Are Your Health Care Providers Helping You Be As Healthy As You Can Be?

The leading cause of morbidity and mortality in the United States is chronic disease.  Heart disease, stroke, cancer, diabetes and lung disease are chronic diseases which can be caused by a person’s lifestyle.  Behaviors like physical inactivity, unhealthy diet and tobacco use are all associated with chronic diseases.  These diseases are preventable.   However, the medical system in the United States is more prone to treating these illnesses after they’ve occurred.  Ideally, health care providers should look towards prevention first.  The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have labeled lifestyle diseases an epidemic.  In response to the epidemic, health care providers are stepping up to the plate to take the first step towards lifestyle disease prevention.

Health: How a Physical Therapist can Help

Physical therapists are the most ideal providers to promote health and wellness in their patients.  A patient may see their physician only periodically for well visits or for the occasional illness.  When a patient attends physical therapy they typically spend an hour with their therapist 2-3 times per week for several weeks.  It is easy to build a strong patient-provider relationship this way.  Physical therapists are well positioned to have dificult lifestyle choice conversations with their patients and establish a system to monitor accountability.

Did you know that physical therapists have basic knowledge and skills to promote health and wellness in five important areas?  Physical therapists can screen for and identify problems with:

  • Physical inactivity
  • Nutrition and weight management
  • Smoking
  • Sleep
  • Stress

Physical therapy patients may be surprised to learn that it is possible their unhealthy behaviors or habits contributed to the pain or injury for which they were seeking physical therapy.  Physical therapy can reduce or eliminate pain.  If patients continue previous behaviors such as poor diet or sedentary lifestyle and do not incorporate some exercise or physical activity into their life it is likely the pain will return.  Sleep and stress also play a vital role in healing and recovery and should be addressed if problematic.

Take Action

Physical therapists are equipped with tips, tricks and resources to help their patients in the areas above.  They can provide education, help with accountability, motivation and support.  If you have a trusting relationship with your physical therapist they can be there to help reinforce your healthy habits along the way.  Ask yourself “Do I engage in health promoting activities?”.  If the answer is “no”, then your physical therapist can be your guide and your way to get started, just ask.


  1. Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys Ther. 2015;95:1433-1444
  2. World Health Organization.  Global action plan for the prevention and control of NCDs 2013-2020.  Available at:

Self-Management of Pain: Your Physical Therapist as a Guide

Too many medical approaches in today’s society are dependent on others (therapists, doctors, etc) and include passive treatments (medications, injections, etc.).  It can be empowering to take control of your own health and seek active forms of treatment for conditions such as low back pain, arthritis, or even every day sprains and strains.  Self-management allows you to develop a sense of control over your problem and offer you tools to use for a lifetime.  However, many are unsure where to start.

Therapeutic Alliance and Self-Management of Pain

In order to optimize self-management for any painful condition, a meaningful working relationship, or therapeutic alliance, in which the patient and provider work together, should be established.  This begins by developing a patient-preferred approach to treatment.  If you prefer to exercise aerobically then you should not be forced to perform lumbar stabilization exercises for your back pain.  If you enjoy strength training in the gym you should not be prescribed aerobic exercise for your knee pain.  Exercise you enjoy is medicine for the body and mind.  Both forms of exercise have been shown to be beneficial for managing back pain.  Let’s choose together what you prefer.

Developing a positive therapeutic alliance with your physical therapist also allows for the careful monitoring of progress over time.  There are going to ups and downs along the way.  Your physical therapist can help pick you up during challenging times.  Your physical therapist can also progress your plan appropriately when things are going well.  A physical therapist can work as a coach offering constructive feedback and encouragement.   They can help you make periodic adjustments to your self-management program.  With this approach, you are in control of your own health and your therapist acts only as a guide.

Health Physical Therapy
Physical therapists help you develop a plan for long-term health

The interaction between you and your health care provider is one of the strongest predictors of patient satisfaction with physical therapy care.  It is also a key contributor to your successful outcome.  Research shows the amount and quality of the interaction between a patient and their physical therapist has a profound impact for those with persistent back pain.  Taking advantage of these positive interactions will magnify the effects of any exercise program or lifestyle modification. Having the same therapist, will potentially enhance the therapeutic alliance, guide you towards your preferred self-management strategies, and help you achieve the best possible long-term outcome.

