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Boland K, Pigott T, Forbes R. ‘I am the educator and the learner at the same time’: a qualitative survey of the knowledge and use of adult learning theory in UK musculoskeletal physiotherapists' patient education. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patient education is a core component of musculoskeletal care, yet broad definitions exist and effective delivery methods are unclear. Musculoskeletal physiotherapists' use of patient education has been described as individualised and collaborative, reflecting a person-centred model of care. However, discrepancies between perceived and actual practice, and therapist-centred approaches to education, have been observed. Little is known about the theoretical basis of musculoskeletal physiotherapists' patient education practice, yet the adult learning theory frames how adults interact with education and echoes the principles of person-centred care. The aim of this study was to analyse the use of adult learning theory to inform patient education practice among UK musculoskeletal physiotherapists. Methods This study used a novel, online questionnaire to collect quantitative and qualitative data from a self-selecting sample of UK musculoskeletal physiotherapists, using a multimodal recruitment strategy. Complete responses were provided by 66 participants. Categorical and narrative data were collected and descriptive and thematic analyses undertaken. Results Participants generally self-rated their educational competencies highly, with the exception of evaluating patient education. Participants were more familiar with reflective and self-directed learning than with other adult learning theories. Two main themes were described: implicit adult learning theory knowledge and challenges in applying adult learning theory. Conclusions The results suggest that musculoskeletal physiotherapists may have implicit knowledge of adult learning theory, yet challenges exist in applying them. This finding supports the establishment of ongoing training in educational skills for physiotherapists and could be used as a catalyst for musculoskeletal physiotherapists to reflect on their knowledge and use of adult learning theory.
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Affiliation(s)
- Katy Boland
- School of Health & Society, University of Salford, Manchester, UK
| | - Tim Pigott
- School of Health & Society, University of Salford, Manchester, UK
| | - Roma Forbes
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Killingback C, Clark C, Green A. Being more than "just a bog-standard knee": the role of person-centred practice in physiotherapy: a narrative inquiry. Disabil Rehabil 2021; 44:5847-5854. [PMID: 34236270 DOI: 10.1080/09638288.2021.1948118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to understand how physiotherapeutic encounters were experienced over time by one service user and the extent to which the encounters were person-centred. METHODS This narrative inquiry study had one participant purposively sampled due to their extensive experience of physiotherapy in healthcare systems in the United Kingdom. Data were collected through interviews and analysed using Clandinin and Connelly's three-dimensional framework. RESULTS Time-related aspects of physiotherapeutic encounters were noted in the evolutionary journey of physiotherapy practice. Personal and social aspects were evident in the words and attitude of the physiotherapists. The influence of place was noted in the role that external forces and the environment played in shaping how physiotherapy was experienced. CONCLUSIONS These narratives remind physiotherapists and healthcare providers to reflect on the role they play in shaping the experience of service users and whether those experiences are considered to be person, therapist, or institution centred. Those training pre-registration physiotherapy students need to consider giving students the opportunity to develop and reflect on their philosophy of practice early in the curriculum to enhance the experience of service users in the long-term.IMPLICATIONS FOR REHABILITATIONIt is important for therapists to consider preconceived ideas of what a service user may want, and to listen to them as unique people, with a future journey ahead of them to understand what is truly important to them.Physiotherapists need to reflect on the role they play and the words they use in shaping the experience of care for service users, and whether this is perceived as being person or therapist centred.Physiotherapists who are more person-centred in practice were better placed to promote self-management of long-term conditions.Providing pre-registration physiotherapists with the opportunity to develop their own value-based philosophy of practice during training may enhance the experiences of their service users in the future.
