Patient-Identified Outcomes of Importance Association With Expectations, Therapeutic Alliance, and Outcomes in Musculoskeletal Conditions

OBJECTIVE: To identify patient subgroups based on their perceived importance of improvement across multiple domains (pain, fatigue, emotional distress, and interference) using the Patient-Centered Outcomes Questionnaire. Additionally, we examined the association between subgroups, treatment expectations, therapeutic alliance, and clinical outcomes. DESIGN: A prospective cohort study conducted in a university-based outpatient physical therapy clinic. METHODS: Patients (N = 169) with musculoskeletal conditions completed the Patient-Centered Outcomes Questionnaire, the Credibility and Expectancy Questionnaire, and the Working Alliance Inventory–Short Form Revised (WAI-SR). Cluster analysis identified patient subgroups based on their improvement priorities. Differences between subgroups in expectations, therapeutic alliance, and changes in pain and function were analyzed using t tests and analysis of variance. RESULTS: Two- and three-cluster solutions were considered. In both solutions, 2 subgroups emerged rating all domains as highly important, 1 subgroup, Global Importance, and a second subgroup prioritizing pain and interference, Pain and Function. The 3-cluster solution identified a subgroup characterized by high importance ratings for pain, interference, and fatigue ( Pain and Function with Fatigue). The Global Importance groups reported significantly higher expectations for treatment success ( P = .025, P = .008). The Global Importance subgroup from the 2-cluster solution also reported stronger therapeutic alliance ( P = .032). No differences were found between subgroups in pain or functional improvements. CONCLUSION: In this exploratory analysis, the Global Importance subgroups had stronger therapeutic alliance and higher expectations for treatment success. JOSPT Open 2026;4(1):91-100. Epub 17 December 2025. doi:10.2519/josptopen.2025.0165