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

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 relatives and healthcare professionals. The total sample of the included studies is 182 participants (96 health professionals, 76 users and 10 relatives). Semi-structured interviews, focus group discussions and written reflections were mainly used to collect the data. In conclusion, the therapeutic alliance can be an active component in the post-stroke rehabilitation process. Being recognized as a person, collaboration with the therapeutic team, empathy, empowerment, confidence, professional skills, maintenance of hope and the role of the family have been identified as aspects that can have an influence on the therapeutic alliance.