A Mixed Methods Approach to Understanding Common Factors Association with Pain and Functional Outcomes in Musculoskeletal Pain Conditions

Author

Mary Beth HolmesFollow

Date of Award

Fall 9-15-2022

Document Type

Dissertation

Degree Name

PHD - Doctor of Philosophy

Department

Education

First Advisor

Kelvin Ramirez

Second Advisor

Steven George

Third Advisor

Peiwei Li

Abstract

Healthcare costs continue to rise the provision of value-based care with evidence to support improvement in patient outcomes is essential for service coverage. While physical therapy has proven to be effective for the treatment of painful musculoskeletal conditions ostensibly different treatment approaches have yielded similar results. These findings have led to an exploration of the influence of the features present across all interventions, variables known as the “common factors”, on physical therapy outcomes. Research pertaining to common factors remains in the early stages in physical therapy literature, with studies primarily aimed at defining and exploring singular concepts. Using Wampold’s Contextual Model as a framework this study explored the influence of several common factors; empathy, expectancy, credibility, therapeutic alliance, and autonomy support, on pain and functional outcomes for individuals receiving physical therapy for painful musculoskeletal conditions. Using a mixed-methods approach survey data and semi-structured interviews provided insight into the relationship between the common factors and standardized patient outcomes measures, along with important contextual information from patients' perceptions of their physical therapy experience. The results demonstrated the following significant findings; a weak inverse relationship between patient expectation and improvement in pain rating (r_s = -.277 p <.001), and a moderate to a weak relationship between therapeutic alliance measures (WAI Task r_s = .337 p = .002), credibility rating (r_s = .255, p = .002) and improvement on functional measures. Themes from participant interviews illustrated the importance of the bond between patients and providers and how common factors influence the development of a strong therapeutic relationship that in turn leads to increased patient engagement and adherence to physical therapy recommendations. By utilizing an established framework, the Contextual Model, this study contributes to physical therapy literature by exploring the influence of common factors on pain and functional outcomes.

Language

English

Number of Pages

165

Embargo Period

9-5-2022

Recommended Citation

Holmes, Mary Beth, "A Mixed Methods Approach to Understanding Common Factors Association with Pain and Functional Outcomes in Musculoskeletal Pain Conditions" (2022). Educational Studies Dissertations. 193.
https://digitalcommons.lesley.edu/education_dissertations/193