Human technologies in rehabilitation: 'Who' and 'How' we are with our clients.

PURPOSE: It is often observed that different rehabilitation practitioners carrying out the same intervention can have a quite different impact on outcome. The relationship or connection between the practitioner and patient, referred to here as the therapeutic alliance (TA), is receiving growing attention as potentially contributing to the disparate response to treatment observed. In this paper, we discuss what we currently know about the TA in rehabilitation and its impact on engagement (and what do we not know) and consider the ramifications of not knowing. KEY MESSAGES: The TA is increasingly identified as an important determinant of engagement in, and health outcome following, rehabilitation. However, research identifying its core components is limited, with very little exploring howpractitioners might develop a more positive TA with patients. Further, what we do know/understand is limited by inadequate measurement tools. Research aiming to better understand the key ingredients of the TA that contribute to outcome and its role in rehabilitation is urgently required.
CONCLUSIONS: Arguably, if we fail to advance knowledge in this field and seek answers to some of the questions we have raised, we may fail to tap into the true potential of the TA as a covariate of rehabilitation outcome.