What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies

Figures & data

Table 1. Inclusion and exclusion criteria for eligibility.

Inclusion criteria

Research involving qualitative methods English language publications Peer reviewed in academic journals Patient or qualified physiotherapist views on experience, perspective, attitudes or understanding on person-centred practice Person-centredness constituting the key focus of study aims or findings Based on the musculoskeletal outpatient model of care.

Exclusion criteria

Studies reporting on views, perspective, attitudes or understanding of non-qualified physiotherapists, professions other than physiotherapist or patients’ family/carers. Home and inpatient-based rehabilitation including care/residential/nursing homes. Studies based on non-musculoskeletal adult specialities. Grey literature and systematic reviews Quantitative study design

Figure 1. PIC parameters and search strings.

Review population is defined as being musculoskeletal physiotherapists and their patients; review interest as person-centred (and synonym) approaches to physiotherapy practice; and review context as musculoskeletal physiotherapy outpatients settings. The databases searched are listed as: Academic search premier; CINAHL complete; MEDLINE; APA PsycInfo; SPORTDiscus with Full Text. Search parameter one is defined as: Person-cent* or “person cent*” OR patient-cent* or “patient cent*” with no filter field selected. Search parameter two is defined as: Physiotherap* or “physical therap*” employing “all text” filter. Combining both search parameters produced 5756 articles, reduced to 3250 after limiting to English, academic journal, and duplication removal.

Figure 2. PRISMA flow diagram demonstrating the screening process for this review.

5759 records were identified through database and hand searching; 3181 were excluded at the title and abstract screening stage due to their being duplicates, conference proceedings, quantitative studies or insufficiently focused on person-centredness; 69 articles were assessed at the full text stage—60 of these were excluded for being: insufficiently focused on person-centredness (n = 30), reviews (n = 9), not physiotherapy specific (n = 8), not MSK outpatient specific (n = 9), unsuitable for qualitative synthesis (n = 3), or inaccessible (n = 1). This left nine articles which met the inclusion criteria and were included in the synthesis.

Table 2. Quality appraisal of included studies.

Criteria	Ahlsen et al. [47]	Cooper et al. [27]	Cowell et al. [25]	Ibsen et al. [48]	Kidd et al. [49]	Meerhoff et al. [50]	Morera-Balaguer et al. [51]	Morera-Balaguer et al. [35]	Sullivan et al. [52]
1. Was there a clear statement of the aims of the research?	Y	Y	Y	Y	Y	Y	Y	Y	Y
2. Is a qualitative methodology appropriate?	Y	Y	Y	Y	Y	Y	Y	Y	Y
3. Was the research design appropriate to address the aims of the research?	Y	Y	Y	Y	Y	Y	Y	Y	Y
4. Was the recruitment strategy appropriate to the aims of the research?	Y	Y	Y	Y	Y	Y	Y	Y	Y
5. Was the data collected in a way that addressed the research issue?	Y	Y	Y	Y	Y	Y	Y	Y	Y
6. Has the relationship between researcher and participants been adequately considered?	Y	N	N	Y	N	Y	N	N	Y
7. Have ethical issues been taken into consideration?	Y	Y	Y	Y	Y	Y	Y	Y	Y
8. Was the data analysis sufficiently rigorous?	Y	Y	Y	Y	Y	Y	Y	Y	Y
9. Is there a clear statement of findings?	Y	Y	Y	Y	Y	Y	Y	Y	Y
10. How valuable is the research?	Y	Y	Y	Y	Y	Y	Y	Y	Y
Total number of items with Y response	10/10	9/10	9/10	10/10	9/10	10/10	9/10	9/10	10/10

KEY: Y: Yes; U: Unclear; N: No.

Table 3. Overview of included studies.

