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Poulsen LK, Kirk JW, Raunsø N, Stamp ABM, Lyng KD, Clausen MB. Unravelling interacting barriers and facilitators to adherence and delivery of exercise-based care in the treatment of Subacromial Pain Syndrome - an exploratory qualitative study. Disabil Rehabil 2024:1-19. [PMID: 39180307 DOI: 10.1080/09638288.2024.2388867] [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: 12/21/2023] [Revised: 06/27/2024] [Accepted: 08/01/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Subacromial Pain Syndrome (SAPS) is a common persistent pain condition. Exercise-based care is first-line recommendation, but an insufficient exercise dose hampers effectiveness. This study explores individual and contextual barriers and facilitators for delivery of and adherence to exercise-based care in people with SAPS. MATERIALS AND METHODS Participants in this exploratory qualitative study were involved in the management of SAPS in Denmark. Triangular interviews and analyses were conducted within 3 themes (delivery of recommended services, adherence to recommendations, and frames of the clinical pathways) using the Theoretical Domains Framework (TDF) and the Behavioural Change Wheel model (BCW) to map barriers and facilitators into the Capability, Opportunity, Motivation and Behaviour (COM-B) model. RESULTS From interviews with 10 persons with SAPS and 37 healthcare practitioners and double-deductive analyses, 30 subjects of target behaviour within 13 TDF domains emerged across perspectives and COM-B components. Central barriers to delivery and adherence were inconsistencies in diagnostic terminology, cross-professional disagreements, beliefs, and expectations towards pathway services. CONCLUSION We identified interrelated individual and contextual barriers to delivery and adherence across all aspects of the BCW, underpinning the complexity of the subject. Findings support that effectiveness of exercise-based care is linked to contextual barriers to delivery and adherence.
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Affiliation(s)
- Lise Kronborg Poulsen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Hvidovre University Hospital, Hvidovre, Denmark
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Nanna Raunsø
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Anna-Birgitte Møller Stamp
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Kristian Damgaard Lyng
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Centre for General Practice at Aalborg University, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
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Ampiah PK, Hendrick P, Moffatt F, Ampiah JA. Barriers and facilitators to the delivery of a biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana. A qualitative study. Disabil Rehabil 2024:1-11. [PMID: 38963089 DOI: 10.1080/09638288.2024.2374497] [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: 10/13/2023] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Low back pain management has evolved with researchers advocating for a biopsychosocial management model. The biopsychosocial management model has been predominantly applied in high-income countries and underexplored in low- and middle-income countries including Ghana. This study aimed to explore the potential barriers and facilitators to patients with chronic low back pain (CLBP) and physiotherapists engagement with a biopsychosocial intervention (exercise and patient education) as part of a feasibility study. MATERIAL AND METHODS This was a qualitative study embedded within a mixed-methods, sequential, feasibility study, in Ghana, applying semi-structured interviews. Two categories of participants involved in this study were, two trained physiotherapists, and six patients with CLBP, sampled within the feasibility study. RESULTS Regarding the barriers and facilitators to the delivery of the BPS intervention, five interlinked themes emerged from the thematic analysis. These were: structure and process of delivery; patients' expectations; patients' health beliefs, autonomy, and engagement; external influences and personal and professional characteristics of physiotherapists. CONCLUSION The themes that emerged from this study demonstrated many positive facilitators based on participants' improved understanding of LBP and the clarity and purpose of the biopsychosocial intervention. The results therefore demonstrate a potential to deliver the biopsychosocial intervention in a Ghanaian context.
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Affiliation(s)
- Paapa Kwesi Ampiah
- Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - Paul Hendrick
- Department of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, UK
| | - Fiona Moffatt
- Department of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, UK
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Boyle EM, Evans K, Coates S, Fary RE, Bennell K, Sterling M, Rebbeck T, Beales DJ. Patient experiences of referral practices and primary care physiotherapy for chronic nonspecific low back pain. Physiother Theory Pract 2024; 40:1326-1342. [PMID: 36331383 DOI: 10.1080/09593985.2022.2141599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. PURPOSE This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. METHODS An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. RESULTS Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. CONCLUSION Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes.
