Patient Beliefs, Expectations and the Therapeutic Alliance in Musculoskeletal Physical Therapy: What a Qualitative Study and a Prospective Cohort Found

This course is written for licensed physical therapists and physical therapist assistants working in outpatient orthopedics, and for clinicians in any setting who deliver hands-on care and want an accurate account of what two recent studies report about patient beliefs, treatment expectations and the therapeutic alliance. Physical therapist assistants may take this course; the course describes the assistant’s part as care delivered under the direction and supervision of the physical therapist, with evaluation, diagnosis and plan-of-care decisions remaining with the therapist.

Physical therapists and physical therapist assistants in outpatient orthopedic and general musculoskeletal practice.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

Petosky T, Vraa DL, Rentmeester C, Subialka J, Young JL. How Do Patients Believe Manual Therapy Works? An Exploratory Qualitative Study. JOSPT Open. 2026;4(1):82-90. doi:10.2519/josptopen.2025.0149

Holmes MB, Gary G, Friend C, George SZ. Patient-Identified Outcomes of Importance Association With Expectations, Therapeutic Alliance, and Outcomes in Musculoskeletal Conditions. JOSPT Open. 2026;4(1):91-100. doi:10.2519/josptopen.2025.0165

After completing this course, you will be able to:

1. Describe the three themes — mechanical, neurophysiological and psychological — that participants used to explain how manual therapy works in the exploratory qualitative study, and state the authors' observation that participants more often named outcomes than mechanisms.
2. Name the patient priority subgroups derived in the prospective cohort study and state which subgroup reported higher treatment expectations and a stronger therapeutic alliance.
3. Explain what the two papers together do and do not show about the relationship between patient beliefs, patient-identified priorities and short-term pain and function outcomes, and where the two reports diverge.

1. Start Here: How This Course Works
2. Part One: How Patients Believe Manual Therapy Works
3. Who Took Part in the Interview Study
4. How the Interviews Were Conducted and Analyzed
5. Mechanical, Neurophysiological and Psychological Beliefs
6. What the Interview Findings Mean and Where They Stop
7. Part Two: Patient Priorities, Treatment Expectations and the Therapeutic Alliance
8. Who Was Enrolled in the Outpatient Cohort
9. How Priorities, Expectations and Alliance Were Measured
10. The Priority Subgroups and What Differed Between Them
11. Limits of an Exploratory Cohort and What the Authors Concluded
12. Bringing It Together
13. Where the Two Papers Agree
14. Where the Findings Diverge
15. Eliciting Beliefs and Expectations in the Subjective Examination
16. What Remains Open
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. Petosky T, Vraa DL, Rentmeester C, Subialka J, Young JL. How Do Patients Believe Manual Therapy Works? An Exploratory Qualitative Study. JOSPT Open. 2026;4(1):82-90. doi:10.2519/josptopen.2025.0149
2. Holmes MB, Gary G, Friend C, George SZ. Patient-Identified Outcomes of Importance Association With Expectations, Therapeutic Alliance, and Outcomes in Musculoskeletal Conditions. JOSPT Open. 2026;4(1):91-100. doi:10.2519/josptopen.2025.0165