What matters most: a qualitative study of person-centered physiotherapy practice in community rehabilitation

ABSTRACT

Background

Person-centered approaches to care require physiotherapists to engage in trying to understand the full range of biomedical, psychological, and social factors that people bring to the consultation, along with the client’s individual responses to those factors. If, however, the main issues of importance to people are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving interventions that clinicians think they need, rather than care based on their expressed needs and preferences.

Objective

To understand people’s abilities to express the issues of importance to them within a consultation and clinicians’ abilities to acknowledge and address those issues.

Design

A qualitative study using an interpretive phenomenological approach.

Methods

Eight clients were interviewed before they met their physiotherapist, the initial consultation with their physiotherapist was recorded, and both were interviewed separately afterward.

Analysis

The clients frequently do not raise their emotions or feelings as issues of importance, and physiotherapists generally struggle to elicit, or identify as important, such matters. How these were presented to the clinician and subsequently addressed varied. We formulated three themes: 1) managing complex situations; 2) establishing a person-centered agenda; and 3) addressing emotional issues.

Conclusions

Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.

KEYWORDS:

• Person-centered care
• physiotherapy
• community rehabilitation
• qualitative
• physical therapy

Acknowledgement

This work was supported by a Grant from the Chartered Society of Physiotherapy Charitable Trust (Grant Number PRF/15/A25).

Declaration of interest

The authors declare no conflict of interest.

Notes

1. HCP denotes healthcare professional (i.e. physiotherapist).

2. In media res: a literary term to denote when a story, play, film opens in the midst of the plot (from Latin = in the midst of things); exposition is bypassed and filled in gradually

3. “Hello, my name is” is a UK campaign for more compassionate care (www.hellomynameis.org.uk)

4. STRoke Information, Psycho-Education and Screening (STRIPES): Level 1: https://stroke-education.org.uk/course/stroke-information-psycho-education-screening-stripes-level-1/.

Additional information

Funding

This work was supported by the Chartered Society of Physiotherapy Charitable Trust [PRF/15/A25].