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Affiliation(s)
- Eileen M Boyle
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
| | - Kerrie Evans
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
- Healthia Limited, Bowen Hills Queensland, Australia
| | - Sonia Coates
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
| | - Robyn E Fary
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
| | - Kim Bennell
- Department of Physiotherapy, University of Melbourne, Centre for Health, Exercise and Sports Medicine, Parkville Carlton, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMR Centre of Research Excellence in Road Traffic Injury recovery, The University of Queensland, Brisbane City Queensland, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, The University of Sydney, Darlington Sydney, Australia
| | - Darren J Beales
- Curtin enAble Institute and Curtin School of Allied Health, Faculty of Health Sciences Curtin University, Kent Street Bentley, Kent Street Bentley, Perth, Australia
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Ekhammar A, Larsson MEH, Bernhardsson S, Holmgren K. The PREVSAM model, "prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders", is seen as beneficial for patients risking persistent musculoskeletal disorders but may be difficult to implement - a focus group study. Disabil Rehabil 2024:1-11. [PMID: 38800999 DOI: 10.1080/09638288.2024.2356011] [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: 04/05/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The rehabilitation model "Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders" (PREVSAM) was tested in a randomised controlled trial. This study aimed to explore participating healthcare professionals' experiences of working according to the PREVSAM model, and their perceptions of its clinical benefit and feasibility in primary care rehabilitation. METHODS A focus group study including 12 healthcare professionals from five primary care rehabilitation clinics was analysed according to the focus group methodology described by Krueger and Casey. RESULTS Four themes were identified. A clear framework describes how PREVSAM facilitates person-centred teamwork. The value of teamwork highlights benefits and challenges with teamwork. Through thick and thin discusses perceived patient benefits. In the ideal world focusses on feasibility of implementing the model. CONCLUSIONS The participants experienced that the PREVSAM model may be beneficial for the patients, for their own work situation and workplace, and for society. Identifying psychological risk factors was perceived as helpful, but not enough to capture patients in need of team-based rehabilitation. While considered feasible, barriers for implementing the model were identified. Managers and healthcare policy makers must prioritise and create appropriate conditions for team-based musculoskeletal rehabilitation in primary care.
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Affiliation(s)
- Annika Ekhammar
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Primary Care Rehabilitation, Gothenburg, Sweden
| | - Maria E H Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Kristina Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pichonnaz C, Ancey C, Mbarga J, Foley RA. Patients' expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations. Disabil Rehabil 2024; 46:1776-1786. [PMID: 37128151 DOI: 10.1080/09638288.2023.2205171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations. MATERIALS AND METHODS A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities. RESULTS Twenty patients participated (9 male, 11 female, aged 21-58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back. CONCLUSION The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.
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Affiliation(s)
- Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Céline Ancey
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Josiane Mbarga
- Department of research and development, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Rose-Anna Foley
- Department of research and development, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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Kealy E, Hebron C. Holding space and sitting with emotions: the lived experiences of physiotherapists using psychological strategies in pain care. Physiother Theory Pract 2024:1-14. [PMID: 38299915 DOI: 10.1080/09593985.2023.2300400] [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: 08/01/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Persistent pain is the biggest global cause of years lived with disability. Physiotherapists working in pain care aim to take a holistic perspective helping persons to gain a multidimensional understanding of their condition and achieve meaningful goals despite their symptoms. In recent years there has been a paradigm shift in physiotherapeutic pain care toward a psychologically informed physiotherapy approach. Physiotherapists have incorporated principles of strategies such as: cognitive behavioral therapy (CBT); acceptance and commitment therapy (ACT); psychological flexibility; or mindfulness-based therapies in helping persons move forwards despite their pain. OBJECTIVES The purpose of this study was to explore the lived experience of physiotherapists using psychological strategies in pain care. METHODS Seven participants were purposefully recruited for this study and data was collected through semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Master themes were developed to help express the qualitative meanings of the lived experiences. FINDINGS Seven master themes were identified: 1) Trust; 2) Active listening; 3) Developing understanding; 4) Exploring the journey; 5) Making it meaningful; 6) Being held; and 7) Holding space and sitting with emotions. All themes are interwoven and profoundly connected in the essence of a safe "space." CONCLUSION Participants described a journey toward holding space and sitting with emotions. All themes were interwoven and profoundly connected in the essence of a safe "space," where persons can voice their emotions in a non-judgmental environment. The themes may represent a pathway for the physiotherapist to facilitate a person on their journey of healing.
