Measuring verbal communication in initial physical therapy encounters
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Updated: May 16, 2026
Modeling Verbal Behavior Deficits with the Stimulus Control Ratio Equation, SCoRE
Published on: May 14, 2019
Lisa C Roberts1, Christopher T Whittle, Jennifer Cleland
1Faculty of Health Sciences, University of Southampton, Building 45, Highfield, Southampton, Hampshire, SO17 1BJ, UK. l.c.roberts@soton.ac.uk
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.
Design:
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%).
Limitations:
Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded.
Conclusion:
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.
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