Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies (original) (raw)
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Patient-centredness in physiotherapy from the perspective of the chronic low back pain patient
Physiotherapy, 2008
Objective To define patient-centredness from the patient's perspective in the context of physiotherapy for chronic low back pain (CLBP). Design Qualitative study using semi-structured interviews to explore perceptions of various aspects of physiotherapy management of CLBP. Setting Physiotherapy departments in one geographical area of the UK National Health Service. Participants Twenty-five individuals who had received physiotherapy for CLBP within the previous 6 months. Results Six key themes emerged as the dimensions that the participants perceived to be important for patient-centred physiotherapy: communication; individual care; decision-making; information; the physiotherapist; and organisation of care. Communication was the most important dimension, underpinning the five other dimensions as well as being a distinct dimension of patient-centred physiotherapy. Conclusions Physiotherapists should have an understanding of the six dimensions of patient-centred physiotherapy for CLBP. Improving physiotherapists' communication skills may better facilitate patient-centred physiotherapy, and therefore enhance the experience of physiotherapy for this client group.
Physiotherapy Research International, 2012
Background and Purpose. Patient participation is nowadays considered important for high quality patient care. Although the literature on health care professions provides some insights into this topic, specific aspects in the field of physiotherapy are less known. The objective of this review was to investigate how patients and physiotherapists perceive patient participation, especially in regards to what it means for them and the role patients play during physiotherapy treatment sessions. Methods. We used a narrative synthesis of qualitative studies. We conducted a systematic search in six databases using a set of key words, extracted relevant data, performed quality assessment and synthesized findings from the selected studies. Results. Out of 160 studies, 11 were retained. Two main themes emerged: the conceptualization of patient participation and the patients' role preferences. Patient participation included various activities including goal setting, information exchange, decision-making and exercise training and often influenced the power relation between patient and physiotherapist. Patients' willingness to participate varied, and they often did not play their desired role. Conclusions. Patients and physiotherapists perceived participation to be valuable yet challenging. Problems of conceptualization, power inequalities, lack of health professionals' skills and lack of the right attitude to share power and responsibility from both sides were some of the barriers that impeded optimal participation.
Archives of physiotherapy, 2018
The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study's aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients. Interpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and se...
Patient-centered care in physical therapy: definition, operationalization, and outcome measures
Physical Therapy Reviews, 2016
Background: The term patient-centered care (PCC) is increasingly used in health care with the intent of improving outcomes. How PCC is defined and operationalized in the physical therapy literature and its outcome measures have not been systematically explored. Such knowledge is needed in the interest of designing studies and comparing their findings. Objectives: (1) to describe how the term PCC is conceptualized in the physical therapy literature, and operationalized and implemented in research; and (2) to describe the measures used to evaluate its effectiveness. Methods: CINAHL, Medline, PsycINFO, PubMed, and SportDiscus databases were searched from databases' inceptions to April 2015, using a combination of keywords. Two investigators performed title, abstract, and full-text screening. Study protocols and expert opinion were excluded. Definitions of PCC and modes of implementation were extracted from the eligible articles and synthesized along with study characteristics and outcome measures. Results: One thousand four hundred and seventy-five articles were retrieved; 8 met inclusion criteria. The term PCC was defined variably. Frequently, no definitions were provided, even though implementation and clinical implications were described. Mixed associations were observed between PCC and outcomes. Most articles had low levels of evidence. Conclusion: Although PCC is considered integral to physical therapy practice, there is no commonly accepted definition; thus, description of its implementation and outcomes has been non-specific and varied. We reviewed PCC in the physical therapy context. Further, the degree to which PCC is truly PCC in the absence of an interprofessional team needs to be reconciled. The findings of this exploratory review generated research questions for subsequent systematic review.