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Affiliation(s)
- Eoin Kealy
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
| | - Clair Hebron
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
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Dickson C, de Zoete RMJ, Berryman C, Weinstein P, Chen KK, Rothmore P. Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:104-115. [PMID: 37769242 PMCID: PMC10833081 DOI: 10.1093/pm/pnad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To identify and synthesize patient-related barriers to and enablers of the implementation of high-value physiotherapy (HVP) for chronic pain. Furthermore, to review what patient-related interventions have been used to facilitate the implementation of HVP for chronic pain, as well as their efficacy. METHODS We systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain. We used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. RESULTS Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient's understanding of exercise benefits. Other barriers included fear of movement, fragmented care, and cost. Ten studies explored interventions, 9 of which aimed to improve exercise adherence. Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls. CONCLUSION Patients with chronic pain experience barriers to HVP, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. Our findings suggest that interventions seeking to enhance implementation of HVP need to consider the multifactorial barriers experienced by patients with chronic pain. STUDY REGISTRATION Open Science Framework (https://doi.org/10.17605/OSF.IO/AYGZV).
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Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance Unit, IIMPACT in Health, The University of South Australia, Adelaide, 5001, Australia
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
- Brain Stimulation, Imaging and Cognition Group, The University of Adelaide, Adelaide, 5000, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide, 5000, Australia
- South Australian Museum, Adelaide, 5000, Australia
| | - Kexun Kenneth Chen
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
| | - Paul Rothmore
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, 5005, Australia
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Jenkins LC, Summers SJ, Nasser A, Verhagen A. Dry needling perceptions and experiences: A survey of Australian physiotherapists. Musculoskelet Sci Pract 2024; 69:102895. [PMID: 38081107 DOI: 10.1016/j.msksp.2023.102895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND There is a lack of information on the use of dry needling in Australian physiotherapy practice. OBJECTIVES Our primary aim was to enhance the understanding of why Australian physiotherapists use dry needling in clinical practice. The secondary aim was to explore Australian physiotherapists experiences with adverse events caused by dry needling. DESIGN Cross-sectional online survey. METHOD We developed a survey and disseminated it through email to physiotherapists from all states and territories in Australia. Participant demographics and responses were reported as frequencies and percentages. RESULTS/FINDINGS We invited 1006 Australian physiotherapists, of which 232 (23%) viewed the online survey and 203 (20%) consented to participate, of which nearly all completed the survey (n = 198, 98%). Most respondents worked in private practice (n = 164, 83%), with 127 (64%) reporting using dry needling as an intervention within the previous 12 months. Physiotherapists typically used dry needling to decrease pain intensity (n = 105, 85%) and reduce muscle tension (n = 100, 81%). Reports of minor adverse events were common and included discomfort during the treatment (n = 77, 62%) and bruising (n = 69, 56%). Some respondents reported experiencing major adverse events including prolonged aggravation of symptoms (n = 10, 8%) and syncope (n = 16, 13%). CONCLUSIONS We found that many Australian physiotherapists in private practice use dry needling, usually to decrease pain intensity and muscle tension. Minor adverse events were experienced by more than half the respondents and between 8 and 13% of the Australian physiotherapists surveyed reported experiencing a major adverse event due to dry needling.
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Affiliation(s)
- Luke C Jenkins
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia.
| | - Simon J Summers
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Nasser
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
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Raghunandan R, Howard K. Research Note: Discrete choice experiments to elicit preferences for decision-making in physiotherapy. J Physiother 2024; 70:73-77. [PMID: 38072716 DOI: 10.1016/j.jphys.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Rakhee Raghunandan
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Kleiner MJ, Kinsella EA, Miciak M, Teachman G, Walton DM. The 'responsive' practitioner: physiotherapists' reflections on the 'good' in physiotherapy practice. Physiother Theory Pract 2023; 39:2625-2638. [PMID: 35794693 DOI: 10.1080/09593985.2022.2092567] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Being 'responsive' is named as an element of ethic of care theories, yet how it is enacted is not clearly described in health professional practice. Being 'responsive' is implied within patient-centered approaches and promoted as important to health care practices, including physiotherapy. However, ways of being a responsive practitioner have not been explicitly examined. Practitioners' perspectives about how a 'good' physiotherapist enacts responsiveness have potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, and patient interactions. PURPOSE The purpose of this research was to explore experienced musculoskeletal (MSK) practitioners' perceptions of 'responsiveness' in the practice of a 'good' physiotherapist. METHODS A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of what constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on 'responsiveness,' which emerged as a major theme in the original study. FINDINGS Six themes were identified related to 'Being responsive' in a 'good' physiotherapist: Being person-centered, Being attentive, Being open, Being a listener, Being validating, and Being positive. CONCLUSIONS As a relational way of practicing, being responsive may facilitate person-centered approaches including a relational understanding of autonomy, inviting dialogue, and sharing power and decision-making with patients. Pivotal to the practice of a 'good' physiotherapist, being responsive in the ways underscored by participants suggests researchers, educators, and practitioners consider relational ways of practicing as a balance to the technical aspects of physiotherapy.