What Self-Management Looks Like

Your physical therapist will first seek to understand your beliefs about pain and your condition.  Many people hold negative beliefs which are unhelpful to recovery or they are simply untrue.  For example, many people continue to believe that a herniated disc will never heal.  Your physical therapist will redirect you towards what you can control and strategies to improve self-efficacy.

Often a large amount of active participation over a long time is needed to change unhelpful beliefs and poor lifestyle habits.  Your physical therapist will guide you towards forms of physical activity you prefer and which are appropriate.  It is also important that you fully understand the time it takes for the body to heal itself.  The body’s natural healing mechanisms can be enhanced with the appropriate dose of physical activity.  Start too slow and your recovery will be delayed.  Start too fast and “flare-ups” will kill your motivation. Your physical therapist will help you find the best starting point and teach you how to progress.

Learn more about why we hurt

Exacerbations of pain are going to occur.  You are going to have “flare-ups” of your back pain, neck pain, or shoulder pain.  This needs to be accepted and expected.  You want to develop resilience for these set ups.  There are always strategies available to help you through these challenging times.  Thinking the worst is never helpful in these situations.  Remaining optimistic is the first step.  Next, identify what is under your control to get you back on track.  This is where your physical therapist can help you focus your efforts.

Closing Thoughts                         

People with persistent pain conditions don’t always need more medical treatment.  They need a coach or guide to show them how to manage on their own with active forms of treatment.  Physical therapists can fill this role.  Developing a positive working relationship, or therapeutic alliance, with your physical therapist will get you set on the right track.  The rest is up to you.  To learn more about how pain works, download our free report.

Resilience: The Final Piece of Recovery from Injury

Resilience is the ability to recover from or adjust to misfortune or change.   Successful recovery from injury requires resilience to overcome physical and psychological challenges.  There will always be times during rehabilitation when things seem to never go as planned.  This could be a set back where pain or swelling increases temporarily for unexplained reasons.  During these situations, it can be easy to look for excuses or a quick fix solution.  However, the true solution often lies within us in the form of resiliency.

Developing Resilience

Physical therapists, trainers, or coaches can assist by instilling a sense of resiliency within their patients or clients.  This begins by developing trust and truly understanding what the end goal is.  Understanding the desired outcome and feeling prepared for when adversity strikes is a crucial step towards building resilience.  Attempting to motivate or push individuals is rarely successful under conditions of adversity.  Parents who continuously push their child in sports often undermine resilience and contribute to burnout.  The same often occurs during rehabilitation when healthcare providers fail to collaborate and problem solve with their patients.

Resilience and Mindset

Patients and athletes recovering from an injury often expect the worst.  This mindset is extremely detrimental to recovery.  In order to handle adversity and the challenges of rehabilitation, it is important to put in good old-fashioned hard work.  This work must be purposeful, intense, and practiced repeatedly in order to build resilience.  Those who commit to putting in the work build resilience and begin to expect success.  Those who fail to put in the work often expect the next set back and feel helpless about it.  Ultimately, we become what we continuously think about.  Expecting a set back with a sense of helplessness will nearly always lead to failure.

Resilience from Michael Jordan

Putting in the Work & Mental Toughness

Following through with a rehabilitation program at 100% is an example of putting in the work.  This contributes to developing resilience through physical means such as building a foundation of strength and optimizing movement patterns.  Putting in the work also develops resilience through mental toughness.  When injury or adversity ensues, some look for passive solutions while others dig deep into their mental toughness and work to make things right.   These are life skills and personal traits which go beyond rehabilitation or sport.


Successful recovery from injury requires resilience.  Resilience requires purpose, goals, hard work, repetition, and mental toughness.  Developing a trusting and collaborative relationship with your physical therapist will better prepare you for when adversity strikes.   When adversity does appear, the solution is often found within.   The resilient individual will adapt and overcome.  When things are not going well during rehabilitation, take back control and get yourself back on track.

