Expanding physiotherapy practice in remote rehabilitation: a qualitative study of therapeutic alliance in a transdisciplinary concussion intervention

Background Persistent post-concussion symptoms (PPCS) affect up to one-third of individuals after concussion and can substantially impact daily life, participation, and wellbeing. Telehealth is increasingly used to support rehabilitation, but concerns have been raised that remote formats may compromise the therapeutic alliance (TA), a recognised component of effective physiotherapy.Methods A qualitative phenomenological–hermeneutic design explored TA in a remotely delivered transdisciplinary concussion programme. Five adults with PPCS receiving the programme completed individual semi-structured interviews. A physiotherapist and an occupational therapist delivering the programme subsequently completed a dyadic interview. Data were analysed using systematic text condensation.Results Both participants and therapists reported that a strong TA could be established remotely. Individualised support, collaborative planning, empathic communication, and validation of personal circumstances were central to fostering trust and engagement. The flexibility of remote delivery was valued for reducing travel demands and enabling sessions to be adapted to individual needs. Challenges included aligning expectations, the absence of nonverbal cues, and the limited programme duration, which shaped how TA could develop over time.Conclusion Remote rehabilitation can support a robust TA when therapists employ advanced communication skills, manage expectations, and adapt delivery to participants’ circumstances, offering a feasible and patient-centred model of physiotherapy care.Trial Registration URL: ClinicalTrials.gov Identifier: NCT05233475. Registered on 10 of February 2022.