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Affiliation(s)
- Michelle J Kleiner
- QuinnRehab, Barrie, ON, Canada
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Elizabeth Anne Kinsella
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gail Teachman
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, London, ON, Canada
| | - David M Walton
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, Elborn College, London, ON, Canada
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12
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ShahAli S, Shahabi S, Etemadi M, Hedayati M, Anne BC, Mojgani P, Behzadifar M, Lankarani KB. Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research. Heliyon 2023; 9:e20736. [PMID: 37860510 PMCID: PMC10582494 DOI: 10.1016/j.heliyon.2023.e20736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists' time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.
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Affiliation(s)
- Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Maryam Hedayati
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Barth Cornelia Anne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Ogawa T, Fujimoto S, Omon K, Ishigaki T, Morioka S. Shared decision-making in physiotherapy: a cross-sectional study of patient involvement factors and issues in Japan. BMC Med Inform Decis Mak 2023; 23:135. [PMID: 37488562 PMCID: PMC10367402 DOI: 10.1186/s12911-023-02208-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making. METHODS The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement. RESULTS Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score. CONCLUSIONS The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.
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Affiliation(s)
- Tatsuya Ogawa
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan.
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, 3-2-2 Sasayuridai, Kanmaki-Cho, Kitakatsuragi-Gun, Nara, 639-0218, Japan.
| | - Shuhei Fujimoto
- Kyoto University Graduate School of Public Health, Yoshida-Honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan
- Shizuoka Graduate University of Public Health, 4-27-2 Kitaando, Aoi-Ku, Shizuoka-Shi, Shizuoka, 420-0881, Japan
| | - Kyohei Omon
- Rehabilitation Center, Kishiwada Rehabilitation Hospital, 2-8-10 Kanmatsu-Cho, Kishiwada-Shi, Osaka, 596-0827, Japan
- Department of Cognitive Behavioral Science, Kyoto University Graduate School of Human and Environmental Studies, Yoshida-Nihonmatsucho, Sakyo-Ku, Kyoto City, 606-8501, Japan
| | - Tomoya Ishigaki
- Department of Physical Therapy, Faculty of Rehabilitation, Nagoya Gakuin University, 3-1-17 Taiho, Atsuta-Ku, Nagoya-Shi, Aichi, 456-0062, Japan
- Department of Rehabilitation, Kawaguchi Neurosurgery Rehabilitation Clinic, 9-25-202 Kourien-Cho, Hirakata-Shi, Osaka, 573-0086, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan
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14
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Mármol-López MI, Marques-Sule E, Naamanka K, Arnal-Gómez A, Cortés-Amador S, Durante Á, Tejada-Garrido CI, Navas-Echazarreta N, Juárez-Vela R, Gea V. Physiotherapists' ethical behavior in professional practice: a qualitative study. Front Med (Lausanne) 2023; 10:1158434. [PMID: 37529240 PMCID: PMC10390221 DOI: 10.3389/fmed.2023.1158434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background In health professions, ethics is considered a fundamental competence. The increase in clinical autonomy in the field of physiotherapy is associated with an increase in ethical situations in their clinical practice. Objective To explore the ethics of the clinical relationship between physiotherapists and patients, the ethics training received by physiotherapists, and if in the clinical context, physiotherapists identify the necessary attitudes and apply the ethical recommendations of the profession for the ethical situations they experience. Methods A qualitative exploratory and descriptive study was performed with physiotherapists. Data were collected through semi-structured interviews. The data were analyzed using content analysis, as proposed by Krippendorf. The study protocol was approved by the University of Valencia Ethics Committee of Human Research. Results This study included 15 physiotherapists (66.66% women, average age = 42.2 years), which was sufficient to reach data saturation. We identified four categories: (i) Ethics of the clinical relationship (ethical values, principles, and norms; type of clinical relationship), (ii) Ethics training received (during the physiotherapy studies; current training of students; low importance of ethics in the curriculum), (iii) Necessary attitudes for professional ethical practice (main attitudes were identified: personal attitudes and professional attitudes); (iv) Experiences from professional practice (general; public sector vs. private sector). Conclusion The ethics of the clinical relationship between physiotherapists and patients is determined by the attitudes of the practitioner, which are the result of his or her values and previous experiences; and are very centered on ethics of indication (founded mainly on the principles of Beneficence and Non-Maleficence). It is necessary to improve the ethical training received by physiotherapists, which is poorly focused on professional attitudes.
