An investigation of the measurement properties of the physiotherapy therapeutic relationship measure in patients with musculoskeletal conditions

Figures & data

Figure 1. Measurement framework and proposed scaling structure for the physiotherapy therapeutic relationship measure.

Table 1. Participant demographic and clinical characteristics.

Characteristic	Number of responses	Categories	Mean, median or number	%, Range or SD
Age (years)	152	Years	43	16.6
Gender	163	Female	87	53.4
		Male	72	44.2
		Prefer not to answer	4	2.5
Language	163	English	147	90.2
		English as an additional language	16	9.8
Education level	159	Some high school	16	10.1
		High school diploma	12	7.5
		Some post-secondary	20	12.6
		Diploma or certificate	40	25.2
		University undergraduate degree (e.g. BSc, BA)	43	27.0
		Professional or graduate degree (e.g. BScN, MD, MBA)	28	17.6
Patient population	163	Inherited bleeding disorders	43	26.4
		Inflammatory arthritis	33	20.2
		General musculoskeletal	87	53.4
General self-rated health	158	Excellent	26	16.5
		Very good	62	39.2
		Good	53	33.5
		Fair	12	7.6
		Poor	5	3.2
Reported chronic or persistent pain	163		60	36.8
Reason for seeking physiotherapy*	163	Acute injury	79	48.5
		Chronic condition or injury	89	54.6
		Post-surgery	36	22.1
		Annual assessment	32	19.6
		Education program	4	2.5
		Workers’ compensation	7	4.3
		Motor vehicle accident	14	8.6
		Chronic or persistent pain	48	29.4
Importance of friendliness	158	Very important	90	57.0
		Important	55	34.8
		Somewhat important	13	8.2
		Not at all important	0	0.0
Global Rating of Therapeutic Relationship (rating 0–10).	161		9.43	0.99
Control preferences scale	157	I prefer to make treatment decisions on my own.	0	0.0
		I prefer to make treatment decisions after hearing the opinion of my physiotherapist.	37	23.6
		I prefer to share treatment decisions with my physiotherapist.	53	33.8
		I prefer that my physiotherapist makes treatment decisions after hearing my opinion.	41	26.1
		I prefer that my physiotherapist makes the treatment decisions.	26	16.6
Trust in healthcare providers (5–25)	163		17.1	5.1
Duration of therapeutic relationship (months) n = 164	163		24	0.7-360
Most recent encounter with the physiotherapist (months)	163		4	0-36
Total number of encounters	144		8	3-150
Number of telerehabilitation appointments	158	None	131	82.9
		1–2	22	13.9
		3 or more	5	3.2
Physiotherapist’s gender	151	Male	64	42.4
		Female	84	55.6
		Prefer not to say	3	2.0
Approximate age of physiotherapist	151	20 to 40	121	80.1
		40 or Older	30	19.9
Type of clinical setting	154	Specialized chronic disease interdisciplinary clinic	27	17.5
		Hospital physiotherapy department	15	9.7
		Physiotherapy private practice	111	72.1
		Telehealth (over the internet)	1	0.6
Survey format	163	Online	144	93.5
		Paper	19	12.3

*Participants could choose more than 1 option; therefore, proportions do not add up to 100%.

Table 2. Item descriptive statistics.