Healthcare
The physiotherapist represents a resource for the psychophysical well-being of an individual. Specific characteristics of the physiotherapist–patient relationship can influence the outcome of rehabilitation. This study aimed to explore physiotherapists’ representations on how they perceive their relationship with their patients, in order to highlight helpful elements in promoting the outcome of the intervention. In this study, 50 physiotherapists (27 females and 23 males; mean age = 42 years; sd = 12.2) participated in an individual interview, conducted remotely via videocall. Socio-demographic and occupational data were collected. The interviews were recorded and transcribed. Texts were analyzed using emotional text mining (ETM). Participants organized their work by means of three categories: (1) work with the patient, in which the physiotherapists described two complementary elements of the therapy, which are the observable-technical aspects of their work and the internal predispo...
Patient Preference and Adherence, 2016
Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goalsetting process because patients can identify and rate their own problems. The aim of this study is to explore patients' experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves-to increase awareness and motivation and to inform the physiotherapistas well as being useful for the physiotherapist-to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC's process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
Are physiotherapists comfortable with person-centred practice? An autoethnographic insight
Disability and Rehabilitation, 2014
Purpose: This study aimed to understand our shared conflicting response and discomfort to personcentred rehabilitation within the context of our physiotherapy rehabilitation culture by reflecting on our own experiences as research physiotherapists and clinicians. Method: This study used autoethnographical methods to explore the personal and professional experiences of two physiotherapists in neurological rehabilitation. Data were collected through ten written reflections and five joint discussions. The data were analysed collaboratively through focused conversations and writing. We looked for patterns in our data and the literature to triangulate our findings. Joint narratives were structured based on three headings: Where we have come from, Challenges to our position and Where we are now. Results: The four main topics of discussion were goal setting, hope, the physiotherapy paradigm and person-centred practice. Physiotherapy practice is typically underpinned by a biomechanical discourse, which separates the mind and the body. This paradigm limits our ability to manage aspects of person-centred practice, such as valuing patient preferences, fostering hope, managing expectation and building a positive therapeutic relationship. Conclusion: Awareness of existing influences on theory and practice is necessary to move the physiotherapy profession towards a greater degree of understanding and application of the principles of person-centred practice.
Physiotherapy Theory and Practice, 2018
Purpose: To conduct a knowledge translation exercise by sharing knowledge from a scoping review, describing physiotherapists' attitudes toward and beliefs about chronic pain, and to gain perspectives on these findings from physiotherapists working with this clientele. Method: We conducted three focus groups with a total of 14 outpatient physiotherapists working in public hospitals. We first showed a video (reflecting an encounter between a clinician and a person living with chronic pain) created based on themes that emerged from a scoping review we conducted, followed by a discussion about attitudes and beliefs toward chronic pain. The sessions were audio-taped and transcripts were analyzed through descriptive and thematic analysis. Results: The consultations reinforced three core themes related to physiotherapists' attitudes toward and beliefs about chronic pain: 1) the development of chronic pain; 2) the relationship to disability and the legitimacy of chronic pain; and 3) physiotherapists' ability to manage psychological aspects of their patient's pain. Conclusion: Physiotherapists in our sample appear unsure of how to interpret severe pain within the context of minimal objective findings. Physiotherapists may benefit from training on how to assess and treat psychosocial factors associated with pain.
Client feedback on physiotherapy counselling in primary health care
Patient Education and Counseling, 2005
The extent of rehabilitation services is adequate, but little feedback is available on these services and service users. This paper is based on a client feedback survey of physiotherapy services conducted in Spring 2000. The purpose of the paper is to compare patients' perceptions of the physiotherapy instruction they received in a private outpatient facility and in a public physiotherapy facility. The results of the study showed that physiotherapy clients were satisfied with the therapy and instruction they received. They felt they received an adequate amount of instructions and advice. The rehabilitee's strong commitment to care, high motivation and a support network are important to independent rehabilitation in the future. As for the point of contact, the majority of clients in the private physiotherapy facility were gainfully employed while the health centre had almost as many retired clients. Client instruction was not dependent on the point of contact.