How do patients with musculoskeletal pain define success with physical therapy? A mixed-methods study

Objective: To identify how individuals seeking care for a musculoskeletal condition define success, understand the patients’ perspectives regarding why they define success as they do, and identify if there were health history factors associated with patients’ definitions of success. Design: A mixed-methods convergent parallel cohort design. Setting: Outpatient physical therapy clinics. Participants: Individuals aged 18–89 years seeking musculoskeletal physical therapy. Main Measures: Online surveys and one-on-one virtual interviews. Ordinal logistic regression was used to model the relationship between demographic and health history variables on survey scores. Thematic coding of qualitative data identified common themes. Integration of quantitative and qualitative data was performed to infer the influence of factors on definitions of success. Results: A total of 463 surveys and 20 interviews were completed. A shorter symptom duration and previous positive experience with physical therapy are associated with how participants defined success. The most common success theme was a desire to return to the previous level of function or accomplish a specific functional goal. Symptom improvement and greater mobility were identified as the primary criteria for success. Integration of results indicates that the survey item with the highest mean score, the need to have a thorough understanding of the condition, is independent of any of the main interview themes. However, it also can be inferred that the most common theme was influenced by the survey items with the third and fourth highest mean scores: the need to improve the current quality of life and the need to return to all previous activities. Conclusion: Returning to a previous level of function or achieving a specific functional goal was the most common pretreatment determinant of patient-defined success. Shorter symptom duration and a previous positive experience with physical therapy are the only covariates that have a statistically significant association with specific criteria for success.