	Content*	Item	Descriptive statistics				Response endorsement frequencies (%)							Item-scale correlation
			Mean	SD	Median	Range	0	1	2	3	4	5	Missing	Total P-TREM score
Item 1	CX	Explains how physiotherapy will help my condition.	4.66	0.60	5	4	0.0	0.6	0.0	3.1	25.8	70.6	0.0	0.75
Item 2	CX	Helps me understand my injury or condition.	4.67	0.67	5	4	0.0	1.2	0.0	3.7	20.2	74.8	0.0	0.75
Item 3	CX	Personalizes treatment to my needs.	4.71	0.55	5	3	0.0	0.0	0.6	3.1	21.0	75.3	0.6	0.78
Item 4	CX	Adapts our treatment plan as my injury or condition changes.	4.69	0.64	5	5	0.6	0.0	0.6	1.8	22.7	74.2	0.0	0.72
Item 5	CX	Helps me feel hopeful about my future health.	4.55	0.72	5	3	0.0	0.0	2.5	6.1	25.8	65.6	0.0	0.74
Item 6	CX	Educates me on ways that I can help myself.	4.64	0.63	5	3	0.0	0.0	1.2	4.3	23.9	70.6	0.0	0.74
Item 7	CX	Acknowledges my physical concerns.	4.62	0.72	5	4	0.0	0.6	2.5	3.1	22.1	71.8	0.0	0.80
Item 8	CD	Would notice if I were uncomfortable.	4.50	0.73	5	3	0.0	0.0	2.5	6.7	28.8	62.0	0.0	0.73
Item 9	CX	Appreciates what I know about how my condition affects me.	4.44	0.76	5	4	0.0	0.6	1.2	9.2	31.9	57.1	0.0	0.78
Item 10	CX	Encourages me to be mindful of sensations in my body (e.g. During hands-on treatment, exercises).	4.45	0.70	5	4	0.0	0.6	0.6	6.2	37.9	54.7	1.2	0.64
Item 11	CX	Adjusts their touch based on how it feels to me.	4.55	0.61	5	2	0.0	0.0	0.0	6.2	32.7	61.1	0.6	0.72
Item 12	CX	Moves my injured body part with care.	4.64	0.61	5	3	0.0	0.0	1.3	3.1	25.6	70.0	1.8	0.76
Item 13	BO	Is respectful when examining me.	4.73	0.54	5	4	0.0	0.6	0.0	1.2	21.6	76.5	0.6	0.65
Item 14	CD	Listens carefully to what I am saying.	4.67	0.62	5	3	0.0	0.0	1.2	4.3	20.4	74.1	0.6	0.80
Item 15	CX	Is available for me to contact outside of our appointments, if needed.	4.28	1.02	5	4	0.0	3.1	4.3	9.9	26.7	55.9	1.2	0.58
Item 16	CX	Would go ‘above and beyond’ to help me with my rehabilitation if needed (e.g. research my injury or condition, spend a little extra time with me).	4.42	0.85	5	4	0.0	0.6	4.3	7.4	28.2	59.5	0.0	0.75
Item 17	CD	Is honest with me about how much I can expect to improve.	4.56	0.69	5	3	0.0	0.0	2.5	3.7	28.8	65.0	0.0	0.76
Item 18	BO	Is easy to talk to.	4.74	0.55	5	4	0.0	0.6	0.0	1.8	20.2	77.3	0.0	0.77
Item 19	BO	Takes the time to get to know me.	4.57	0.71	5	4	0.0	1.2	0.6	3.7	28.8	65.6	0.0	0.80
Item 20	CD	Gives me their full attention when they are with me.	4.71	0.53	5	2	0.0	0.0	0.0	3.7	21.5	74.8	0.0	0.77
Item 21	CD	Is committed to fully understanding my injury or condition.	4.64	0.72	5	4	0.0	0.6	1.8	4.9	17.8	74.8	0.0	0.81
Item 22	CX	Gives me enough time to talk about my concerns.	4.61	0.66	5	4	0.0	0.6	0.6	4.3	26.4	68.1	0.0	0.86
Item 23	CD	Would be open to my suggestions.	4.55	0.66	5	3	0.0	0.0	1.2	5.6	29.8	63.4	1.2	0.82
Item 24	CD	Is interested in me not only as a patient, but as a person.	4.46	0.81	5	4	0.0	0.6	1.9	11.1	23.5	63.0	0.6	0.83
