The therapeutic relationship in remote support for self management of chronic dizziness

Abstract

Telephone-delivered therapy is often used to deliver support as it can help overcome barriers that may previously have prevented patients with chronic illness from accessing key services. Very little research has looked at the therapeutic relationship during telephone support for people self-managing a chronic illness. the empirical work in this thesis is nested within a randomised controlled trial (RCT) of self-management of chronic dizziness, a condition that can be debilitating with serious consequences. This thesis explored the role of the therapeutic relationship during telephone support for using booklet-based vestibular rehabilitation (VR) to self-manage chronic dizziness.

A meta-analysis of telephone delivered therapy for chronic illness was conducted to examine whether or not telephone therapy can affect physical health outcomes. Eight RCTs (1093 patients) were included, and the results found that telephone delivered therapy significantly improved physical health outcomes in people with chronic illness (d = 0.225, 95% Cl = 0.105, 0.344). A qualitative study of people's experiences of self-managing chronic dizziness using booklet-based VR with or without telephone support (n=33) identified themes characterising people's experiences, thoughts and feelings about these models of VR delivery. Findings indicated that participants valued telephone support. Quantitative analysis examining predicators of outcome (n=112) found that the therapeutic relationship predicted change in handicap, and was related to greater enablement, although it was not related to change in dizziness symptoms. A final mixed methods study aimed to evaluate the development of the therapeutic relationship using Roter Interaction Analysis System to examine recorded therapy sessions. This study found patient centredness during therapy to be related to the therapeutic relationship. Exploratory analyses identified specific features of patient-centredness that may be related to better and worse alliance. A qualitative analysis of high and low patient centred therapy sessions found that high patient centredness sessions were more likely to include general chat, encouragement, reassurance, and therapists were more responsive to participant cues. Low patient centred sessions were more likely to include participant concerns and therapists not responding to participant cues.

This thesis identified a number of potential elements of telephone support that may be important for the development of the therapeutic relationship in patients self-managing dizziness.

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Identifiers

ORCID for Ingrid Muller: orcid.org/0000-0001-9341-6133

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

ORCID for Sarah Kirby: orcid.org/0000-0003-1759-1356

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