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Affiliation(s)
| | | | - Angela Green
- Hull University Teaching Hospitals NHS Trust, Hull, UK
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Zahari Z, Ishak A, Justine M. The effectiveness of patient education in improving pain, disability and quality of life among older people with low back pain: A systematic review. J Back Musculoskelet Rehabil 2020; 33:245-254. [PMID: 31356191 DOI: 10.3233/bmr-181305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to gain an overview of patient education and the effects of patient education for older people with low back pain (LBP). METHODS The search strategies were performed via EBSCO MEDLINE, EBSCO CINAHL, Science Direct, PubMed, and PEDro databases from 2006 to 2016. The keywords "patient education", "low back pain", "elderly", "older adults", "older persons" and "older people" were used during the literature search. Boolean operators were used to expand or limit the searching scope and manual exclusion was performed to choose articles eligible for this study. RESULTS A total of 2799 articles were retrieved but only five articles were related with patient education for older people with LBP. Findings suggest that patient education for older people may differ in terms of its contents such as health education, self-management, video education, and postural education. The high methodological quality of the studies revealed that patient education showed improvement in terms of pain, disability and quality of life among older people with LBP. CONCLUSIONS Patient education improved pain and had positive effects on disability and quality of life among older people with LBP. However, due to the limited number of RCTs more studies are needed to provide evidence for its effectiveness.
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Affiliation(s)
- Zarina Zahari
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor Campus, 42300 Puncak Alam Selangor, Malaysia
| | - Azizah Ishak
- Physiotherapy Services, Kluang Utama Specialist Hospital, Kluang Johor, Malaysia
| | - Maria Justine
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor Campus, 42300 Puncak Alam Selangor, Malaysia
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Jäppinen AM, Muñoz M, Kettunen T, Piirainen A. Patients' narratives of patient education in physiotherapy after total hip arthroplasty. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1862. [PMID: 32573053 DOI: 10.1002/pri.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/27/2020] [Accepted: 05/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to explore patients' narratives of patient education in physiotherapy after a total hip arthroplasty (THA). METHOD The data was collected via open thematic interviews from ten patients who had had a primary THA. The interviews were analysed using a qualitative, narrative method. RESULTS Three story models of patient education in physiotherapy were identified: Supportive patient education in physiotherapy, Co-operative patient education in physiotherapy and Contradictory patient education in physiotherapy. The emphasis of narration in the first story model was on the trust in the guidance, functioning interaction in the second and insufficient patient education in physiotherapy in the third story model. DISCUSSION According to the results of this study, patients with THA experience functioning interaction and trust in the patient education in physiotherapy as enhancing the rehabilitation process. Conversely insufficient patient education about exercising and follow-up physiotherapy made the patients feel insecure and according to them might have slowed down the rehabilitation process. These findings can be utilized in planning and improving patient education in physiotherapy after THA.
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Affiliation(s)
- Anna-Maija Jäppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland.,Department of Internal Medicine and Rehabilitation, Helsinki University Hospital, Helsinki, Finland
| | - Minna Muñoz
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland.,Validia Rehabilitation, Helsinki, Finland
| | - Tarja Kettunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland.,Unit of Primary Health Care, Central Finland Health Care District, Jyväskylän, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylän, Finland
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Jäppinen AM, Hämäläinen H, Kettunen T, Piirainen A. Patient education in physiotherapy in total hip arthroplasty (THA) - The perspective of physiotherapists. Physiother Theory Pract 2018; 36:946-955. [PMID: 30204535 DOI: 10.1080/09593985.2018.1513617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE There is limited knowledge about patients' and physiotherapists' perceptions of patient education in physiotherapy in hip arthroplasty. The aim of this study was to describe physiotherapists' conceptions of the patient education in physiotherapy needed by patients undergoing total hip arthroplasty. METHODS The data for this qualitative study were collected using group and individual semi-structured interviews. Seven physiotherapists were interviewed. The research data were analyzed using a phenomenographic method. RESULTS Three categories of patient education in physiotherapy in hip arthroplasty were produced and the categories formed a hierarchy. The narrowest descriptive category was Schematic physiotherapy complying with the protocol. Identifying individual rehabilitation needs was the second category, and the third, widest category was Coaching home rehabilitation. The differences between the categories were described in four themes: 1) Moving; 2) Exercising; 3) Interaction in relation to patient; and 4) Health care system. CONCLUSION According to the results, patient education in physiotherapy optimally aims to identify patients' individual rehabilitation needs, advice on coping at home and especially helping patients to be prepared for and capable of long rehabilitation for which they are themselves responsible. These findings resulting from descriptive categories can be utilized in developing education methods and physiotherapists' competence in patient education.
