Weekly Literature Review: Patient Satisfaction and Professional Practice in Physical Therapy

Introduction

This week's literature review examines critical aspects of physical therapy practice through five distinct research studies and reports that collectively illuminate the complex dynamics between patient satisfaction, clinical outcomes, and professional practice standards. The reviewed literature spans from patient-centered care factors that drive satisfaction to systemic challenges affecting the profession, including attendance patterns, ethical considerations in productivity-driven environments, and workforce demographics. These studies provide valuable insights for clinicians, administrators, and policymakers seeking to enhance both patient care quality and professional practice sustainability in contemporary physical therapy settings.

Summary of Key Research Findings

The literature reveals several interconnected themes regarding patient satisfaction, clinical practice, and professional development in physical therapy. Nicholson et al. (2023) demonstrated that patient education and shared decision-making are the strongest predictors of satisfaction in private musculoskeletal physical therapy, with 86% of patients reporting complete satisfaction when therapists effectively advised on problem prevention and involved patients in care decisions. This finding challenges traditional assumptions about satisfaction drivers, showing that interpersonal therapeutic skills outweigh external factors like facility amenities.

Balinski et al. (2024) explored the paradoxical relationship between therapist confidence and patient outcomes in chronic pain management, finding that higher therapist comfort levels were associated with lower attendance rates and increased self-discharge among chronic low back and knee pain patients. With only 73% attendance and 55% completion rates, this study highlights the complexity of chronic pain treatment and suggests that therapist confidence may not translate to effective holistic patient management.

The disconnect between satisfaction and clinical improvement was further examined by Beattie et al. (2011) in their workers' compensation study, where 90% of patients reported satisfaction despite only 70.1% experiencing perceived clinical improvement. This research revealed that interpersonal dynamics and professional conduct significantly influence patient satisfaction independent of symptom resolution, suggesting that therapeutic relationships have value beyond measurable clinical outcomes.

Ethical considerations in practice emerged prominently in Tammany et al. (2019), who found that 73.9% of Texas physical therapists work under formal productivity goals, with skilled nursing facilities showing the highest rates of observed unethical behavior. The study established a significant correlation between increased productivity expectations and unethical practices, while organizational emphasis on ethics and evidence-based practice served as protective factors.

Finally, the APTA Demographics Report (2023) provided comprehensive workforce data showing physical therapy as the fifth largest licensed clinical profession, with continued growth outpacing population increases. However, the profession continues to struggle with diversity representation, though encouraging trends appear in recent DPT applicant demographics.

Main Points

Patient Satisfaction Drivers:

• Patient education and shared decision-making are the strongest predictors of satisfaction in private practice settings

• Interpersonal therapeutic skills significantly outweigh external factors like facility amenities in determining patient satisfaction

• Therapeutic alliance, listening skills, and genuine therapist interest correlate strongly with patient satisfaction ratings

Clinical Practice Challenges:

• Higher therapist comfort levels with chronic pain treatment paradoxically correlate with lower patient attendance and higher dropout rates

• Patient satisfaction operates independently from perceived clinical improvement, with 90% reporting satisfaction despite only 70% experiencing improvement

• No-show rates serve as strong predictors of treatment discontinuation and self-discharge

Ethical and Professional Considerations:

• Nearly three-quarters of physical therapists work under formal productivity standards that significantly influence clinical decision-making

• Skilled nursing facilities demonstrate the highest prevalence of observed unethical behaviors in practice

• Organizational emphasis on ethics and evidence-based practice serves as protective factors against unethical behavior

Workforce Demographics and Trends:

• Physical therapy represents the fifth largest licensed clinical profession with growth rates significantly exceeding population growth

• The profession remains less diverse than the U.S. population, particularly underrepresenting Black/African American and Hispanic/Latino clinicians

• Board certification and advanced training correlate with higher earnings and demonstrate greater diversity than the general profession

Practice Setting Insights:

• Outpatient settings dominate employment for both PTs (39-43%) and PTAs (38-48%)

• Specialization rates remain relatively low at approximately 11% of practicing physical therapists

• Geographic distribution of practitioners creates persistent access gaps across different states and regions

Conclusion

This week's literature review reveals a profession at a critical juncture, balancing patient-centered care excellence with systemic pressures and demographic challenges. The research consistently emphasizes that meaningful patient-therapist relationships, characterized by effective communication, shared decision-making, and genuine therapeutic alliance, represent the cornerstone of successful physical therapy practice regardless of clinical setting or patient population.

However, the literature also exposes concerning tensions within the profession. The paradox of increased therapist confidence correlating with poorer patient outcomes in chronic pain management suggests that technical competence must be coupled with comprehensive patient-centered approaches. Similarly, the independence of patient satisfaction from clinical improvement indicates that the therapeutic relationship itself holds intrinsic value that extends beyond traditional outcome measures.

The ethical implications of productivity-driven practice models cannot be ignored, particularly as the profession continues to grow and face increasing administrative pressures. The correlation between productivity expectations and unethical behavior underscores the need for organizational cultures that prioritize both ethical practice and evidence-based care delivery.

Moving forward, the physical therapy profession must address workforce diversity challenges while maintaining its commitment to patient-centered care excellence. The encouraging diversity trends in recent DPT applicants provide hope, but sustained effort will be required to create a profession that truly reflects the populations served. Ultimately, these findings suggest that the future success of physical therapy lies not merely in technical advancement or productivity optimization, but in preserving and enhancing the fundamental therapeutic relationships that define quality patient care.

Citations

American Physical Therapy Association. (2023). A physical therapy profile: Demographics of the profession, 2021–2022. https://www.apta.org

Balinski, M., Blanchard, L., Mendoza, R., Zaranec, M., Duncombe, A., & Madhavan, S. (2024). Factors associated with physical therapy attendance rate and self-discharge in people with chronic pain. JOSPT Open, 2(4), 332–339. https://doi.org/10.2519/josptopen.2024.1136

Beattie, P. F., Nelson, R. M., & Heintzelman, M. (2011). The relationship between patient satisfaction with physical therapy care and global rating of change reported by patients receiving worker's compensation. Physiotherapy Theory and Practice, 27(4), 310–318. https://doi.org/10.3109/09593985.2010.490575

Nicholson, V., Tuttle, N., Papinniemi, A., & Evans, K. (2023). Patients report being satisfied with private musculoskeletal physical therapy when therapists educate effectively and facilitate shared decision making. Brazilian Journal of Physical Therapy, 27, 100501. https://doi.org/10.1016/j.bjpt.2023.100501

Tammany, J. E., O'Connell, J. K., Allen, B. S., & Brismée, J.-M. (2019). Are productivity goals in rehabilitation practice associated with unethical behaviors? Archives of Rehabilitation Research and Clinical Translation, 1, 100002. https://doi.org/10.1016/j.arrct.2019.100002

Episode 15 of Future Proof PT is Out. Link below.