Item 25	CX	Understands what is important to me (e.g. My goals, what I value).	4.55	0.71	5	4	0.0	0.6	0.6	7.4	26.4	65.0	0.0	0.83
Item 26	BO	Respects me for who I am (e.g. My cultural background, gender).	4.66	0.55	5	2	0.0	0.0	0.0	3.7	26.4	69.9	0.0	0.63
Item 27	BO	Genuinely cares if I get better.	4.70	0.56	5	3	0.0	0.0	1.2	1.2	23.9	73.6	0.0	0.87
Item 28	CD	Is committed to helping me with my rehabilitation.	4.69	0.57	5	3	0.0	0.0	1.2	1.8	23.9	73.0	0.0	0.88
Item 29	BO	Cares about my well-being.	4.69	0.54	5	3	0.0	0.0	0.6	1.9	25.9	71.6	0.6	0.88
Item 30	CD	Is focussed on what we are doing during physiotherapy.	4.70	0.55	5	2	0.0	0.0	0.0	4.3	21.5	74.2	0.0	0.83
Item 31	CX	Gives their best effort during our appointments.	4.71	0.54	5	3	0.0	0.0	0.6	2.5	22.4	74.5	1.2	0.77
Item 32	CD	Shares some details about their life outside of the clinic (e.g. Their hobbies, interests, family, pets).	4.13	1.05	4	4	0.0	3.1	4.9	15.4	29.0	47.5	0.6	0.49
Item 33	BO	I like my physiotherapist.	4.72	0.54	5	3	0.0	0.0	0.6	2.5	21.5	75.5	0.0	0.83
Item 34	BO	I feel respected by my physiotherapist.	4.73	0.55	5	3	0.0	0.0	1.2	1.2	20.9	76.7	0.0	0.83
Item 35	CD	My physiotherapist and I work well together as a team.	4.64	0.60	5	3	0.0	0.0	1.2	2.5	27.8	68.5	0.6	0.88
Item 36	BO	My physiotherapist and I get along (e.g. Are friendly).	4.65	0.58	5	3	0.0	0.0	0.6	3.7	25.8	69.9	0.0	0.82
Item 37	BO	I care about my physiotherapist as a person.	4.60	0.60	5	2	0.0	0.0	0.0	6.2	27.8	66.0	0.6	0.74
Item 38	BO	I am able to be myself with my physiotherapist.	4.60	0.65	5	3	0.0	0.0	0.6	7.4	23.9	68.1	0.0	0.81
Item 39	BO	I have confidence in my physiotherapist's professional skills.	4.74	0.50	5	2	0.0	0.0	0.0	3.1	19.6	77.3	0.0	0.83
Item 40	BO	I can depend on my physiotherapist to do what they have promised to do.	4.68	0.60	5	3	0.0	0.0	1.2	3.1	22.1	73.6	0.0	0.84
Item 41	BO	I trust that my physiotherapist would tell me if they did not know how to help me with my injury or condition.	4.61	0.73	5	5	0.6	0.6	0.6	3.1	25.8	69.3	0.0	0.72
Item 42	BO	I trust my physiotherapist enough to discuss a sensitive issue.	4.46	0.83	5	4	0.0	1.9	0.6	8.6	27.8	61.1	0.6	0.71
Item 43	CD	I think my physiotherapist would acknowledge a mistake if they made one.	4.50	0.78	5	4	0.0	1.2	1.8	4.9	30.1	62.0	0.0	0.72
Item 44	CD	I give my full attention to what we are doing during physiotherapy.	4.68	0.51	5	2	0.0	0.0	0.0	1.8	28.2	69.9	0.0	0.59
Item 45	CD	I am open to hearing suggestions from my physiotherapist.	4.80	0.40	5	1	0.0	0.0	0.0	0.0	19.6	80.4	0.0	0.69
Item 46	CD	I am committed to following our treatment plan.	4.56	0.63	5	2	0.0	0.0	0.0	7.4	29.4	63.2	0.0	0.45
Item 47	CD	I answer my physiotherapist’s questions honestly.	4.78	0.42	5	1	0.0	0.0	0.0	0.0	22.1	77.9	0.0	0.57
Item 48	BO	I respect my physiotherapist’s professional opinion.	4.79	0.45	5	2	0.0	0.0	0.0	1.9	16.9	81.3	1.8	0.74
Item 49	CD	I would tell my physiotherapist if they did something I didn’t like during physiotherapy.	4.53	0.71	5	4	0.0	0.6	1.3	5.0	30.6	62.5	1.8	0.64