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Affiliation(s)
- Anna-Maija Jäppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä , Jyväskylä, Finland.,Department of Internal Medicine and Rehabilitation, Helsinki University Hospital , Helsinki, Finland
| | - Harri Hämäläinen
- Department of Internal Medicine and Rehabilitation, Helsinki University Hospital , Helsinki, Finland
| | - Tarja Kettunen
- Faculty of Sport and Health Sciences, University of Jyväskylä , Jyväskylä, Finland.,Unit of Primary Health Care, Central Finland Health Care District, Jyväskylä, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä , Jyväskylä, Finland
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Identification of competencies for patient education in physiotherapy using a Delphi approach. Physiotherapy 2018; 104:232-238. [DOI: 10.1016/j.physio.2017.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
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Ali N, May S, Grafton K. A systematic review of grounded theory studies in physiotherapy. Physiother Theory Pract 2018; 35:1139-1169. [PMID: 29791261 DOI: 10.1080/09593985.2018.1474403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Aim: This systematic review aimed at appraising the methodological rigor of grounded theory research published in the field of physiotherapy to assess how the methodology is understood and applied. A secondary aim was to provide research implications drawn from the findings to guide future grounded theory methodology (GTM) research. Methods: A systematic search was conducted in MEDLINE, CINHAL, SPORT Discus, Science Direct, PubMed, Scopus, and Web of Science to identify studies in the field of physiotherapy that reported using GTM and/or methods in the study title and/or abstract. The descriptive characteristics and methodological quality of eligible studies were examined using grounded theory methodology assessment guidelines. Findings: The review included 68 studies conducted between 1998 and 2017. The findings showed that GTM is becoming increasingly used by physiotherapy researchers. Thirty-six studies (53%) demonstrated a good understanding and appropriate application of GTM. Thirty-two studies (47%) presented descriptive findings and were considered to be of poor methodological quality. Conclusions: There are several key tenets of GTM that are integral to the iterative process of qualitative theorizing and need to be applied throughout all research practices including sampling, data collection, and analysis.
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Affiliation(s)
- Nancy Ali
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Stephen May
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Kate Grafton
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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New-graduate Physical Therapists' Self-efficacy to Perform Patient Education Is Influenced by Entry-level Training Experiences. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/jte.0000000000000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Forbes R, Mandrusiak A, Smith M, Russell T. Training physiotherapy students to educate patients: A randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2018; 101:295-303. [PMID: 28847438 DOI: 10.1016/j.pec.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To determine the effect of a training intervention on physiotherapy students' self-efficacy and skills in the area of patient education. METHODS Final year physiotherapy students were randomised to an intervention group or a wait-list control group. The intervention group participated in a 3.5h training intervention about patient education that included video observation, simulated patient practice and structured feedback. The control group did not receive any training. Self-efficacy was assessed at baseline (T1) and after the intervention (or no intervention for the control group) (T2). Patient education performance was assessed by a blinded rater from a video-recorded standardised clinical examination. RESULTS 83 students were randomised to the intervention group and 81 students to the control group. There were no differences in demographic variables or self-efficacy between groups at baseline. There was significant improvement in self-efficacy for the intervention group, but no change for the control group. The intervention group performed significantly better than the control group for nine of the eleven performance items, with significantly higher scores overall. CONCLUSION A training intervention enhances physiotherapy student self-efficacy and performance in patient education. PRACTICE IMPLICATION Use of patient education training is recommended to enhance student self-efficacy and performance.
