










































MANUSCRIPT TYPE


EVIDENCE-TO-PRACTICE REVIEW 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 

 
 

The Value of Patient-Provider Interactions in Orthopedic Settings: An 
Evidence-to-Practice Review  
Matthew S. Panetta, SCAT, ATC; Carly J. Wilson, SCAT, ATC; and Zachary Winkelmann, PhD, SCAT, ATC 
University of South Carolina, Columbia, SC 
  

 
ABSTRACT 

Clinical outcomes are influenced by specific physical therapy 
interventions and several nonspecific factors associated with 
the healthcare professional, patient, and setting. The 
relationship built between patients and providers is based on 
treatment outcomes is referred to as the patient-provider 
interaction, which is a nonspecific factor. The purpose of this 
review was to investigate patients’ and clinicians’ perceptions 
of factors that influence patient-provider interactions. Eleven 
different databases were accessed as potential research 
sources. Thirteen qualitative studies were selected that 
examined the perceptions of non-specific factors which 
impact the patient-clinician relationship as well as the 
perceptions that healthcare providers and patients in 
musculoskeletal settings. Out of these 13 articles, four 
common themes were found to influence the patient-provider 
interaction across all the literature selected for this review: 
clinician interpersonal and communication skills, clinician 
practical skills, individualized patient-centered care, 
organizational and environmental factors. Articles for this 
study were only considered for review if they were published 
in English. This was stated as a limitation of the study, as well 
as the fact that this review only identified factors that are 
perceived to be related to patient-provider interactions. The 
review highlighted that patients and clinicians believe 
communication, interpersonal and practical skills, 
individualized care, and appropriate time and flexibility for 
patient care influence patient-provider interaction in 
musculoskeletal settings. These factors can serve as 
facilitators as well as barriers, depending on the level of 
intensity that they are implemented in the overall patient-
provider interaction. Athletic trainers, as healthcare 
professionals, need to be responsible for implementing 
patient-centered care concepts to encourage a healthy 
patient-provider interaction. 
 
Key Phrases 
Organizational and personal outcomes & patient education 
 
Correspondence 
Dr. Zachary Winkelmann, University of South Carolina 
1300 Wheat Street, Columbia, SC 29208.  
E-mail: winkelz@mailbox.sc.edu  
Twitter: @zachwinkelmann 
 
 
 
 
 

Full Citation 
Panetta MS, Wilson CJ, Winkelmann ZK. The value of 
patient-provider interactions in orthopedic settings: an 
evidence-to-practice review. Clin Pract Athl Train. 
2020;3(3):18-23. 
https://doi.org/10.31622/2020/0003.3.4.     
 
Submitted: April 20, 2020 Accepted: September 1, 2020 

 

ORIGINAL REFERENCE AND SUMMARY 

O'Keeffe M, Cullinane P, Hurley J, Leahy I, Bunzli 
S, O'Sullivan P, O'Sullivan K. What influences 
patient-therapist interactions in musculoskeletal 
physical therapy? Qualitative systematic review and 
meta-synthesis. Phys Ther. 2016;96(5):609–622. 
 
SUMMARY 
 
CLINICAL PROBLEM AND QUESTION 
 

Sports medicine providers assist a wide range 

of patients with various degrees of 
musculoskeletal pain, guiding them through both 
the physical and psychological aspects of 
recovery and rehabilitation and often forming 
strong bonds along the way. Healthcare providers 
who practice from a clinician-driven mindset will 
focus on identifying the diagnosis and prescribing 
interventions and rehabilitation for treatment.1 A 
clinician-driven mindset can often cause the 
provider to neglect important patient-centered 
care principles during the patient-provider 
interaction. The patient-provider interaction is 
defined as the sense of collaboration, warmth, 
and support between the patient and the 
clinician.2 Previous research has focused on the 
impacts that patient-provider relationships have 
on treatment outcomes. The common theme 
identified in multiple studies has been a strong 

mailto:winkelz@mailbox.sc.edu
https://doi.org/10.31622/2020/0003.3.4


The Value of Patient-Provider Interactions in Orthopedic Settings: An Evidence-to-Practice Review 
 

