{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T07:49:59Z","timestamp":1767772199429,"version":"build-2065373602"},"reference-count":53,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiotherapy Res Intl"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Purpose<\/jats:title>\n                    <jats:p>Musculoskeletal (MSK) pain is a common issue among higher education students and is often linked to poor physical function and a high psychosocial burden. In direct access physiotherapy, a patient\u2010centered approach is essential for building a strong therapeutic relationship. While therapist attributes are known to influence this relationship, this study aimed to explore whether patient\u2010specific factors, including psychosocial burden, physical function, and chronic pain, are associated with students' perception of the therapeutic relationship during their first physiotherapy visit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational cross\u2010sectional study included 326 higher education students with MSK pain (median age: 26\u00a0years) visiting direct access physiotherapy in Finnish Student Health Service (FSHS). The Experience of the Therapeutic Relationship questionnaire was used to assess the therapeutic relationship. Patient\u2010specific factors included psychosocial burden and psychological distress, measured with the Short Form \u00d6rebro Musculoskeletal Pain Screening Questionnaire (\u00d6MPSQ\u2010SF) and the Mental Health Index (MHI\u20105), respectively; physical function evaluated using the Patient\u2010Specific Functional Scale (PSFS), and chronic pain derived from the \u00d6MPSQ\u2010SF. Additional baseline data, including the level and field of study, FSHS region in Finland, and gender and age, were collected. Multiple linear regression analysis was performed to examine the associations between the therapeutic relationship and patient\u2010specific factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Psychological distress (\n                      <jats:italic>\u00df<\/jats:italic>\n                      \u00a0=\u00a00.30, 95% CI 0.03 to 0.58) and poorer self\u2010rated physical function (\n                      <jats:italic>\u00df<\/jats:italic>\n                      \u00a0=\u00a0\u22120.13, 95% CI \u22120.24 to \u22120.02) were associated with a more negative perception of the therapeutic relationship. However, no significant associations were found for psychosocial burden (\u00d6MPSQ\u2010SF moderate\u2010risk\n                      <jats:italic>\u00df<\/jats:italic>\n                      \u00a0=\u00a0\u22120.19, 95% CI \u22120.50 to 0.12; high\u2010risk\n                      <jats:italic>\u00df<\/jats:italic>\n                      \u00a0=\u00a0\u22120.02, 95% CI \u22120.34 to 0.30) or chronic pain (\n                      <jats:italic>\u00df<\/jats:italic>\n                      \u00a0=\u00a00.004, 95% CI \u22120.22 to 0.22).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Psychological distress and impaired physical function appear to be negatively associated with students' perception of the therapeutic relationship. Integrating these factors into patient\u2010centered care could potentially enhance therapeutic interactions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pri.70112","type":"journal-article","created":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T03:38:37Z","timestamp":1758944317000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Patient\u2010Specific Factors and the Therapeutic Relationship in Direct Access Physiotherapy for Higher Education Students\u2014An Observational Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8051-8945","authenticated-orcid":false,"given":"Heidi Emilia","family":"Riska","sequence":"first","affiliation":[{"name":"Finnish Student Health Service  Helsinki Finland"},{"name":"Faculty of Sport and Health Sciences University of Jyv\u00e4skyl\u00e4  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaro Ilari","family":"Karppinen","sequence":"additional","affiliation":[{"name":"Medical Research Center Oulu University of Oulu and Oulu University Hospital  Oulu Finland"},{"name":"Research Unit of Health Sciences and Technology University of Oulu  Oulu Finland"},{"name":"Wellbeing Services County of South Karelia  Lappeenranta Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia Eveliina","family":"Heikkala","sequence":"additional","affiliation":[{"name":"Medical Research Center Oulu University of Oulu and Oulu University Hospital  Oulu Finland"},{"name":"Research Unit of Health Sciences and Technology University of Oulu  Oulu Finland"},{"name":"Wellbeing Services County of Lapland  Rovaniemi Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riku Petteri","family":"Nikander","sequence":"additional","affiliation":[{"name":"Faculty of Sport and Health Sciences University of Jyv\u00e4skyl\u00e4  Jyv\u00e4skyl\u00e4 Finland"},{"name":"Wellbeing Services County of Central Finland  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jari Juhani","family":"Villberg","sequence":"additional","affiliation":[{"name":"Faculty of Sport and Health Sciences University of Jyv\u00e4skyl\u00e4  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7648-0130","authenticated-orcid":false,"given":"Arto Jorma","family":"Hautala","sequence":"additional","affiliation":[{"name":"Faculty of Sport and Health Sciences University of Jyv\u00e4skyl\u00e4  Jyv\u00e4skyl\u00e4 Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.002"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1515\/IJAMH.2008.20.4.501"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3233\/BMR\u2010160563"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010017\u20102311\u20103"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u2010006X.75.6.842"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.05.018"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010199102000\u201000008"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0085885"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/21679169.2019.1672786"},{"issue":"2","key":"e_1_2_12_11_1","first-page":"323","article-title":"Prevalence of Biopsychosocial Factors of Pain in 865 Sports Students of the Dach (Germany, Austria, Switzerland) Region\u2014A Cross\u2010Sectional Survey","volume":"19","author":"Bumann A.","year":"2020","journal-title":"Journal of Sports Science and Medicine"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2012.07.002"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1674388"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2016.1223176"},{"issue":"1","key":"e_1_2_12_15_1","first-page":"3","article-title":"The Session Rating Scale: Preliminary Psychometric Properties of a \u201cWorking\u201d Alliance Measure","volume":"3","author":"Duncan B. 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