2025/07/21 by Lauren Lucas, Sarah Peters, Sarah Cotterill +1 · 1 voice
Health Professions · Medicine · #Diabetes Management and Education #Mental Health and Patient Involvement #Stroke Rehabilitation and Recovery
paper · doi:10.1177/02692155251358457
openalex publication_date 2025/07/21 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/02
Objective To understand healthcare professionals’ experiences of developing therapeutic alliances (working relationships) with stroke survivors, and their views on how alliance relates to self-management in community settings. Design Qualitative study. Setting Community. Participants Healthcare professionals recruited purposively from four National Health Service community stroke teams in England. Main measures Semi-structured, one-to-one qualitative interviews, transcribed verbatim and analysed using Braun and Clarke's reflexive thematic analysis. Results Nineteen clinicians (six physiotherapists, four occupational therapists, two speech and language therapists, two nurses, one psychologist and four people in assistant/trainee roles) were included in the study. Three main themes were developed from the data. (1) The team can’t come forever : alliances were shaped by the time-limited nature of community rehabilitation and relied on trust, buy-in, and clearly defined roles and expectations. (2) Therapeutic alliances help and hinder : whilst alliances supported motivation and engagement, complicated power dynamics sometimes undermined self-management. (3) Confusion about what self-management is : participants often equated self-management with self-directed rehabilitation and described a lack of clarity, confidence and training in supporting emotional and long-term adjustment needs. Strong alliances were viewed as essential for self-management, but formal support strategies were rarely used. Conclusions Community-based healthcare professionals consider therapeutic alliance to be the foundation for stroke self-management in the community. However, a limited understanding of self-management among clinicians, combined with unbalanced power dynamics, may restrict patient autonomy. Relationship-based training (e.g. Bridges) and the development of self-management champion roles within organisations may enhance clinicians’ confidence and consistency in delivering self-management support in the community.