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Patient- and Physical Therapist–Level Predictors of Patient-Reported Therapeutic Alliance: An Observational, Exploratory Study of Cohorts With Knee and Low Back Pain

      Highlights

      • Patient- and physical therapist–level factors predicted patient-reported therapeutic alliance.
      • Patient-reported therapeutic alliance can be influenced modifiable physical therapist factors (ie, physical therapist attitudes, beliefs, and self-efficacy).
      • These relationships may vary based on musculoskeletal pain condition.

      Abstract

      Objective

      To identify patient- and physical therapist–level predictors for therapeutic alliance at the end of an episode of physical therapy for knee or low back pain (LBP).

      Design

      Secondary analysis of observational cohort.

      Setting

      Outpatient physical therapy clinics.

      Participants

      Patients receiving physical therapy for knee (n=189) or LBP (n=252) and physical therapists (n=19). Candidate predictor variables included demographics, patient clinical characteristics, and physical therapist attitudes and beliefs (Pain Attitudes and Beliefs Scale for Physical Therapists) and confidence in providing patient-centered care (Self-Efficacy in Patient-Centeredness Questionnaire).

      Interventions

      Not applicable.

      Main Outcome Measures

      Patient-reported therapeutic alliance was measured using the 12-item Work Alliance Inventory–Short Revised (WAI-SR).

      Results

      Final linear mixed models indicated different patient- and physical therapist–level factor contributions in predicting final WAI-SR scores across cohorts with knee and LBP. Female sex was a consistent patient-level predictor for both knee (estimated β=1.57, P<.05) and LBP (β=1.42, P<.05), with age (β=−0.07, P<.01) and baseline function (β=0.06, P<.01) contributing to cohorts with knee and LBP, respectively. Physical therapist–level predictors included female sex (β=6.04, P<.05), Pain Attitudes and Beliefs Scale for Physiotherapists behavioral (β=0.65, P<.01), and Self-Efficacy in Patient-Centeredness Questionnaire (SEPCQ) Exploring Patient Perspective (β=−0.75, P<.01) subscale scores for LBP, with SEPCQ Sharing Information and Power subscale scores (β=0.56, P<.05) contributing to both cohorts with knee (β=0.56, P<.05) and LBP (β=0.74, P<.01). Random effects for patients nested within physical therapists were observed for both cohorts.

      Conclusions

      These findings provide preliminary evidence for inconsistent relationships among patient- and physical therapist–level factors and therapeutic alliance across cohorts with knee and LBP.

      Keywords

      List of abbreviations:

      CAT (computerized adaptive test), ICC (intraclass correlation coefficient), LBP (low back pain), LCAT (lumbar computerized adaptive test), PABS-PT (Pain Attitudes and Beliefs Scale for Physiotherapists), SEPCQ (Self-Efficacy in Patient-Centeredness Questionnaire), TA (therapeutic alliance), WAI-SR (Work Alliance Inventory–Short Revised)
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