Trauma-informed physiotherapy and the principles of safety, trustworthiness, choice, collaboration, and empowerment: a qualitative study

ABSTRACT

Introduction

Trauma is common and may lead to lasting adverse effects on health. Trauma-informed practice does not treat trauma but uses a strengths-based approach to encourage engagement in services.

Objective

To understand how physiotherapy attends to trauma-informed principles.

Methods

This qualitative ethnographic study was set in an Australian hospital. Three data collection methods were used, including observations of clinical practice, interactive reflexive group discussions with physiotherapists, and interviews with patients. Data analysis included an initial inductive phase followed by thematic mapping to trauma-informed principles. Critical reflexivity was used throughout to examine how the authors’ perspectives and assumptions affected the analysis.

Results

Twelve observations of consultations, ten interviews with people receiving physiotherapy, and five group discussions with physiotherapists were conducted. Themes produced within each of five principles of trauma-informed care included: Safety: not just a number, uncertainty beyond managing physical risks, upbeat approach as default needs balance, pragmatic environments inadequate; Trustworthiness: touch needs further consideration, assumed consent; Choice: limited options; Collaboration: let’s do it together, variable consideration of the patient as expert, task focus, pushing the “right” treatment, missing insight into power imbalance; Empowerment: extending function and independence, building nonphysical skills but lack of clarity.

Conclusion

Physiotherapy incorporates crucial aspects of trauma-informed care, but opportunities exist to enhance physiotherapists’ skills and knowledge, particularly in relation to non-physical safety considerations.

KEYWORDS:

• Trauma
• empowerment
• physiotherapy

Acknowledgments

We would like to thank all the participants involved in the research study and acknowledge support for this project from physiotherapy, allied health, and mental health staff at St Vincent’s Hospital Melbourne. We gratefully acknowledge a grant from the Inclusive Health Fund at St Vincent’s Health Australia.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09593985.2024.2315521

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The work was supported by the Inclusive Health Fund St Vincent’s Health Australia.