How do novice physiotherapists practice patient education? A video elicitation interview study in musculoskeletal clinical practice in Portugal

Background and purpose Musculoskeletal disorders are a leading cause of disability worldwide, for which person-centred education is recommended as a first-line approach. However, novice physiotherapists often face greater challenges in delivering patient education, and limited understanding exists regarding how it is enacted in everyday clinical practice. This study aimed to explore how Portuguese novice physiotherapists enact patient education during musculoskeletal sessions and how they rationalise their educational practices.Methods An ethnographic study was conducted, involving video-based observations of musculoskeletal treatment sessions delivered by novice physiotherapists, followed by video-elicitation interviews. Data were analysed using a deductive, data-driven content analysis approach.Results Eight novice physiotherapists (≤5 years of professional experience) participated. Educational practices were categorised into three types of therapeutic relationship: activity-passivity, guidance-cooperation, and mutual participation. Most participants demonstrated characteristics of more than one type across interactions; although, a dominant type could be identified for each physiotherapist. Overall, practices tended to cluster towards activity–passivity and guidance–cooperation, with fewer instances of mutual participation.Conclusion The findings suggest that patient education delivered by Portuguese novice physiotherapists remains largely physiotherapist-centred, with limited enactment of shared decision-making and patient autonomy. These results highlight the need for educational and mentorship strategies that better support novice physiotherapists in translating person-centred principles into routine musculoskeletal practice.