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Background/Aims: In studies exploring the effectiveness of physical therapy treatment for painful musculoskeletal conditions, interventions appear to improve patient-reported outcomes. The interventions adopt different approaches, but there is a lack of agreement about which approach is most effective. Thus, research is needed to look at the potential influence of other variables present, such as common factors. Common factors are elements present across different treatments, which are necessary conditions for forming a therapeutic alliance and providing patient-centred care. While there is a positive relationship between common factors and patient outcomes noted in physical therapy, the mechanism through which these factors influence patient outcomes is less understood. The aim of this study was to explore participants' perceptions of the influence of common factors on physical therapy outcomes. Methods: Interviews were undertaken with seven individuals participating in physical therapy. The contextual model provided the framework to move beyond defining common factors to discussing how these elements contribute to the therapeutic changes seen in physical therapy. Results: Participants discussed how the therapeutic relationship is influenced by perceived trust and credibility, enhanced by goal setting, and individualised care. When these common factors are present, the potential for engaging in the work of physical therapy and enacting healthy behaviours and actions by patients were enhanced. Conclusions: By understanding common factors in physical therapy, a more complete view of the effects of interventions may be possible. Implications for practice: This study sheds light on the clinical impact of common factors in physical therapy, highlighting the pivotal role of therapeutic relationships built on trust, credibility, and individualized care. Recognizing and integrating these common factors into practice may enhance patient engagement and foster better therapeutic outcomes in musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

Therapeutic alliance (TA) has been positively correlated to improvements in patient outcomes. This study examined the Working Alliance Inventory (WAI) relationship with changes in disability and pain intensity for patients receiving physical therapy (PT) treatment for acute and chronic musculoskeletal pain conditions. Fifty participants were dichotomized into success or failure by the minimal clinically important difference (MCID) on region-specific patient-reported outcome measures (PROM) and Numeric Pain Rating Scale (NPRS). Regression and correlation statistics examined the relationship between WAI with change scores and quantity of PT. Independent t-tests compared WAI scores across categorical variables. WAI scores were higher for those meeting MCIDs on PROM and NPRS compared to those who did not. WAI scores were significantly correlated with improvement on region-specific outcome measures and NPRS. Regression analysis found the patient rating of the TA to be a positive predictor for improvement on regions specific outcome measures and NPRS. Patients who rated the TA higher were more likely to meet the MCID for region-specific disability and pain intensity. Patient ratings of the TA were associated with improved change scores on pain rating and standardized outcome measures during a course of treatment for musculoskeletal pain conditions. Patients' early rating of the therapeutic alliance (TA) is associated with improvements seen on pain and functional outcomes. Physical therapists should assess the TA and use strategies to enhance the alliance to optimize patient's experiences with physical therapy. [ABSTRACT FROM AUTHOR]

Multiple disease-specific systematic reviews on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive. To date, there have been two systematic reviews that examined manual therapy specifically but both considered effects within diagnoses. The purpose of this systematic review was to identify the effectiveness of manual therapy to the glenohumeral joint across all painful shoulder conditions. A search of MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Randomized Controlled Trials for articles dated 1996 to June 2009 was performed. Inclusion for review were manual therapy performed to the glenohumeral joint only; non-surgical painful shoulder disorders; subjects 18-80 years; and outcomes of range of motion, pain, function, and/or quality of life. Quality assessment was performed using the PEDro scale with subsequent data extraction. Seventeen related articles were found with seven fitting the inclusion criteria. The average PEDro score was 7.86, meeting the cutoff score for high quality. Significant heterogeneity in outcome measures prohibited meta-analysis. Five studies demonstrated benefits utilizing manual therapy for mobility, and four demonstrated a trend towards decreasing pain values. Functional outcomes and quality-of-life measures varied greatly among all studies. Manual therapy appears to increase either active or passive mobility of the shoulder. A trend was found favoring manual therapy for decreasing pain, but the effect on function and quality of life remains inconclusive. Future research utilizing consistent outcome measurements is necessary. [ABSTRACT FROM AUTHOR]

Clinical empathy has been studied in a number of health-care disciplines suggesting that higher practitioner empathy leads to improved patient health and wellness and improved patient outcomes. While some aspects of the physical therapist-patient relationship have been described, evidence of quantitative assessment of clinical empathy in physical therapists is scarce. To investigate the level of self-reported clinical empathy in physical therapists and its relationship to practice environment and workplace engagement, the Jefferson Scale of Empathy-Health Provider version (JSE-HP) and the Oldenburg Burnout Inventory (OLBI) were used. Study participants were 123 physical therapists working full time at either an acute care setting, a rehabilitation hospital, or an outpatient clinic. These physical therapists demonstrated a mean JSE-HP score of 118.5 (9.1) and a mean OLBI score of 15.63 (3.5). This mean empathy score was found to be higher than reported empathy level of some health disciplines such as nursing and pharmacy yet lower than others such as mental health workers, psychiatrists, and pediatricians. Practice setting was not found to be a significant factor regarding empathy levels in physical therapists. As reported in previous studies, there was a positive correlation between being female and having higher empathy levels. A positive correlation was found between age and work disengagement. Finally, our hypothesis regarding a negative correlation between empathy and work disengagement was confirmed, suggesting that workplace disengagement may diminish a physical therapist's empathy, which may then negatively affect patient clinical outcomes. [ABSTRACT FROM AUTHOR]