 

19 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

bond between the healthcare provider and 
patient results in improved patient outcomes and 
recovery.3 Positive patient interactions in 
therapeutic rehabilitation settings have been 
linked to reduced pain and disability, as well as 
higher treatment satisfaction.4 However, there is 
little known about what specific components 
ultimately help form and facilitate that crucial 
relationship between the patient and healthcare 
provider. The primary clinical question of this 
systematic review was to explore what factors 
hindered or assisted the relationship formed 
between sports medicine providers and their 
patients through the therapeutic rehabilitation 
process. The research team of this systematic 
review focused on the term “nonspecific factors”, 
defined as factors associated with provider, 
patient, and setting, to differentiate from more 
clinically related factors such as prescribed 
interventions.  

SUMMARY OF LITERATURE 

Previous literature selected for the guiding 
systematic review2 had to meet specific guidelines 
based on the clinical question. Studies were 
included if they examined the opinions and 
viewpoints of patients or physical therapists in 
regard to the factors that proved to enable or 
serve as an obstacle to a positive interaction 
between patients and their provider.2 Exclusion 
criteria was defined as primarily quantitative 
studies, literature that was not reported in English, 
studies looking at settings that did not fit 
musculoskeletal physical therapy or conditions, or 
measured only the strength of the relationship 
between healthcare provider and patient rather 
than the factors that established it in the first 
place.2 Through quality assessment and screening, 
13 articles were approved to be included in the 
systematic review and meta-synthesis with a total 
of 253 patients and 78 providers being 
interviewed. The guiding systematic review2 was 
the first to look at provider and patient 
perceptions of patient-centered care 

simultaneously. Eight articles investigated 
clinician’s interpersonal and communication skills, 
ten articles evaluated clinician practical skills, 
seven articles examined individualized patient-
centered care, and six articles investigated 
organizational and environmental factors.2 

SUMMARY OF OUTCOMES 

The authors from the guiding systematic review2 
examined the providers’ and patients’ perceptions 
of factors that influence patient-provider 
interactions in musculoskeletal settings. The authors 
examined the thirteen qualitative studies using the 
Critical Appraisal Skills Programme (CASP) 
Qualitative Research Assessment Tool. The 
patient-provider interaction is also referred to as 
the relationship between patients and healthcare 
providers on treatment outcomes. The relationship 
is usually built from a sense of collaboration, 
warmth, and support between individuals and 
includes agreement on goals and interventions 
and overall attitudes among each other.2 This is 
essentially the basis of patient-centered care: 
ensuring that high quality, holistic care is being 
provided that includes the values and goals of the 
patient.  

FINDINGS AND CLINICAL IMPLICATIONS 

From the 13 studies that were included, four 
themes were reported to influence patient-
clinician interactions (Figure 1). The first theme 
encompassed clinician interpersonal skills, such as 
active listening, empathy, friendliness, 
encouragement, confidence, and nonverbal 
communication.2 Physical therapist practical skills 
comprised the second theme, which focused on 
clinician practical skills, which included proficiency, 
training and ability to explain healthcare 
concepts to the patient. Theme three was 
individualized patient-centered care, which was 
assessed by taking the patient’s opinion into 
consideration and individualizing the treatment. 
Lastly, organizational, and environmental factors,  



The Value of Patient-Provider Interactions in Orthopedic Settings: An Evidence-to-Practice Review 
 

 

20 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

  

Interpersonal and 
Communication Skills

Active listening Allow patients to tell their stories 
without interruption 

Encourgament Provide accurate reassurance as a 
form of emotional support

Empathy Consider how the patient's pain could 
impact their lives

Confidence Find the balance between confidence 
and arrogance

Friendliness Integrate a pleasant daily greeting 
for each patient

Non-verrbal
communication

Consider your body language and 
the patien'ts mannerisms

Practical Skills 

Patient education
Provide simple and clear instructions. 
Tell them the "why" of their treatment 

plan.

