Background & Aims
Prior research has found that Latino patients in a Federally Qualified Health Center (FQHC) have higher rates of non-adherence to a physical therapy (PT) referral compared to non-Hispanic White patients.1 Latinos also experience disparities in healthcare access, diagnosis, and treatment of chronic pain.2-3 Understanding the motivations and challenges that influence engagement in PT among Latino patients with chronic pain may help providers identify strategies to improve PT engagement and outcomes. The purpose of this study was to assess the motivations and challenges to engaging in PT for Latino patients with chronic spine pain at a FQHC located near the US-Mexico border.
Methods
Seven Latino/a participants with chronic spine pain (2M, 5F; 40-63 years; 6 Spanish-speakers, 1 English-speaker) were purposively sampled from a FQHC. Four participants engaged in a hybrid cognitive behavioral-based physical therapy (CBPT) telerehabilitation program for eight weeks, which included two in-person and six telehealth sessions. The CBPT participants attended all PT treatment sessions. Three participants received traditional in-person PT at the FQHC. One traditional PT participant completed treatment (10 sessions) and two participants attended half of their recommended PT sessions (3 and 5 sessions). Semi-structured interviews were conducted upon completing treatment to explore participants’ motivations and challenges to engaging in PT. Interviews were audio-recorded and transcribed. Two independent coders used Rapid Qualitative Analysis to identify participant perspectives on their PT treatment experiences.
Results
Interviews supported three themes on motivations to engage in PT: (1) improvement in outcomes including reduced pain and increased mobility (“I can do more activities that I did before the pain that I couldn’t do before PT”), (2) therapeutic alliance with the physical therapist (“He [my PT] accompanied me in my process”), and (3) positive experiences with clinic staff (“All that attention they give to people makes you feel like you matter”). Challenges to engaging in PT were discussed less often and included both environmental and personal barriers:(1) lack of transportation (“How am I going to come and go if I don’t have a way to drive?”), (2) time constraints due to family caregiver responsibilities (“…not able to fully commit myself to the exercises because of my mother’s worsening dementia”), and (3) negative thoughts about PT (“…maybe I was going to be worse than how I was”).
Conclusions
Improvements in pain and mobility are motivating factors for patient engagement in PT. Positive experiences between patients and clinic staff and therapeutic alliance with providers also appear to increase motivation to engage in PT treatment. The impact of identified challenges to PT engagement such as transportation and caregiver responsibilities could be minimized by connecting patients with transportation and caregiving resources. Negative thoughts about engaging in PT could be addressed through patient education and establishing a strong therapeutic alliance. PT clinics and providers may consider these factors to increase motivation and mitigate challenges to PT engagement among Latino patients with chronic spine pain.
References
1.Dionicio P, Lin SF, Khasira M, et al. Factors Associated with Satisfaction with Physical Therapy Services – a Survey of Patients with Musculoskeletal Pain at a Federally Qualified Health Center. Physical Therapy Theory and Practice [In Press]. 2024.
2.Nguyen M, Ugarte C, Fuller I, Haas G, Portenoy RK. Access to care for chronic pain: racial and ethnic differences. J Pain. May 2005;6(5):301-14.
3.Sharpe JA, Martin BI, Fritz JM, et al. Identifying patients who access musculoskeletal
physical therapy: a retrospective cohort analysis. Family Practice. 2021;38(3):203-209.
doi:10.1093/fampra/cmaa104
Presenting Author
Cristina Rangel Batalla
Poster Authors
Topics
- Racial/Ethnic/Economic Differences/Disparities