Characteristics and Specific Aspects of the Therapeutic Alliance in Physiotherapy Care: A Qualitative Study in France.

Abstract

Background and purpose Therapeutic alliance (TA) refers to mutuality and congruence concerning the bonds, goals, and tasks shared between the physiotherapist and patient. It relies on positive connections through partnership, communication, empathy, and mutual respect. TA is recognized as a central factor in the success of rehabilitation; however, most research remains rooted in psychological frameworks. In physiotherapy, the use of touch or physical activity creates unique relational dynamics that have not been studied in the French healthcare context. Thus, this study aims to identify and describe the characteristics of the TA in French physiotherapy. Methods A qualitative interpretive description design was chosen for its flexible, practice-oriented approach suitable for exploring complex clinical phenomena. Inductive analysis allowed themes to emerge from participants' experiences without a preconceived framework. Individual semi-structured interviews were conducted with private practice musculoskeletal physiotherapists and rehabilitation patients. Interview transcripts were analyzed using inductive thematic analysis to identify key themes. Rigor was enhanced through reflexive journaling, peer debriefing, and an audit trail. Results Thirteen interviews were completed. Three main themes were identified-"foster trust," "find meaning and collaborate," and "weigh going the extra mile and boundaries"-all encompassed by an overarching theme of creating a climate of safety. In addition to common TA qualities, physiotherapy-specific factors emerged: centrality of the body in care, frequent appointments, informal interactions, and social support. French contextual factors were also noted, such as extended patient contact time and the physician's influential role. Discussion The resulting framework supports reflection on relational practices and deepens understanding of the TA in physiotherapy in relation to other disciplines such as psychotherapy or cultural contexts.