Scientific title:
Understanding therapeutic alliance in the context of supported self-management in community stroke services
University of Manchester
Principal investigator:
Ms Lauren Lucas
Grant value:
Research ID:
SA PGF 21\100008
Research area:
Start date:
Saturday 1 January 2022
End date:
Wednesday 1 January 2025
3 years
Year awarded:

Why is this research needed?

Recovery after stroke is tough, but with the right specialist support and a ton of courage and determination, the brain can adapt. The impact of stroke varies depending on which part of the brain is affected. Almost 75% of stroke patients require physiotherapy at home and survivors may need support for many years after in order to live the best life they can.  
The relationship between a therapist and patient is thought to be important. However, very little is known about how this relationship impacts recovery with the physical effects of stroke in the long term. There isn’t any research that has asked stroke survivors what they think about the importance of the relationship in relation to their long-term stroke self-management.  

This research is the first step to understand if new guidelines, training, tools and treatments should focus on this aspect of care to improve recovery after stroke.

What is this research aiming to do?

Lauren aims to understand if the quality of the relationship between physiotherapists and stroke survivors should be a focus in stroke care at home. Her research will also identify the most important aspects of the relationship that could improve recovery and life after stroke in the long term.  

Martin, a stroke survivor said: “Physiotherapy was crucial in my recovery and it’s crucial that stroke survivors stay positive and determined to do the work with professional as well as between appointments and on their own. This research all about relationships goes into finding a way to do this.”

How will the research do this?

Lauren will research the importance of the relationship between physiotherapists and stroke survivors receiving therapy at home in a number of different ways to gather the best results.  

Firstly, she will review existing research to understand what is currently known about the quality of the relationship between therapist and patient on their ability to manage health conditions for the long term. As there is so little research in stroke, Lauren will look at research in different long-term health conditions too, where knowledge could be relevant to stroke.  

Lauren will then ask up to 75 stroke survivors that have had support from a physiotherapist at home about their thoughts and experiences. This will find out how important the relationship is, how relationships may change the stroke survivors ability to manage the effects of stroke, and the most important parts of the relationship.  

Lauren will work with people affected by stroke in her research, including developing and testing questionnaires, and planning how she will reach out to stroke survivors to take part. 

What is the benefit of this research?

This research will understand the role of the relationship between therapist and stroke survivor for long-term recovery. This can lead to better guidelines, training, tools and support for both therapists and stroke survivors to improve long-term recovery.

Lauren said: “I have been a physiotherapist for over 10 years, but until I worked in research, I paid little attention to the value of the working relationships I built with my patients.  

I’ve always been aware that I developed better relationships with some patients than others and that this often improved treatment outcomes. But right now, therapists like myself, don’t know how our interactions might support longer-term stroke recovery and self-management. I hope that my research can change this so that all therapist and patient relationships can be supportive for stroke recovery.”

Meet the researcher

Lauren is an experienced physiotherapist that has worked in a community stroke and neurological rehabilitation team in Salford. 

In 2020, she was awarded a pre-doctoral clinical academic fellowship funded by the National Institute for Health Research, the largest public funder of health research in the UK, which set her on the track to secure this fellowship.  

At the University of Manchester, Lauren works in a multidisciplinary stroke research group combining knowledge across pre-clinical and clinical research at all stages of stroke care. 

While working as a researcher full-time, she will explore options to work as a physiotherapist to maintain her professional registrations, and links with stroke survivors and care professionals. 

Lauren said: “My interest in the relationship between therapists and patients has been shaped through my experience as a physiotherapist and researcher, leading me to pursue this Stroke Association fellowship. I’ve worked with people affected by stroke in the UK and in New Zealand. I’m excited that this funding can support my ambition to build a career in research to improve long-term stroke rehabilitation.”

Research terms and definitions

These terms are often used in research like Lauren’s to describe aspects of stroke care and recovery.  

Therapeutic alliance. This is a collaborative and affective bond between therapist and patient.  

Patient activation. This describes a patient’s behaviours that relate to their understanding of, and actions to fulfil, their role in managing their health.  

Supported self-management. This is a type of care for people living with long-term conditions that enables them to manage their health and well-being on a day-to-day basis.