Hip fractures represent a global public health issue that demands high cost both from the patient and from the society. Functional exercise in the subacute phase of a hip fracture is essential in reducing these costs. To the best of our knowledge, no qualitative study has explored the patients’ experiences in participating in an exercise program during the first month after surgery. Thus, this study aims to explore how older people who had participated in an evidence-based exercise intervention describe their relationship with their therapists and how this relationship might contribute to their motivation for exercise. Thirteen women and six men, who all had experienced a hip fracture and were staying in the same short-term rehabilitation unit, were interviewed by the last author. The interviews lasted from 30 to 70 min. The participants’ mean age was 86 years and they had all participated in a High Intensity Functional Exercise (HIFE) program in one-on-one sessions for 2 weeks, a total of 10 sessions. The recruitment was done by therapists involved in an RCT evaluating the HIFE-program with the attempt to obtain maximum variation. Data were analyzed through systematic text condensation in collaboration between all authors. The analysis yielded three main themes integrated in the core theme “Therapeutic alliance is an interpretative filter for the participants’ experiences.” The three themes were “The feeling of mutuality and respect in the alliance”; “A trusting and motivating relationship” and “Tailoring of the instruction and program to make the task understandable”. These themes concerned basic needs in the relationship between the participants and the therapists which brought forward a feeling of mutual respect. The most prominent finding was the experience of trust in the therapists’ abilities, and how this contributed to the participants’ motivation to fulfil the program and achieve meaningful changes. Our findings suggest that therapeutic alliance is an indispensable aspect of a therapy, and relational knowledge and competence are prerequisites in the transfer of professional knowledge in a therapy. Our findings can be useful to therapists involved in clinical practice, especially to those working with vulnerable groups.

中文翻译：

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良好的治疗联盟对于在髋部骨折亚急性期的一群年长的挪威人中促进运动动机的重要性；定性研究

髋部骨折代表了全球性的公共卫生问题，需要患者和社会付出高昂的代价。髋部骨折亚急性期的功能锻炼对于降低这些成本至关重要。据我们所知，尚无定性研究探讨患者在术后第一个月参加运动计划的经历。因此，本研究旨在探讨参加循证运动干预的老年人如何描述他们与治疗师的关系以及这种关系如何有助于他们的运动动机。最后一位作者采访了十三名妇女和六名男子，他们均经历了髋部骨折并留在同一短期康复室。采访持续了30到70分钟。参与者的平均年龄为86岁，他们都以一对一的形式参加了高强度功能锻炼（HIFE）计划，为期2周，共10场。招募工作由参与RCT的治疗师对HIFE计划进行评估，以期获得最大的差异。所有作者之间通过系统的文本压缩对数据进行了分析。分析得出了与核心主题“治疗联盟是参与者体验的解释性过滤器”相结合的三个主要主题。三个主题是“联盟中的相互尊重感”；“信任和激励的关系”和“定制指令和程序以使任务易于理解”。这些主题涉及参与者与治疗师之间关系中的基本需求，这带来了相互尊重的感觉。最突出的发现是对治疗师能力的信任经验，以及这如何有助于参与者实现计划并实现有意义的改变的动力。我们的发现表明，治疗联盟是治疗必不可少的方面，而相关知识和能力是治疗中专业知识转移的先决条件。我们的发现对参与临床实践的治疗师特别是与弱势群体合作的治疗师可能有用。以及这如何有助于参与者实现计划并实现有意义的改变的动力。我们的发现表明，治疗联盟是治疗必不可少的方面，而相关知识和能力是治疗中专业知识转移的先决条件。我们的发现对参与临床实践的治疗师特别是与弱势群体合作的治疗师可能有用。以及这如何有助于参与者实现计划并实现有意义的改变的动力。我们的发现表明，治疗联盟是治疗必不可少的方面，而相关知识和能力是治疗中专业知识转移的先决条件。我们的发现对参与临床实践的治疗师特别是与弱势群体合作的治疗师可能有用。