Identifying Expert Physical Therapists: Part 2

Previously, I discussed the attributes of expert physical therapists. Experts share an inner drive for continual learning and improvement of their craft. Experts collaborate with patients to solve problems and possess a belief that patients are responsible for their own health. Several other related themes include spending more time with their patients, placing a greater emphasis on educating their patients, being more responsive to their patients needs, and possessing more extensive knowledge than novices1, 2.

A study by Resnik and Jensen3 further explored the characteristics of expert and novice physical therapists based on the outcomes of their patients seeking care for low back pain. From the results of this study, experts were distinguished from novices by a patient-centered approach which resulted in superior results/outcomes for their patients. Within this approach patients are viewed as active participants in therapy (not passive recipients). The primary goal of therapy is the empowerment of the patient. Empowerment is achieved through collaboration between the therapist and patient, ongoing patient education, and the establishment of a positive therapeutic relationship or alliance. The patient-centered approach results from the interplay of the expert’s clinical reasoning, knowledge base, clinical practice style, and values & virtues.

Expert Clinical Reasoning

Successful outcomes from physical therapy can be fostered through the empowerment of patients and interactions which promote self-efficacy. Patients benefit when given a sense of control over their problem. This sense of control and empowerment can be accomplished through education, avoiding passive treatments (ultrasound, hot packs, etc), minimizing unnecessary visits, and assisting patients with developing self-management strategies. Experts collaborate to solve problems and resemble more of a coach, teacher, or guide than they do a “healer”.

Knowledge Base of Expert Physical Therapists

Years of experience do not distinguish experts from the average. Experts obtain knowledge through clinical experiences, specialty education, their colleagues, and continual self reflection. Experts seek out knowledge and consult with their peers about challenging patient cases. They typically practice in supportive environments where professionals learn from each other. Experts emphasize the observation of functional movement constantly evaluating their patient’s movement patterns.

Values & Virtues of Expert Physical Therapists

It is obvious to others that expert physical therapists enjoy their work and have a passion for helping others. Many view the practice of physical therapy as “a calling”. As mentioned, experts possess a drive to continually learn and improve their skills. Experts are humble and inquisitive; both characteristics of lifelong learners.

Clinical Practice Style of Expert Physical Therapists

Experts adapt and individualize their interactions, examination, and treatments to meet patient needs and foster empowerment. Patient education is central to the expert clinical practice. Expert’s value the continuity of care with their patients and are very stringent with delegating tasks to aides or assistants. Most practice without support personnel.

In Closing

Patients receiving the services of physical therapists should seek out experts who possess the attributes and characteristics discussed here. It is appropriate and recommended to visit multiple physical therapist clinics to observe these attributes in action before deciding on a physical therapist to collaborate with. In particular, take note of the style which a physical therapist interacts with their patients. Look for signs of a coach or educator who engages their patients in the decision making process, and ultimately empowers their patients to take ownership of their overall health.

Thank you for reading!



  1. Jensen GM, Gwyer J, Shepard KF. Expert practice in physical therapy. Phys Ther. 2000;80(1):28-43-52.
  2. Jensen GM, Shepard KF, Gwyer J, Hack LM. Attribute dimensions that distinguish master and novice physical therapy clinicians in orthopedic settings. Phys Ther. 1992;72(10):711-722.
  3. Resnik L, Jensen GM. Using clinical outcomes to explore the theory of expert practice in physical therapy. Phys Ther. 2003;83(12):1090-1106.


What is Expertise in Physical Therapy?

Recent changes in health care have placed increased pressure on physical therapists to become more efficient and effective with their treatments. More so than ever, the diagnosis, treatment, and education of a patient must be done quickly and accurately in a limited number of treatment sessions. In order to practice in such an environment, physical therapists must possess adequate problem solving skills and be able to utilize knowledge within the decision making process. These attributes are believed to be present in expert health care professionals. However, expertise is a difficult term to define, let alone recognize in practice. In its most simplistic form, clinical expertise can be described as advanced skills and/or knowledge in a particular field. However, possessing these attributes alone do not guarantee expertise. Understanding how expert physical therapists practice has important implications for how patients interact and collaborate with their physical therapist.


