Association Between Patient-Specific Factors and the Therapeutic Relationship in Direct Access Physiotherapy for Higher Education Students—An Observational Cross-Sectional Study

Abstract

Background and Purpose: Musculoskeletal (MSK) pain is a common issue among higher education students and is often linked to poor physical function and a high psychosocial burden. In direct access physiotherapy, a patient-centered approach is essential for building a strong therapeutic relationship. While therapist attributes are known to influence this relationship, this study aimed to explore whether patient-specific factors, including psychosocial burden, physical function, and chronic pain, are associated with students' perception of the therapeutic relationship during their first physiotherapy visit. Methods: This observational cross-sectional study included 326 higher education students with MSK pain (median age: 26 years) visiting direct access physiotherapy in Finnish Student Health Service (FSHS). The Experience of the Therapeutic Relationship questionnaire was used to assess the therapeutic relationship. Patient-specific factors included psychosocial burden and psychological distress, measured with the Short Form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-SF) and the Mental Health Index (MHI-5), respectively; physical function evaluated using the Patient-Specific Functional Scale (PSFS), and chronic pain derived from the ÖMPSQ-SF. Additional baseline data, including the level and field of study, FSHS region in Finland, and gender and age, were collected. Multiple linear regression analysis was performed to examine the associations between the therapeutic relationship and patient-specific factors. Results: Psychological distress (ß = 0.30, 95% CI 0.03 to 0.58) and poorer self-rated physical function (ß = −0.13, 95% CI −0.24 to −0.02) were associated with a more negative perception of the therapeutic relationship. However, no significant associations were found for psychosocial burden (ÖMPSQ-SF moderate-risk ß = −0.19, 95% CI −0.50 to 0.12; high-risk ß = −0.02, 95% CI −0.34 to 0.30) or chronic pain (ß = 0.004, 95% CI −0.22 to 0.22). Discussion: Psychological distress and impaired physical function appear to be negatively associated with students' perception of the therapeutic relationship. Integrating these factors into patient-centered care could potentially enhance therapeutic interactions.