JMIR Publications

ABSTRACT

Background:

Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve healthcare interventions. However, findings have been conflicting for patient experiences and outcomes, with the impact in physical therapy, especially in a digital context, being largely unexplored.

Objective:

To evaluate the impact of race/ethnicity or gender concordance between patient and physical therapist in engagement and clinical outcomes following a digital care program in patients with musculoskeletal conditions.

Methods:

This secondary analysis of two prospective longitudinal studies examined the impact of both race/ethnicity and gender concordance between patients and physical therapists on outcomes for a digital intervention for musculoskeletal conditions. Outcomes included engagement (measured by completion rate), satisfaction and clinical outcomes (response rate for pain, anxiety, depression, and daily activities impairment).

Results:

From 71,201 patients, 63.9% (N=45,507) were matched with their physical therapist in terms of race/ethnicity, while 61.2% (N=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted OR 0.90, 95% CI 0.84;0.95, P<.001) and Hispanic (adjusted OR 0.79, 95% CI 0.65;0.93, P=.009) groups, as well as women (adjusted OR 0.90, 95% CI 0.85;0.94, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95%CI 8.27;8.77) reported across all dyads except in Asian patients, who experienced higher satisfaction in discordant dyads. Response rates for pain, anxiety and daily activities impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting higher response rate when matched with physical therapists from other races/ethnicities (adjusted OR 1.20, 95% CI 1.02;1.39, P=.02). In terms of gender, men had a slightly higher pain response in discordant dyads (adjusted OR 1.08, 95% CI 1.01;1.15, P=.03), and higher depression response in concordant dyads (adjusted OR 0.81, 95% CI 0.68;0.95, P=.01).

Conclusions:

Race/ethnicity and gender concordance between patients and physical therapists did not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on adherence. These results highlight the importance of other physical therapists characteristics besides race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken and cultural safety training as ways to optimize care. Clinical Trial: ClinicalTrials.gov (NCT04092946, NCT05417685)