patients with PD who participated in the Lee Silverman Voice Treatment BIG program were included. Gait-related assessments, which included gait speed at 10-meter walking test (10-MWT) and timed up & go, were conducted before and after the program. WA was assessed using Working Alliance Inventory (WAI) for both patients and therapists after the completion of the fifth session. The difference between patient- and therapist-rated WAI was analyzed using an unpaired t-test. Correlational analyses between both patient- and therapist-rated WAI scores and improvement rates in gait-related assessments were also performed.

Results

Patients rated WAI scores significantly higher than therapists. Only patient-rated WAI scores were correlated with improvement rates in gait speed on 10-MWT, while therapist-rated WAI showed no significant correlation.

Conclusion

The results suggest patients with PD perceived WA higher than therapists in the early phase of rehabilitation, and patients' perceptions may influence functional improvements in rehabilitation.