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Affiliation(s)
- R Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
| | - A Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - M Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - T Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Wijma AJ, Bletterman AN, Clark JR, Vervoort SC, Beetsma A, Keizer D, Nijs J, Van Wilgen CP. Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies. Physiother Theory Pract 2017; 33:825-840. [DOI: 10.1080/09593985.2017.1357151] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amarins J Wijma
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, The Netherlands
- Pain in Motion International Research Group, Brussels, Belgium
| | | | - Jacqui R Clark
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Sigrid C.J.M Vervoort
- UMC Utrecht Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anneke Beetsma
- Department of Physiotherapy, Hanze University of Applied Sciences, School of Health Studies, Groningen, The Netherlands
| | - Doeke Keizer
- Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, The Netherlands
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - C. Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, The Netherlands
- Pain in Motion International Research Group, Brussels, Belgium
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Forbes R, Mandrusiak A, Smith M, Russell T. A comparison of patient education practices and perceptions of novice and experienced physiotherapists in Australian physiotherapy settings. Musculoskelet Sci Pract 2017; 28:46-53. [PMID: 28171778 DOI: 10.1016/j.msksp.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 12/13/2016] [Accepted: 01/16/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient education is an integral component of physiotherapy practice. Little is known about the differences in reported use and perception of patient education between experienced and novice physiotherapists. Understanding these differences has important implications for training approaches and physiotherapy practice. OBJECTIVES To compare how experienced and novice physiotherapists report frequency of patient education practices and their perceptions of the importance of these practices. DESIGN AND METHODS A web-based purpose-designed survey was developed, piloted and administered to practicing physiotherapists through direct email. Of 305 complete responses, two subgroups were explored for comparative analysis: 'novice' (≤5years' experience, n = 52); and 'experienced' (≥11 years' experience, n = 204). RESULTS The experienced group rated 14 of 15 educational items higher than the novice group in relation to frequency of use and perceived importance. Experienced physiotherapists reported a significantly higher frequency of using one-to-one discussion, personalised handouts and explicitly seeking patient understanding (p < 0.05). Novice physiotherapists perceived more barriers to patient education, particularly those related to characteristics of the patient (p < 0.05). CONCLUSION Experienced physiotherapists report higher use of self-management education and education content that is patient-centred. Experienced therapists report a higher frequency of seeking explicit patient understanding to evaluate their teaching than novice physiotherapists and perceive fewer patient-related barriers to their practice. These findings are important when considering teaching and learning of patient education skills. Students or novice physiotherapists may benefit from strategies to facilitate patient-centred education, self-management education, evaluation approaches and strategies to manage barriers.
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Affiliation(s)
- Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Michelle Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Jäppinen AM, Hämäläinen H, Kettunen T, Piirainen A. Patients’ conceptions of preoperative physiotherapy education before hip arthroplasty. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2015.1061051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thomson OP, Petty NJ, Ramage CM, Moore AP. Qualitative research: Exploring the multiple perspectives of osteopathy. INT J OSTEOPATH MED 2011. [DOI: 10.1016/j.ijosm.2011.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Harman K, Bassett R, Fenety A, Hoens AM. Client Education: Communicative Interaction between Physiotherapists and Clients with Subacute Low Back Pain in Private Practice. Physiother Can 2011; 63:212-23. [PMID: 22379262 PMCID: PMC3076921 DOI: 10.3138/ptc.2009-52p] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore, through focus-group interviews, client education provided by physiotherapists in private practice who treat injured workers with subacute low back pain (SA-LBP). METHODS Six focus-group interviews were held in the fall of 2006 to explore treatment practices of physiotherapists for this population. Each of the 44 physiotherapists who volunteered attended one of six regional sessions. RESULTS Three overarching themes emerged: the critical importance of education; education: a multidimensional concept; and the physiotherapist-client relationship. In this study, we found that education provides continuity by tying together the separate tasks occurring during one treatment session. Our participants said that time is of the essence in private practice and described how they provide education seamlessly, making this type of delivery efficient. CONCLUSIONS Education is a highly valued aspect of practice for physiotherapists. Verbal, tactile, and visual information obtained from the client as assessment and treatment progress is explored, expanded, and contextualized in conversation with the client. In a communicative, interactive process, client fears, other contextual information, and physiotherapist information about procedures and techniques, exercises, and anatomy are collaboratively interrelated.
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Affiliation(s)
- Katherine Harman
- Katherine Harman, PT, PhD: Associate Professor, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia
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Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, de Oliveira Sousa SL, del Baño-Aledo ME, Lomas-Vega R. How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study. BMC Health Serv Res 2010; 10:60. [PMID: 20219095 PMCID: PMC2847560 DOI: 10.1186/1472-6963-10-60] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 03/10/2010] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. Methods This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises. Results Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises. Conclusions Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.
