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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 17, 2021
Accepted:
May 24,
2021
Received in revised form:
May 21,
2021
Received:
April 15,
2021
Footnotes
Disclosures: Julie Fritz has a financial relationship with Focus on Therapeutic Outcomes (FOTO) Inc outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
