What do patients referred to physical therapy for a musculoskeletal condition expect? A qualitative assessment

The takeaway

What do patients expect from physical therapy before their first appointment for a musculoskeletal problem?

Before starting physical therapy, patients most want pain relief, a clear diagnosis, an explanation of the treatment plan, exercise guidance, and a realistic prognosis. Many patients are unsure how physical therapy fits into their overall care and view it as a last resort.

DescriptiveRead paper

Primary study25 ParticipantsLimited evidence

Key points

All 25 participants (100%) expected a meaningful outcome, primarily pain relief
96% expected education, exercise instruction, evaluation, and an explanation of their pain cause
Manual therapy was mentioned by only 36% of participants, lower than expected given prior survey-based research
Many participants could not clearly describe physical therapys role in their overall healthcare plan
The authors propose a fifth clinical question beyond Gifford's four: 'What is the expected outcome of physical therapy?'

How it was conducted

Design: Qualitative study using structured virtual interviews and open-ended responses, guided by phenomenological and pragmatic frameworks
Participants: 25 adults (18 female, 7 male; mean age 47.04 years) referred for outpatient physical therapy for musculoskeletal pain
Recruitment: Consecutive sample screened from 25 clinics within a large health system; 205 patients screened, 25 enrolled
Interview approach: Structured questions based on Gifford's four patient-expectation questions; interviews conducted via Microsoft Teams, lasting under 30 minutes
Analysis: Transcripts coded and thematized in NVivo 1.5.1 using deductive coding guided by an a priori rubric; saturation was reached

What they found

Outcome theme: mentioned by 25/25 participants (100%), referenced 180 times; focused on pain alleviation and fear of ongoing pain
Education theme: mentioned by 24/25 participants (96%), referenced 155 times; participants wanted to understand their condition, exercises, and self-management
Exercise theme: mentioned by 24/25 participants (96%), referenced 123 times; no interview question explicitly asked about exercise
Evaluation theme: mentioned by 24/25 participants (96%), referenced 71 times; participants expected initial and ongoing progress assessments
Cause of pain theme: mentioned by 24/25 participants (96%); 40% felt they already had a diagnosis and 56% wanted one
Manual therapy: mentioned by only 9/25 participants (36%), with manipulation referenced 14 times and massage 11 times
Physical therapy's role in healthcare: most participants were vague; many described physical therapy as a 'last resort' or cost-saving alternative to surgery

Limitations

Single geographic region limits generalizability to other regions or countries
76% of participants had prior physical therapy experience, which may have shaped their expectations in ways the study could not isolate
Interview questions were framed around Gifford's pain-focused questions, which may have biased responses toward pain-related themes
Participants were not given the opportunity to review or correct their transcripts

Why it matters

For patients: Patients starting physical therapy can better prepare by knowing that sharing their goals, diagnosis questions, and expectations about exercise and duration helps clinicians tailor care.
For clinicians: Clinicians should proactively address five key questions at the first visit, including expected outcome, to align expectations and improve satisfaction and adherence.
For readers: This study fills a gap by capturing pre-treatment patient expectations in their own words, revealing that manual therapy is less central to patient expectations than prior surveys suggested.

Source

doi:10.1016/j.msksp.2022.102543

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