Jensen & Colleagues1 were the first to investigate the attributes of expert practice in physical therapy. The researchers identified four major dimensions of expert practice: knowledge, clinical reasoning, movement, and virtues. At the center of their proposed model is the idea that expert physical therapists viewed their practice as starting and ending with the patient (a patient-centered approach). Expert physical therapists make it a point to listen to, believe, and understand all their patient’s concerns and then collaborate with the patient to formulate a plan to regain function. Now, let’s further explore the four core dimensions of expert physical therapy practice.

Knowledge: Patient-Centered

 Formal study such as academic degrees, advanced training, and other methods of self study are acknowledged as important components of lifelong learning in any field. However, expert physical therapists view their patients as the most important source of their knowledge. This is often exemplified through the essential practice of active listening. With active listening, the expert maintains eye contact, sits at the same level as the patient, and engages in focused interaction. Patients are allowed to tell their story instead of the physical therapist running down a list of questions that more closely resembles a prisoner interrogation instead of a true conversation. This allows the expert to not only understand the diagnosis but to also understand the patient as a person and how their problem is impacting their life. Experts also engage in a reflective process about their patients which further enhances learning and the storage of new clinical knowledge.

A Collaborative Process

Together with the patients, the expert physical therapist seeks to understand what the patient wants and expects from their therapist and how this fits into the context of their life. Once the patient and therapist have identified the problem(s), both must collaborate to problem solve. The therapist’s primary role is to educate the patient about movement and function. The treatment plan must make sense for the patient. The physical therapist should answer all questions until it does make sense. Effective treatment depends on the patient understanding their role and then following through. This enhances the likelihood that the patient will take control and be willing to modify behaviors and lifestyle factors necessary to regain function.

Movement as a Central Focus

Experts possess and utilize hands on skills when assessing patient’s functional movement and when engaged in treatment. They also assess movement through seeing with their eyes and feeling with their hands. Experts seem to unconsciously guide, facilitate, and reinforce a desired movement from their patients through touch and a therapeutic tone of voice. Experts rarely utilize equipment in the clinic or as part of a home program. Instead patients are instructed in exercises with guidance from the therapist’s hands while always relating the purpose back to the patient’s goals. Experts typically prescribe a few simple exercises specific to functional movements important to the patient.

Virtues: Caring & Commitment

Experts possess the personal attributes of caring and commitment. They are committed to doing what is best for the patient. Challenging patient cases or problems are exciting to these experts. Experts also communicate this sense of caring and commitment as evidenced by spending adequate time with the patient in the clinic and through other means of interactions (telephone, emails, etc).

Putting Expertise into Practice

The perceived greatest barrier to expert practice is time with the patient and the changing landscape of health care strengthens this threat. Physical therapists need time with their patients in the clinic and time to later reflect on their clinical practice. Under the right circumstances and in the right environment physical therapists and their patients can flourish. Important considerations to take advantage of the expertise of any physical therapist include maintaining continuity of care with the same physical therapist at each session, limiting the involvement of non-licensed personnel (i.e., aides or techs), and fostering interactions which promote collaboration between the patient and their therapist.

Thanks for reading!



  1. Jensen GM, Gwyer J, Shepard KF. Expert practice in physical therapy. Phys Ther. 2000;80(1):28-43.

Shared Decision Making in Physical Therapy

Shared decision making between a patient and health care provider is linked with improved patient satisfaction, adherence to treatment, and health outcomes. Involving a patient in decision making may also reduce anxiety and improve confidence in any physical therapy treatment plan. Traditional models of health care use a provider focused approach which does not always incorporate patient values or preferences. Shared decision making enhances the patient-doctor relationship by allowing “2-way traffic” or a balancing of power between a patient & his or her health care provider.

Charles & Colleagues have defined five characteristics of shared decision making

  1. At least 2 parties are involved: patient & therapist
  2. Both parties take steps to participate in the process of treatment decision making
  3. Information sharing between parties is a prerequisite to sharing decisions
  4. Deliberation takes place by discussing the treatment preference of both parties
  5. A treatment decision is made & both participants agree on the decision

Research has shown that most patients seeking health care prefer to share decisions with their provider. Studies have investigated patient involvement in general medicine, cardiology, oncology, and mental health. But how about patients seeking care from a physical therapist?

