Musculoskeletal Faculty Beliefs about the Therapeutic Relationship

Abstract

Introduction. Contextual factors like the therapeutic relationship (TR) are shown influence patient outcomes, sometimes more so than specific physical therapy interventions when treating musculoskeletal (MSK) pain. However, physical therapists are often unaware or lack the skills to develop a TR. This lack of competence appears partly from inadequate entry-level education training. Considering that teacher beliefs play a substantial role in what and how content is taught, having an awareness of these beliefs may provide a deeper understanding of this problem. Fourteen MSK faculty from different physical therapy programs with varying levels of teaching and clinical experience. This basic qualitative design explored physical therapy MSK faculty's beliefs regarding TR using semi-structured interviews. Inductive thematic analysis focused codes and categories into themes. Emergent themes helped answer the study's research questions. Participants' perceptions of the TR were more detailed than others, but all fell within the confines of the conceptual framework. All believed that therapists needed to be intentional in developing a TR and should be considered a top priority when treating patients with MSK pain. All participants integrated the TR into the MSK curriculum at varying levels. Participants' understanding of pain science and the perceived importance of contextual factors like the TR led to an evolution in their curriculum. Participants reported decreasing the emphasis on specific factors while increasing the emphasis on the TR. Participants reported replacing specific factor content with teaching activities for the TR. These changes appear to be an appropriate response to what the evidence suggests about the TR’s impact on MSK pain. However, it is uncertain whether these changes are mainstream or sufficient to improve physical therapists' abilities in this domain.