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Patient-centredness in physiotherapy from the perspective of the chronic low back pain patient. Physiotherapy 2008. [DOI: 10.1016/j.physio.2007.10.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liddle SD, Gracey JH, Baxter GD. Advice for the management of low back pain: A systematic review of randomised controlled trials. ACTA ACUST UNITED AC 2007; 12:310-27. [PMID: 17395522 DOI: 10.1016/j.math.2006.12.009] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 12/15/2006] [Accepted: 12/15/2006] [Indexed: 11/24/2022]
Abstract
To synthesise the evidence relating to the effectiveness of advice, the relevance of its content and frequency, and to compare the advice being offered to acute, subacute and chronic low back pain (LBP) patients. A systematic review of Randomised Controlled Trials (RCTs) using advice, either alone or with another intervention. The QUOROM guidelines and the Cochrane Collaboration Back Review Group Guidelines for Systematic Reviews were followed throughout: methodological assessment identified RCTs of 'high' or 'medium' methodological quality, based on their inclusion of at least 50% of the specified internal validity criteria. Outcome measures were analysed based on five recommended core outcome domains; pain, work disability, back-specific function, generic health status and satisfaction with care. Relevant RCTs (n=56) were scored for methodological quality; 39 RCTs involving 7347 patients qualified for inclusion, based upon their methodological quality. Advice as an adjunct to exercise was most effective for improving pain, back-specific function and work disability in chronic LBP but, for acute LBP, was no more effective for improving these outcomes than simple advice to stay active. Advice as part of a back school was most effective for improving back-specific function in subacute LBP; these trials generally demonstrated long-term positive results. Advice as an adjunct to exercise was the most common form of treatment for acute and chronic LBP; advice as part of a back school was most commonly used for subacute LBP. Fifteen percent of acute LBP trials had a positive outcome, compared to 86% and 74% of subacute and chronic LBP trials respectively. A wide variety of outcome measures were used, making valid comparisons between treatment outcomes difficult. The advice provided to patients with LBP within RCTs varied considerably depending on symptom duration. The findings of this review have important implications for clinical practice, and for the design of further clinical trials in this area. Advice to stay active is sufficient for acute LBP; however, it appears that RCTs do not commonly reflect these recommendations. No conclusions could be drawn as to the content and frequency of advice that is most effective for subacute LBP, due to the limited number and poor quality of RCTs in this area: this review provides preliminary support for advice as part of a back school approach. Given that the effectiveness of treatment for subacute symptoms will directly influence the development of chronicity, these results would suggest that education and awareness of the causes and consequences of back pain may be a valuable treatment component for this patient subgroup. For chronic LBP there is strong evidence to support the use of advice to remain active in addition to specific advice relating to the most appropriate exercise, and/or functional activities to promote active self-management. More investigation is needed into the role of follow-up advice for chronic LBP patients.
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Affiliation(s)
- S Dianne Liddle
- Health and Rehabilitation Sciences Research Institute, University of Ulster at Jordanstown, Shore Road, Newtownabbey Co. Antrim, BT37 OQB, Northern Ireland.
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Dean SG, Smith JA, Payne S, Weinman J. Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain. Disabil Rehabil 2005; 27:625-36. [PMID: 16019873 DOI: 10.1080/0963820500030449] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Physiotherapy for low back pain (LBP) includes exercise therapy. Unfortunately adherence is problematic. This study explores patients' and physiotherapists' perceptions of exercise adherence. METHOD Nine LBP patients and eight physiotherapists were interviewed. Interpretative Phenomenological Analysis (IPA) was used to explore transcript data. RESULTS The main theme 'managing time', reveals how pressure on time reflects society's view of time as a commodity. Theme components include 'the bargaining process': physiotherapists spend time listening, exploring patient beliefs, but modify patients' expectations of quick cures with the need to own their back care. 'Reviewing the future' identifies fears about long-term disability, highlighting the importance of recovery time knowledge. CONCLUSIONS Interpreting participants' stories illustrates how investing in routine exercise could help re-interpret LBP as part of everyday life.
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Affiliation(s)
- Sarah G Dean
- Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, New Zealand.
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Trede F, Higgs J. Re-framing the clinician's role in collaborative clinical decision making: re-thinking practice knowledge and the notion of clinician-patient relationships. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1473-6861.2003.00040.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Harland N, Lavallee D. Biopsychosocial Management of Chronic Low Back Pain Patients with Psychological Assessment and Management Tools. Physiotherapy 2003. [DOI: 10.1016/s0031-9406(05)60043-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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