Research Supporting Patient Involvement in Physical Therapy

A 2013 study by Dierckx & colleagues1 showed that more than two-thirds of patients seeking care from a physical therapist prefer to be involved in the treatment decision making process. The majority of patients either wanted to share their opinions or be actively involved in establishing the treatment plan. However, most alarming from this study, was the fact that in most cases physical therapists falsely perceived that their patient did not want to share decision making. Many physical therapists assumed patients preferred to be passive in the decision making process but this was not the case as most patients preferred to be more involved. This study shows that most decision making in physical therapy continues to be based on a paternalistic approach whereby therapists act in ways they consider is best for their patient but ignoring the benefits of involving the patient more.

Implications for Promoting Shared Decision Making

Promoting a balancing of power in the patient-therapist relationship results in greater patient control over their problem. The patient is no longer a passive recipient of treatment but instead becomes actively involved. When exercise therapy is the treatment, the responsibility of success or failure has to be shared between the patient and the therapist. The patient must do their part. Most patients want to share decisions with their physical therapist and most want to express their opinion before a treatment decision is made. Physical therapists that are blind to patient preferences contribute to a lack of patient involvement in their care and promote dependence on the physical therapist. A wiser approach should seek to actively engage more with patients to achieve the goal of shared decision making.  This will promote patient empowerment and control over their pain or problem. For any successful outcome to be achieved in physical therapy, patients must gain a sense of control without dependence on others. Shared decision making is one step towards this outcome.

Thanks for Reading!



  1. Dierckx K, Deveugele M, Roosen P, Devisch I. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. Phys Ther. 2013;93(10):1321-1330.

Communication and the Patient-Therapist Relationship

The result of physical therapy treatment relies on the interplay between the technical ability, communication skills, and reflective capacity of the therapist to respond to the patient’s needs.  In previous articles we discussed how a positive patient-therapist relationship is associated with improved satisfaction and treatment outcomes. Now we turn to which specific factors influence this relationship in an outpatient physical therapy setting.

A recent study by O’Keefe & colleagues investigated which factors influence patient-therapist interactions in outpatient physical therapy. From the research four key themes emerged:

  1. The interpersonal and communication skills of the physical therapist
  2. The practical skills of the physical therapist
  3. Providing individualized patient-centered care (individualizing treatment and considering patient opinions in the care plan)
  4. Organizational or environment factors (time with the therapist and flexibility with appointments)

The remainder of this article goes into more detail about the importance of the communication and practical skills of the physical therapist.

Interpersonal & Communication Skills of the Physical Therapist

Factors related to communication that are associated with positive patient-therapist interactions include active listening, empathy, friendliness, confidence, and encouragement. Patients want to tell their story without being interrupted or rushed. When physical therapists listen to their patients they feel understood and valued which strengthens the relationship. Patients want their physical therapist to empathize with what they are enduring and understand how this impacts their lives.

Physical therapists that interact in a relaxed manner and incorporate humor develop a stronger bond with their patients. Therapists who offer emotional support and encouragement are more likely to motivate their patients to adhere to treatment recommendations. Finally, patients who feel confident in their therapist are more likely to trust and respect their opinions and recommendations. Physical therapists that possess and have mastered these interpersonal skills foster a positive patient-therapist relationship which leads to better results from care.

Practical Skills of the Physical Therapist

Patient education and physical therapist expertise have been shown to be the two most important practical skills which lead to improved patient-therapist relationships. Interestingly, patient education is perceived as important only by patients, not by most physical therapists. This may be related to the notion that many physical therapists view themselves as “healers” who administer a treatment passively vs. a “teacher” who teaches the patient how to actively manage their own problem. Patients prefer the latter where they are provided with a sense of control over their pain or problem.