Study	Context	Methodology	Primary aims	Data collection methods
Ahlsen et al. [48]	Setting: Multidisciplinary Rehabilitation Clinic, Norway Types of conditions commonly seen: Chronic musculoskeletal Perspective: 5 physiotherapists Gender: 2 males, 3 females	Narrative inquiry	Examine therapists’ understanding of patient-as-a-self in patient-centred practice	Semi-structured interviews
Cooper et al. [27]	Setting: Seven Physiotherapy Departments, Scotland Types of conditions commonly seen: chronic non-specific recurrent low back pain (within the previous 6 months) Perspective: 25 patients Gender: 5 males, 20 females	Qualitative study	Define patient-centredness from the patient’s perspective in the context of physiotherapy for chronic low back pain	Semi-structured interviews
Cowell et al. [25]	Setting: Two primary care outpatient physiotherapy departments, London, UK Types of conditions commonly seen: Initial encounter, non-specific chronic low back pain Perspective: filmed observations Gender: 10 physiotherapists (7 males, 3 females) and 20 patients (9 males, 11 females).	Conversation analysis—qualitative observational method	How physiotherapists solicit and respond to the agenda of concerns that patients with non-specific chronic low back pain bring to initial encounters.	Video-recording initial physiotherapy consultations
Ibsen et al. [49]	Setting: Spine centre, Denmark Types of conditions commonly seen: low back pain Perspective: 7 patients Gender: 3 males, 4 females	Interpretive descriptive methodology	Explore patients’ perspective and preferences as part of developing a new low back pain -specific patient reported outcome instrument	Semi-structured focus groups
Kidd et al. [50]	Setting: Hospital physiotherapy outpatient departments, New Zealand Types of conditions commonly seen: Musculoskeletal Perspective: 8 patients who had recently received physiotherapy Gender: 4 males, 4 females	Grounded theory	To determine patients’ perspectives of components of patient-centred physiotherapy and its essential elements	Semi-structured interviews
Meerhoff et al. [51]	Setting: primary care physiotherapy practice of two regional networks, Holland Types of conditions commonly seen: Musculoskeletal problem Perspective: 21 patients Gender: 6 males, 15 females	Qualitative thematic analysis (Braun and Clarke, 2006)	Explore the perspective of patients with musculoskeletal health problems on using patient reported outcome measures for quality improvement in primary care physiotherapy practice and determine what barriers and facilitators patients perceive	Semi-structured interviews
Morera-Balaguer et al. [52]	Setting: Outpatient rehabilitation health centres, Spain Types of conditions commonly seen: Neuromusculoskeletal Perspective: 21 physiotherapists > 1 year working same place Gender: 5 males, 16 females	Qualitative study	Explore physical therapists’ perceptions and experiences regarding barriers and facilitators of therapeutic patient-centred relationships in outpatient rehabilitation settings	Focus groups
Morera-Balaguer et al. [35]	Setting: Physiotherapy unit in primary care and hospitals, Spain Types of conditions commonly seen: Neuromusculoskeletal Perspective: 31 patients Gender: 10 males, 21 females	Qualitative thematic analysis with modified constant comparison	Explore the barriers and facilitators for the establishment of a person-centred relationship, based on the experience of physiotherapy patients	Focus groups
Sullivan et al. [53]	Setting: UK Types of conditions commonly seen: Chronic non-specific recurrent low back pain Perspective: 5 physiotherapists Gender: 2 males, 3 females	Interpretative phenomenological analysis	Explore participants’ lived experiences of communicating the diagnosis of chronic non-specific low back pain to their patients during musculoskeletal physiotherapy practice	Interviews

Figure 3. Schema representing review findings.

A large square box displays the title “person-centredness in musculoskeletal physiotherapy” within its lower outer border. In the bottom left, a triangular box houses the theme “person-centred traits” from which a thin two-way arrow points upward to a centre left bubble labelled “physiotherapist.” Projecting from “physiotherapist” are two arrows directed towards an adjacent bubble, boldly bordered, and labelled “patient.” The arrows themselves are labelled with themes “supporting empowerment” below and “treating each patient as a unique person” above. Finally, a centrally placed and chunky two-way arrow housing the theme “effective communication” provides a link between physiotherapist and patient bubbles.

Table 4. Overview of themes.

Theme 1. Treating each patient as a unique person

Theme 2. The importance of communication for achieving therapeutic alliance

Theme 3. Necessary physiotherapist traits for person-centredness

Theme 4. Supporting patient empowerment

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