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Affiliation(s)
- María Isabel Mármol-López
- Research Group GREIACC, Health Research Institute La Fe (IISLaFe), Nursing School La Fe, Adscript Centre, University of Valencia, Valencia, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Department of Physiotherapy, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Kati Naamanka
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Anna Arnal-Gómez
- Physiotherapy in Motion, Department of Physiotherapy, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion, Department of Physiotherapy, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Ángela Durante
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Clara Isabel Tejada-Garrido
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Noelia Navas-Echazarreta
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Vicente Gea
- Faculty of Health Sciences, Research Group Community Health and Care (SALCOM), Valencia International University, Valencia, Spain
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15
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Stonner MM, Skladman R, Bettlach CLR, Kennedy C, Mackinnon SE. Recruiting hand therapists improves disposal of unused opioid medication. J Hand Ther 2023; 36:507-513. [PMID: 35909068 DOI: 10.1016/j.jht.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Opioids often remain unused after upper extremity surgery, and leftover prescriptions are frequently diverted. When administered in a hand surgery clinic, an educational brochure outlining a simple method of opioid disposal has been shown to improve disposal rates after surgery. PURPOSE To understand whether administration of an opioid disposal educational brochure in a hand therapy clinic would increase opioid disposal rates, compared to a hand surgery clinic. STUDY DESIGN Prospective cohort study. METHODS Patients who presented to a hand therapy clinic postoperatively were recruited to participate in this prospective cohort study. An educational brochure outlining a simple method of opioid disposal was made available at the hand therapy and surgery clinics. A questionnaire was later issued to obtain: location of brochure receipt, demographic information, pre- and post-operative opioid use history, and opioid disposal patterns. Chi-square tests and multivariable binary logistic regression assessed associations between medication disposal and explanatory variables. RESULTS Patients who received the brochure were significantly more likely to dispose of excess opioid medication, compared to those who did not receive the brochure (57.1% vs 10.8%, p < .001). Patients who received the brochure at the hand therapy clinic were significantly more likely to dispose of excess opioids (86.4%) compared to those who received the brochure at the surgery clinic (25.0%). Older age was predictive of increased disposal (p =.028*). There were no significant associations between gender, length of follow-up, or surgery type with the incidence of opioid disposal. CONCLUSION Recruiting both hand therapists and surgeons in the distribution of a simple, educational brochure on opioid disposal can increase disposal rates. Patients who received the brochure from the hand therapist were more likely to dispose of excess opioids. The longstanding patient-therapist relationship creates an opportunity for educational initiatives and discussion of stigmatized topics, such as opioid use.
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Affiliation(s)
- Macyn M Stonner
- Program in Occupational Therapy, Milliken Hand Rehabilitation Center, Washington University School of Medicine, St. Louis, MO, USA.
| | - Rachel Skladman
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carrie L Roth Bettlach
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carie Kennedy
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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16
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Ekdahl AS, Gutke A, Olsén MF, Mannerkorpi K. Expertise and individually tailored interventions are expected by pregnant women with pelvic girdle pain who seek physical therapy: a qualitative study. Braz J Phys Ther 2023; 27:100494. [PMID: 36965211 PMCID: PMC10064431 DOI: 10.1016/j.bjpt.2023.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/12/2022] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Pelvic girdle pain (PGP) in pregnancy may result in activity limitations and thus a negative impact on the individual woman's everyday life. Women's expectations when they seek physical therapy because of PGP are not yet known. OBJECTIVE To explore pregnant women's lived experience of PGP and what needs and expectations they express prior to a physical therapy consultation. METHODS A qualitative study using a descriptive phenomenological method. Interviews conducted with 15 pregnant women seeking physical therapy because of PGP, recruited through purposive sampling at one primary care rehabilitation clinic. RESULTS PGP was described by four themes; An experience with larger impact on life than expected, A time for adjustments and acceptance, A feeling of insecurity and concern, A desire to move forward. PGP had a large impact on the pregnant women´s life. Thoughts of PGP as something to be endured was expressed, the women therefore accepted the situation. Finding strategies to manage everyday life was hard and when it failed, the women described despair and a need for help. They expected the physical therapist to be an expert who would see them as individuals and provide advice that could make their everyday life easier. CONCLUSION Our results reveal that pregnant women with PGP delay seeking physical therapy until their situation becomes unmanageable and they run out of strategies for self-care. The women express, in light of their individual experiences, needs and expectations for professional management and advice tailored to their individually unique situation.