Work Type



Fall 2016

Faculty Advisor

Danny McMillian, PT, DSc, OCS




Title: Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome?

Authors: Molly Geiger SPT1, Stephanie Juhnke SPT1, Ellen Maloney SPT1, Danny McMillian DSc.1

Affiliation: 1. School of Physical Therapy, University of Puget Sound

Purpose: Several studies have linked psychosocial factors, such as depression, self-efficacy, and fear-avoidance to poor outcomes, increased disability, and the development of chronic pain. In a primary care setting, Foster has shown self-efficacy to be the most important for determining outcomes. The aim of this study is to examine the relationship between self-efficacy (SE) levels and physical therapy (PT) outcomes. We believe a patient’s SE levels will be positively correlated with PT outcomes. Specifically, higher SE levels will be associated with successful outcomes.

Subjects: 11 Subjects (5 females and 6 males, ages 21-76 years old) from the University of Puget Sound’s outpatient musculoskeletal clinic participated in this study. Patients presented with a wide range of musculoskeletal impairments.

Materials & Methods: Subjects from the University of Puget Sound’s musculoskeletal clinic were recruited for the study. Subjects completed the General Self-Efficacy Questionnaire prior to their initial evaluation and a specified relevant outcome measure and the Numeric Pain Rating Scale on both the initial and final treatments. Changes in outcomes were compared to the minimal clinically important difference (MCID) and then correlated with the GSE score.

Results: The results of this study reveal no statistically significant relationship between SE levels and physical therapy outcome. A Point Biserial Correlation showed that the initial GSE score was only moderately correlated with the pain scale, r=0.589 p-value=0.296, and with the results on the outcome measures, r=0.503 p=0.114. Notably, for all subjects the average GSE score was high at 79.8%. The average GSE scores for those who saw improvement (met MCID or not) versus those who saw no change or worse outcomes was 85.0% and 65.8% respectively.

Conclusion: While this study only shows a moderate correlation between SE levels and PT outcomes, it does shine a light on the uniqueness of PT performed in an educational setting. Because student physical therapists were treating patients under supervision of the clinical instructors, it is conceivable patients pursuing treatment in this setting have high SE levels. This could explain the lack of variability in the data collected as well as indicate a need to expand the psychosocial parameters measured. Although significant results were not achieved, a comparison of SE averages between groups (improved or not) does suggest the potential for a relationship between psychosocial factors and therapeutic outcomes to exist.

Clinical Relevance:

The lack of variability obtained in this study indicates the need for larger sampling and an expansion of the psychosocial factors measured. Additionally, when collecting data in an educational setting, clinical researchers should acknowledge that generalizability might be limited by the unique characteristic of patients receiving care in that setting.


  1. Tijou I, Yardley L, Sedikides C, Bizo L. Understanding adherence to physiotherapy: Findings from an experimental simulation and an observational clinical study. Psych Health. 2010;25(2).
  2. Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain. 2010;148(3):398-406.
  3. Bergbom S, Boersma K, Overmeer T, Linton SJ. Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. PHYS THER. 2011;91:754-764.
  4. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. PHYS THER. May 2011;91:700-711.
  5. Overmeer T, Boersma K, Denison E, Linton SJ. Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? A randomized controlled trial. PHYS THER. 2011;91(5):804-819.
    1. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: Integration of psychosocially informed management principles into physical therapist practice--challenges and opportunities. PHYS THER. 2011;91:790-803.


University of Puget Sound