Patients also want clear explanations about their problem or diagnosis. They want to know how physical therapy can help.  Patients want to know the rationale for employing specific exercises. Avoiding medical technical terminology is important. Patients often feel understand best through use of analogies and metaphors. Also patients believe it is important that their physical therapist possesses excellent technical ability & skills which is often exemplified through advanced training or degrees.


Patients and physical therapist believe a mix of interpersonal and practical skills are important factors which influence their working relationship. Research has shown the strength of this relationship influences treatment satisfaction and outcome. Therefore, seeking out care from physical therapists that understand and possess these skills is recommended to anyone considering outpatient physical therapy as a treatment option.


  1. O’Keeffe M, Cullinane P, Hurley J, et al. What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2015;96(5):609-622.

Patient-Centered Communication

The therapeutic alliance refers to the collaboration between a patient and medical provider, their affective bond, and agreement on treatment goals. The therapeutic alliance was described in more detail in a previous article. As a matter of review, trust and empathy have also been closely linked with the therapeutic alliance. Research has shown that maximizing the therapeutic alliance can positively impact treatment results, health, and patient satisfaction. A strong therapeutic alliance results in improved patient adherence and overall engagement in their treatment. Thus, maximizing the therapeutic alliance is an important component of patient-centered health care.

Communication and Therapeutic Alliance

Effective communication between the patient and medical provider is arguably the most important factor associated with the therapeutic alliance and maximizing its impact on treatment outcomes. Three key communication factors are involved in the patient-therapist encounter. These are verbal factors, non-verbal factors, and interaction styles. Verbal factors pertain to such aspects as greetings and specific questioning during the medical interview. Non-verbal factors include facial expressions, gestures, and body orientation. Interaction styles refer to information giving, providing emotional support, and sharing responsibility in decision making with the patient.

Researchers from Australia investigated which communication factors was most closely associated with a strong therapeutic alliance. Compared to verbal and non-verbal factors, patient-centered interaction styles showed the strongest association with the therapeutic alliance. Specifically, interactions that promoted patient involvement, support, and engagement were strongest. Allowing patients to tell their story and attentively listening to patient concerns are important considerations during the patient-therapist interaction. Answering all patient questions in a comforting and caring manner facilitates and supports the therapist-patient relationship. Finally, the therapeutic alliance is strengthened when therapists ask questions with a focus on the patient’s emotional issues and when therapists show sensitivity towards these emotional concerns. Brushing over patient’s emotional cues during a medical interview is never a good idea.


Patient-Centered Communication Enhances Treatment Effects

Medical providers who adopt communication styles which are comforting, caring, empathetic, and involve the patient will foster a positive therapeutic alliance. This promotes patient adherence and engagement allowing for the best possible treatment outcome for the patient. For patients receiving care in outpatient physical therapy clinics it is important to keep in mind that these non-specific factors will only enhance the effects of any specific treatments used, such as exercise or manual therapy. I believe that both specific and non-specific aspects of treatment need to be considered for patients to obtain the best possible outcome and reach their goals.

Thanks for reading!



  1. Pinto RZ, Ferreira ML, Oliveira VC, et al. Patient-centered communication is associated with positive therapeutic alliance: a systematic review. J Physiother. 2012;58(2):77-87

The Power of the Physical Therapist-Patient Relationship

The therapist-patient relationship, or alliance, is a critical factor in the success of your treatment plan. Therapeutic alliance refers to the sense of collaboration, warmth, trust, and support between you and your medical provider (physician, physical therapist, etc.).

There are 3 components that contribute to therapeutic alliance.

  1. The therapist-patient agreement on goals
  2. Therapist-patient agreement on the treatment plan
  3. The affective bond between the you and your therapist

Therapeutic Alliance in Mental Health & Medicine

A positive therapeutic alliance is associated with positive mental health outcomes for depression, anxiety, mood, interpersonal problems, and overall psychological well being. Trust is an important factor in the patient-physician relationship.

Your trust in your general practitioner is positively correlated with improved pain, general health, and quality of life. Trust forms the basis for self-efficacy.  This in turn leads to improved patient adherence and health outcomes.

therapeutic alliance
Trust is the foundation of the therapist-patient relationship

In psychotherapy and general medicine, a positive therapeutic alliance is associated with improved treatment results. What about physical therapy?

