Patient-therapist clinical encounter: A scoping review of factors that influence a patient’s perception of high value care in musculoskeletal physiotherapy

The objective of this scoping review is to identify factors within the patient–therapist encounter that contribute to patients’ perceptions of high-value MSK physiotherapy care. Methods Design A scoping review methodology was chosen because it aligns with the broad, exploratory objective of this research (1). The protocol follows guidance from the Joanna Briggs Institute, and its reporting adheres to the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (2-3). The final scoping review will be reported according to the PRISMA Extension for Scoping Reviews (4). This protocol has been registered with Open Science Framework, where any future modifications will be documented. Scoping review team Consistent with recognized standards for conducting scoping reviews, the research team represents expertise across physiotherapy practice and scoping review methodology. Several team members are practising physiotherapists with regular clinical exposure to individuals with musculoskeletal (MSK) conditions. The team also includes a Teaching and Learning Librarian with advanced training in search strategy design and information retrieval. Eligibility criteria Population This scoping review will include studies involving adults (≥18 years old) receiving physiotherapy for musculoskeletal (MSK) conditions defined according to the World Health Organization as “impairments in the muscles, bones, joints, and connective tissues that lead to temporary or lifelong limitations in function and participation and can impact people’s ability to work and participate in society (5). Eligible MSK conditions may involve any anatomical region (e.g., spine, upper limb, lower limb) and may be acute, subacute or chronic. Studies involving mixed rehabilitation populations (ex. Neuro and MSK) will be included if the data for adult MSK populations can be extracted separately. Concept The concept of interest is factors within the patient-therapist clinical encounter that influence patients’ perceptions of high value physiotherapy care (e.g., physical therapists’ active listening skills and perceived clinical competence, agreement on goals of therapy, appointment duration). Studies will be excluded if they focus solely on clinical reasoning, physiotherapy treatments or program design, report only patient outcomes, or only measure strength of the therapeutic interaction. Studies including perspectives of high-value care from both patients and physiotherapists will be included only if patient-specific data can be extracted. Context Eligible studies must be conducted in outpatient physiotherapy settings where one-to-one MSK care is provided. Multidisciplinary outpatient settings will be included only when data from the physiotherapist-patient interaction can be extracted. No restrictions will be placed on geographic location, treatment duration, or number of clinical encounters. Additional criteria Only qualitative studies will be included to allow a rich understanding of factors patients perceive as contributing to high-value physiotherapy care. Editorials, commentaries, letters, and reviews will not be included. When a relevant review is identified, its included studies will be screened for additional eligible primary studies. Conference abstracts will not be included unless a corresponding full-text publication can be located, in which the full text will be included. Studies published in any language will be considered. For non-English studies, an initial translation will be generated (e.g., using Google Translate), and a fluent speaker will be sought to review and edit the translation as needed to ensure accuracy. The translation approach for each non-English study will be reported for transparency. Information sources Searches will be conducted from database inception to Jan 28, 2026, in the following electronic databases: MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Scopus, and Web of Science. Grey literature will be sought through ProQuest Dissertations and Theses. Search strategy A comprehensive search strategy will be developed collaboratively with a Teaching and Learning Librarian. The initial strategy will be created in MEDLINE and then adapted to the remaining databases. Search terms will be organized around key conceptual groupings (musculoskeletal conditions, physiotherapy and high value care) and informed by prior reviews examining patient experiences in physiotherapy (6,7). Selection of sources of evidence All retrieved citations will be imported into Covidence for screening and management, where automatic duplicate removal will be performed. Study selection—including title/abstract and full-text screening—will be conducted within Covidence by two reviewers working independently. Title and abstract screening will be conducted by two reviewers working independently using a three-category decision structure: yes, no or maybe. Disagreements between yes/maybe and no decisions will be resolved through discussion; if consensus is not reached, a third reviewer will mediate. Citations receiving yes or maybe decisions from both reviewers will proceed to full text screening. Full texts of potentially eligible studies will be independently assessed by the two independent reviewers to determine whether the study meets the eligibility criteria and should be included or excluded. Any disagreements regarding inclusion and exclusion at this stage will be resolved through discussion; if consensus is not reached, a third reviewer will mediate. To support consistency in study selection, pilot testing will be conducted prior to formal screening. This will include screening 50 citations at the title and abstract stage and 5 full texts at full text stage. If less than 80% agreement is achieved during pilot screening, eligibility criteria will be reviewed and clarified to ensure consistent application. Data charting process A standardized data extraction form will be developed in alignment with scoping review best practices (8). Two reviewers will chart data independently using Microsoft Excel. A pilot test using five studies will be completed to ensure that the extraction form is clear and comprehensive. Any disagreements in extracted data will be resolved through discussion, or if necessary, adjudicated by a third reviewer. When essential information is unclear or missing, authors will be contacted, with one reminder email sent after two weeks if needed. Data items Data to be extracted from eligible studies will include study characteristics (author(s), year of publication, country/region of study, journal or source, study design, data collection methods, study aim, theoretical or conceptual framework used (if any)), information about the patient population (sample size, age, sex/gender, MSK conditions treated, condition duration, prior physiotherapy experience (if described)), information about the characteristics of the physiotherapists (years of clinical experience, advanced training or credentials (if reported), area of practice or specialization (if reported)), and key findings of factors that contribute to patients’ perceptions of high-value MSK physiotherapy care. Synthesis of results The synthesis of results will follow an inductive, descriptive analytical approach consistent with methodological guidance for scoping reviews (8). Study characteristics will first be summarized using descriptive statistics to map the scope of the evidence, including study context, participant characteristics and qualitative data sources. A basic qualitative content analysis using an inductive approach will then be undertaken to identify the factors within the patient-physical therapist clinical encounter that contribute to patients’ perceptions of high value MSK physiotherapy care. First, reviewers will immerse themselves in the extracted data by reading and understanding how data are relevant to the review objective. Reviewers will then conduct open coding to describe the data and develop a coding framework. Codes will then be iteratively grouped into higher order categories and subcategories through team discussion, allowing patterns to emerge directly from the data rather than being determined a priori. Findings will be presented narratively and in tabular form to describe the range and nature of identified factors. References Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. pmid:30453902 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. pmid:25554246 Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26. pmid:33038124 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. Musculoskeletal health [Internet]. [cited 2026 Jan 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist–patient relationship on treatment outcome in physical rehabilitation: a systematic review. Phys Ther. 2010;90(8):1099–1110. doi:10.2522/ptj.20090245. O’Keeffe M, Cullinane P, Hurley J, Leahy I, Bunzli S, O’Sullivan PB, et al. What influences patient–therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis. Phys Ther. 2016;96(5):609–622. doi:10.2522/ptj.20150240. Pollock D, Peters MDJ, Khalil H, McInerney P, Alexander