title: Predictors and impact of the working alliance in the neuropsychological rehabilitation of patients with multiple sclerosis.
abstract: BACKGROUND
  There is preliminary evidence of positive effects of neuropsychological rehabilitation in multiple sclerosis (MS). However, whether a working alliance affects rehabilitation outcome has not been studied.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effects of the baseline patient-related (cognitive, mood and fatigue symptoms, cognitive status, demographic factors) and illness-related factors (duration and severity of the disease) on the alliance, as well as the effects of the alliance on rehabilitation outcome in neuropsychological rehabilitation among MS patients.
  
  
  METHODS
  Fifty-six patients with relapsing-remitting MS received multimodal neuropsychological intervention (attention retraining, learning strategies, psychoeducation, psychological support, homework assignments) conducted once a week in 60-minute sessions for thirteen consecutive weeks. After the intervention, both patients and therapists evaluated the alliance with the short form of the Working Alliance Inventory.
  
  
  RESULTS
  None of the baseline factors was related to the alliance. Better patient-evaluated alliance was associated with a more prominent decrease in fatigue symptoms and greater achievement of rehabilitation goals. Better therapist-evaluated alliance was associated with greater benefit from the intervention as evaluated by therapists.
  
  
  CONCLUSIONS
  A positive patient-therapist alliance may relate to positive neuropsychological rehabilitation outcome in MS.
authors.affiliation: Tampere University Hospital, Department of Neurology and Rehabilitation, PO Box 2000, 33521 Tampere, Finland. Electronic address: eija.rosti-otajarvi@pshp.fi.
authors.forename: Eija
authors.initials: E
authors.lastname: Rosti-Otajärvi
authors.affiliation: Seinäjoki Central Hospital, Department of Neurology, Hanneksenrinne 7, 60220 Seinäjoki, Finland.
authors.forename: Anu
authors.initials: A
authors.lastname: Mäntynen
authors.affiliation: Seinäjoki Central Hospital, Department of Neurology, Hanneksenrinne 7, 60220 Seinäjoki, Finland.
authors.forename: Keijo
authors.initials: K
authors.lastname: Koivisto
authors.affiliation: Tampere University, School of Health Sciences, 33014 Tampere, University Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Masku Neurological Rehabilitation Centre, PO Box 15, 21251 Masku, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Hämäläinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology; D055815:Young Adult
keywords: Alliance; MS; Multiple sclerosis; Neuropsychological rehabilitation; Outcome; Working alliance