SD: standard deviation, 0 = strongly disagree, 1 = disagree, 2 = slightly disagree, 3 = slightly agree, 4 = agree, 5 = strongly agree.

*Conditions: CD; connections: CX; bond: BO.

Table 3. Rotated factor loading matrix.

Item number	Item content	Physio-therapist role	Patient role
Item 2	Helps me understand my injury or condition.	0.757	–0.013
Item 5	Helps me feel hopeful about my future health.	0.780	–0.034
Item 6	Educates me on ways that I can help myself.	0.704	0.069
Item 7	Acknowledges my physical concerns.	0.706	0.105
Item 8	Would notice if I were uncomfortable.	0.638	0.108
Item 12	Moves my injured body part with care.	0.631	0.141
Item 16	Would go 'above and beyond' to help me with my rehabilitation if needed (e.g. Research my injury or condition, spend a little extra time with me).	0.724	0.012
Item 17	Is honest with me about how much I can expect to improve.	0.706	0.080
Item 19	Takes the time to get to know me.	0.827	–0.040
Item 20	Gives me their full attention when they are with me.	0.697	0.085
Item 21	Is committed to fully understanding my injury or condition.	0.803	0.010
Item 22	Gives me enough time to talk about my concerns.	1.016	–0.193
Item 23	Would be open to my suggestions.	0.817	0.020
Item 24	Is interested in me not only as a patient, but as a person.	0.757	0.093
Item 25	Understands what is important to me (e.g. My goals, what I value).	0.678	0.194
Item 29	Cares about my well-being.	0.646	0.311
Item 33	I like my physiotherapist.	1.045	–0.243
Item 34	I feel respected by my physiotherapist.	0.915	–0.092
Item 35	My physiotherapist and I work well together as a team.	0.890	0.008
Item 36	My physiotherapist and I get along (e.g. are friendly).	0.879	–0.068
Item 37	I care about my physiotherapist as a person.	0.499	0.306
Item 38	I am able to be myself with my physiotherapist.	0.657	0.209
Item 41	I trust that my physiotherapist would tell me if they did not know how to help me with my injury or condition.	0.626	0.106
Item 42	I trust my physiotherapist enough to discuss a sensitive issue.	0.635	0.104
Item 43	I think my physiotherapist would acknowledge a mistake if they made one.	0.644	0.086
Item 44	I give my full attention to what we are doing during physiotherapy.	–0.109	0.875
Item 45	I am open to hearing suggestions from my physiotherapist.	0.247	0.549
Item 46	I am committed to following our treatment plan.	–0.113	0.711
Item 47	I answer my physiotherapist's questions honestly.	–0.099	0.842
Item 49	I would tell my physiotherapist if they did something I didn’t like during physiotherapy.	0.288	0.458

The bold numbers represent the factor loadings above 0.6 which is what is ideal in this factor analysis.

Table 4. Descriptive statistics for scale scores.

	Mean	Standard deviation	Median (min-max)	Skew	Kurtosis	Ceiling effects*	Alpha (confidence interval)
Total P-TREM score	138.2	14.8	145 (73–150)	–1.66	3.08	21.5%	0.974 (0.968, 0.979)
Physiotherapist role	114.9	13.3	121 (51–125)	–1.80	4.02	28.8%	0.974 (0.968, 0.980)
Patient role	23.35	2.1	24 (18–25)	–0.95	–0.44	47.9%	0.811 (0.769, 0.851)

*Percentage of respondents scoring the maximum score.

Table 5. Concurrent and convergent validation for P-TREM total score by population subgroups.

Patient population subgroup	Number	Correlation with GRTR (CI)	Correlation with THCP (CI)	Alpha (CI)
General musculoskeletal	87	0.73 (0.61–0.81)	0.18 (−0.03–0.37)	0.973 (0.964, 0.981)
Inherited bleeding disorders	43	0.75 (0.58–0.86)	0.27 (−0.03–0.52)	0.972 (0.959, 0.982)
Inflammatory arthritis	33	0.92 (0.84–0.96)	0.40 (0.07–0.65)	0.976 (0.962, 0.986)