title: Measuring verbal communication in initial physical therapy encounters.
abstract: BACKGROUND
  Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician.
  
  
  OBJECTIVE
  The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application.
  
  
  METHODS
  A cross-sectional study was conducted.
  
  
  METHODS
  Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes.
  
  
  RESULTS
  In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more "history/background probes," more "advice/suggestion," and less "restatement" than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%).
  
  
  CONCLUSIONS
  Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded.
  
  
  CONCLUSIONS
  This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (i.e., Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience.
authors.affiliation: Faculty of Health Sciences, University of Southampton, Building 45, Highfield, Southampton, Hampshire, SO17 1BJ, UK. l.c.roberts@soton.ac.uk
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Roberts
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Whittle
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cleland
authors.forename: Mike
authors.initials: M
authors.lastname: Wald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000523:psychology*; D010817:Physician-Patient Relations; D055815:Young Adult