Validity of the Flemish working alliance inventory in a Dutch physiotherapy setting in patients with shoulder pain

Yasmaine Karel, Marloes Thoomes-de Graaf, Gwendolijne Scholten-Peeters, Paulo H Ferreira, Dimitris Rizopoulos, Bart W Koes, Arianne P Verhagen

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BACKGROUND: Working alliance is the interaction between the patient and therapist. It is a crucial part of the physiotherapeutic process. One instrument to measure working alliance is available in Dutch/Flemish language and validated in psychotherapy setting.

OBJECTIVE: This study aims to validate the Working Alliance Inventory Short-Form in a Dutch physiotherapy setting.

DESIGN: A prospective cohort study in primary-care physiotherapy.

METHOD: To validate the Dutch/Flemish version of the working alliance inventory short-form (WAV-12) a RASCH analysis was used.

RESULTS: Sixty-six physiotherapists enrolled in total 389 patients with an average age of 50 years and a mean duration of shoulder pain of 33 weeks. A total of 274 patients filled in one or more items of the WAV-12. The WAV-12 showes good discriminative abilities and all items contributed to a one-dimensional construct. Due to the selective nature of the missing items, we believed rewording was necessary to make it more suitable to the physiotherapy setting. We performed a Delphi study and revised the WAV-12 into the PAS (Physio Alliance Scale). The validity of the revised version is unknown and is therefore not sufficiently strong to be implemented as a measurement tool.

LIMITATIONS: The response rate for three items especially was low and we found ceiling effects in ten items.

CONCLUSION: Although the measurement instrument shows good internal consistency and reliability, we made adjustments to the WAV-12 for Dutch physiotherapy setting.

Original languageEnglish
Pages (from-to)384-392
Number of pages9
JournalPhysiotherapy, Theory and Practice
Issue number5
Early online date9 Nov 2017
Publication statusPublished - 4 May 2018


FundersFunder number
Dutch Arthritis Association


    • Journal Article
    • Shoulder Pain
    • Physiotherapy
    • therapeutic alliance
    • WAV-12
    • physician-patient relations
    • physiotherapy
    • rasch analysis
    • Working alliance


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