Clinician expertise and 
training

Engage in continuing professional 
development to keep developing 

technical abiltiies

Individualized Patient-
Centered Care

Individualized care Make adjustments to each patient's 
care plan

Considering patient’s 
opinions and preferences

Do not ignore the patient's thoughts 
about certain exercises

Organizational and 
Environmental Factors

Time Spend more time explaining the 
injury, illness, or treatment

Flexibility with patient 
appointments and care

Consider a line of communication for 
the patient to contact you about their 
home care plan after your evaluation

Figure 1. Main Influences of Patient-Provider Interactions in Musculoskeletal Physical Therapy. The first 
and second column are the main themes and traits from the study. The third column includes clinical 
bottom lines and suggestions to improving patient-provider interactions. 



The Value of Patient-Provider Interactions in Orthopedic Settings: An Evidence-to-Practice Review 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

including the time and provider’s flexibility with 
care and appointments constituted the fourth 
theme. The four themes found in this study can be 
incorporated regularly into everyday athletic 
training clinical practice to enhance patient-
provider relationships. 

Theme 1 - Clinician Interpersonal and 
Communication Skills 

There were several interpersonal and 
communication factors from both the patient and 
clinician that determined the quality of 
interactions, such as verbal and nonverbal 
communicative ability, empathy, and trust. Active 
listening was the most common aspect stated by 
both patient and clinician.2 Active listening is 
giving one’s undivided attention to the speaker 
while using appropriate non-verbal 
communication to assure the patient that they are 
being understood.2 Clinicians who actively listen 
will reassure the patient that they are valued, 
which will strengthen the patient-clinician bond.5 
The findings also showed a discrepancy between 
clinician and patient about encouragement for the 
patient during their appointment. Patients that did 
not receive enough encouragement may feel less 
motivated to give their best effort during 
rehabilitation and improvement goals may not be 
met on time.6 From the thirteen articles included in 
the guiding review, there were zero reported 
statements regarding encouragement from the 
clinician’s stance. Athletic trainers should practice 
active listening with non-verbal communication, 
along with sincere empathy and encouragement 
for the patient to optimize patient satisfaction. 

Theme 2 – Clinician Practical Skills 

The next theme focused on the practical skills of 
the clinician. Healthcare professionals and 
patients share the belief that healthcare expertise 
was crucial to the development of a strong 
patient-clinician relationship.2,6 Clinician expertise 
encourages patients to develop trust and reliance 
with the clinician, strengthening the patient-

provider interaction.2 Clinicians stated that 
continuing education and skill development were 
important to the maintenance of the patient-
clinician relationship. Patients highly valued a 
provider who could easily explain the patient’s 
problem, how the provider could help them, and 
why the provider was prescribing specific 
exercises in their rehabilitation.2,7 The concept of 
patient education can relate directly back to 
athletic training, where the athletic trainer is on the 
front lines of sharing and disseminating 
information to the patient on their diagnosis and 
rehabilitation plan while avoiding medical jargon. 
Athletic trainers should address health literacy 
and assist patients in their capacity to process and 
understand their health conditions. Patient 
education with clear explanations can help the 
patient feel more comfortable with their 
rehabilitation protocol and clinician’s decision 
making.2 Athletic trainers share this priority for 
developing and maintaining clinical competency 
and have expressed a professional desire for 
more research to be done in focus group sessions 
for the Prioritized Research Agenda for the 
Athletic Training Profession organized by the 
Strategic Alliance Research Agenda Task Force.8  

Theme 3 - Individualized Patient-Centered Care 

Patient-centered care is the practice of being 
“respectful of and responsive to individual patient 
preferences, needs, and values, and ensuring that 
patient values guide all clinical decisions.”9 
Patients highlighted the importance of 
individualized patient care and taking into 
consideration patients’ opinions and preferences 
in regards to the patient-provider relationship2, 
stating that they found it annoying when their 
clinician ignored their preferences and felt that it 
diminished the overall interaction.5 Patients 
appreciated when their clinician made an effort 
to adjust or adapt their rehabilitation in relation 
to their inability to complete a task, which 
positively affected the patient-provider 
relationship.2 This can easily relate to the 



The Value of Patient-Provider Interactions in Orthopedic Settings: An Evidence-to-Practice Review 
 

 

22 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

profession of athletic training. Athletic trainers are 
providers with the unique opportunity to work with 
patients from initial injury to final discharge. 
Throughout this process, the athletic trainer should 
tailor the patient’s rehabilitation to their functional 
goals and personal preferences to facilitate 
patient engagement and commitment.  