Physical therapy involves a high level of patient-therapist interaction.  You often attend multiple clinic visits per week each lasting 30 to 60 minutes. Therefore, maximizing the therapeutic alliance will positively influence your results in physical therapy.

The Therapist-Patient Relationship in Physical Therapy

A 2010 paper reviewed the research investigating the influence of therapeutic alliance on physical therapy outcomes. Not surprisingly, the researchers found the alliance between the physical therapist and patient had a positive effect on multiple aspects of treatment.

In particular the alliance between the patient and therapist positively correlates

  1. An improved ability to perform activities of daily living
  2. Reduced pain levels
  3. Improved physical functioning
  4. Decreased depression
  5. Improved overall health
  6. Improved patient satisfaction

Therapeutic Alliance & BSR Physical Therapy

In order to maximize the positive impact of the therapist-patient relationship providers must measure and continually seek to improve in this area.

At our Barnegat and Manahawkin physical therapy clinics we utilize the Consultation and Relational Empathy (CARE) Measure to track how well we develop relationships with our patients. Our physical therapists collectively discuss and seek out ways to improve these skills.

We understand the importance of fostering the therapist-patient relationship.  If this is something you are seeking in your physical therapist, contact us to get started.


Patient Satisfaction in Physical Therapy

Health care in the U.S. is shifting towards a value-based system where patient satisfaction plays a key role in the patient experience. Patient satisfaction is a reflection of the individuals overall experience with receiving a given treatment. It can be viewed from two perspectives: the quality of care and customer service. Individuals who are satisfied with the care they receive are more likely to be adherent to prescribed treatments, which is linked to improved outcomes and an overall higher quality of life.

What Determines Patient Satisfaction in Outpatient Physical Therapy?

A 2011 article published in the Physical Therapy Journal asked and answered this question1. Overall a high percentage of patients (68% to 91%) reported being satisfied or completely satisfied with their experience in outpatient physical therapy. Three key dimensions of the patient experience were found to be associated with patient satisfaction. These dimensions are the interpersonal attributes of the physical therapist, the process of delivering care, and how the care was organized. The process of care includes such factors as continuity of care (discussed in a previous article), adequate follow-up, and involving the patient in decision making. The organization of care includes such factors as convenient hours, parking, cleanliness of the clinic, and the overall helpfulness of the staff. The remainder of this article will discuss the physical therapist attributes associated with patient satisfaction.

Physical Therapist Interpersonal Attributes: The Strongest Predictor of Patient Satisfaction

The attributes of the physical therapist have been shown to be highly associated with how satisfied patients are with outpatient physical therapy. Examples of such attributes include the physical therapist’s skills, knowledge, professionalism, and friendliness. Most patients expect these qualities in any health care provider and are sometimes erroneously thought to be universal across all providers. However with the shift of health care towards a value-based system and increasing specialization, advanced training and lifelong learning are becoming increasingly important. Today most expert physical therapists hold doctoral degrees, are board certified, and have completed advanced residency or fellowship programs in their area of specialization.

Knowledge and skills are only the tip of the iceberg when it comes to maximizing patient satisfaction. Effective communication skills are the most important attribute that a physical therapist can possess. Patients want their physical therapist to provide clear explanations about their condition. What is the diagnosis? Patients want their physical therapist to offer prognostic information. How much improvement can I expect and how long will it take? And patients want their physical therapist to explain their role in the treatment process. What can I do for myself to recover quickly? Finally, and perhaps the most important attribute any medical professional can possess is empathy. Patients want to feel they are being listened to and dealt with in a sympathetic and respectful manner. This is becoming increasingly less common as busy clinics render treatment by multiple providers. Therapist-Patient interactions may suffer and empathy is sacrificed in the process.


Multiple factors contribute to patient satisfaction with outpatient physical therapy. The interpersonal attributes of the physical therapist are by far the most important of these factors. Specifically, effective communication and empathy have been shown to be strongly associated with patient satisfaction. When deciding on a physical therapist, do some homework and be sure these attributes are present.

Thanks for reading!



  1. Hush J, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.