Theme 4 - Organizational and Environmental 
Factors 

A healthcare professional’s lack of organization 
regarding the amount of time given to patients 
and appointment flexibility created a general 
dissatisfaction for patients.2 Athletic trainers may 
be limited in their amount of time for patient care. 
In this guiding review, both patients and providers 
stated that allowing patients appropriate time to 
explain their problem and discuss their treatment 
was essential to maintaining a positive patient-
provider interaction.2 It may be beneficial for the 
provider to be proactive and plan out each 
patient’s rehabilitation and main points of 
discussion prior to seeing them, as well as being 
flexible. However, only one healthcare provider 
in the guiding review stated that flexibility with 
patient appointments and care was important, 
compared to five patient statements. Patients 
expressed appreciation towards clinicians who 
accommodated patient care and appointment 
scheduling based on their needs.2 Athletic trainers 
work with a variety of patient populations who 
also have busy schedules that have to be worked 
around to fit in rehabilitation appointments. To 
reduce the feeling of being rushed and increase 
the patient’s satisfaction, athletic trainers should 
outline the allotted time available for the patient’s 
session at the beginning of the appointment.10 By 
implementing patient-centered care techniques 
into appointment scheduling, athletic trainers can 
maximize the use of their time and convey that the 
patient’s time is just as valued. 

CLINICAL BOTTOM LINE 

The guiding review concluded that healthcare 
professionals and patients believe that 
communication and interpersonal skills, practical 
skills, individualized care, and organizational and 
environmental factors have influences on the 
relationship developed during the rehabilitation 
for musculoskeletal injuries. Furthermore, there is a 
difference between clinicians and patients about 
the value of patient education. Patients rated their 
own education of their rehabilitation as highly 
important to the facilitation of the patient-
provider interaction, however clinicians rated it 
low in value. Patients primarily felt importance in 
active listening, patient education, individualized 
rehabilitation, and encouragement from their 
clinician. Clinicians that take the time to actively 
listen and provide individualized care are much 
more likely to develop stronger interactions and 
relationships that may promote rehabilitation 
outcomes.2,5-7 Scheduling out a block of time 
during the day for one patient to come in while 
preventing interruptions from other individuals can 
show the patient that the clinician has their 
undivided attention for communication and 
rehabilitation.5,6,11 

Patients value their feelings and beliefs regarding 
their care planning. Similarly, athletic trainers’ 
value their own time and effort that they put into 
treatment and rehabilitation with their patients. 
Patients in the guiding review reported strong 
values in education from the clinician.  Athletic 
trainers with a sufficient understanding of the 
injury and patient’s goals can enhance the patient-
clinician interaction through patient-centered care 
tactics. Gaining patient insight can be 
accomplished by asking what questions or worries 
the patient may be having about their 
rehabilitation process. Athletic trainers should also 
work on creating a habit in providing clear 
explanations of their responsibilities and duties 
with the patient when creating goals and decision 
making with certain interventions. The guiding 
review also observed that patients reported that 
encouragement from their clinician was important, 



The Value of Patient-Provider Interactions in Orthopedic Settings: An Evidence-to-Practice Review 
 

 

23 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

even though the clinician did not see any value in 
this factor. Encouraging patients through their 
rehabilitation exercises demonstrates a deeper 
level of care and emotional support, which aligns 
specifically with patient-centered care principles. 
The evidence from this review supports clinician 
interpersonal and practical skills, individualized 
care, and organization factors as influences that 
can cultivate the patient-clinician relationship. 

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