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Annelie Gutke
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Närhälsan Eriksberg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Dunphy E, Button K, Murray E, Hamilton FL. Beyond guidelines: A qualitative clinical stakeholder study of optimal management of anterior cruciate ligament rehabilitation. Musculoskeletal Care 2023; 21:117-129. [PMID: 35852464 DOI: 10.1002/msc.1673] [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: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
AIMS This study gathered expert perspectives in the management of anterior cruciate ligament (ACL) rehabilitation to explore current practice, variations in care and optimal management strategies. MATERIALS AND METHODS This was a qualitative semi-structured interview study. The participants' experiences were considered in terms of their roles as employees, managers, clinicians and professional gatekeepers. Purposive and snowball sampling were used to recruit physiotherapists and orthopaedic surgeons. Participants were included if they had a proven record in clinical management or research involving ACL patients. Persons were excluded if they could not speak English. Interviews were conducted in person, via skype or over the phone at a time convenient to the participant. Data was analysed using a framework analysis and critical realist approach. RESULTS Results included 24 interviews that were conducted with 19 physiotherapists and 5 surgeons. Themes of variation in current care and optimal care were explored including subthemes of patient centred practice, evidence based medicine, resources, self-management, multidisciplinary teamwork, training and expertise were explored. Participant's perceptions of current care were that it was a location 'lottery' that significantly varied for patients across the UK. CONCLUSIONS Stakeholders identified that optimal management should be patient centred and incorporate adequate equipment, specific training for physiotherapists and a closely communicating multidisciplinary team. Research is needed to explore cost effective models of optimal rehabilitation that include return to sport strategies.
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Affiliation(s)
- Emma Dunphy
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
| | - Fiona L Hamilton
- Research Department of Primary Care and Population Health, eHealth Unit, London, UK
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Böttinger MJ, Elgeti M, Tschaggeny D, Wasner M, Diermayr G. Barrieren und Förderfaktoren für die Implementierung eines Konzepts zur Förderung evidenzbasierten Arbeitens in der Physiotherapie – Eine Mixed-Methods-Studie. PHYSIOSCIENCE 2023. [DOI: 10.1055/a-1720-8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Zusammenfassung
Hintergrund In der Physiotherapie in Deutschland besteht Bedarf an theoretisch und wissenschaftlich fundierten Implementierungsstrategien zur Förderung des evidenzbasierten Arbeitens (EBP). Bei der Entwicklung solcher Strategien ist es notwendig, die Rahmenbedingungen und Einflussfaktoren im individuellen Kontext zu erfassen und zu berücksichtigen. In diesem Zusammenhang wurde das „science4practice“-Konzept mit dem Ziel entwickelt, die Umsetzung von EBP in physiotherapeutischen Einrichtungen zu fördern.
Ziel Erhebung von Barrieren und Förderfaktoren für die Implementierung des „science4practice“-Konzepts.
Methode Im Rahmen einer Mixed-Methods-Studie wurden qualitative, semistrukturierte Interviews sowie eine quantitative Erhebung anhand eines Online- und Papierfragebogens durchgeführt. An den Interviews nahmen Geschäfts- und Therapieleitungen therapeutischer Einrichtungen sowie Physiotherapeut*innen ohne Leitungsverantwortung teil. An der quantitativen Befragung nahmen Physiotherapeut*innen ohne Leitungsverantwortung teil. Die Daten der Interviews wurden mittels thematischer Inhaltsanalyse ausgewertet. Die Daten der quantitativen Erhebung wurden deskriptiv analysiert.
Ergebnisse Aus den 15 durchgeführten Interviews konnten die mangelnden Fähigkeiten zur Literaturrecherche und -bewertung, negative Erfahrungen mit Veränderungsprozessen sowie unzureichende Zugangsmöglichkeiten zu wissenschaftlicher Literatur als Barrieren abgeleitet werden. Als Förderfaktoren wurden die Unterstützung durch Vorgesetzte sowie die Verfügbarkeit von Ressourcen für die Implementierung des Konzepts identifiziert. Die Umfrageergebnisse von 47 Physiotherapeut*innen ohne Leitungsverantwortung zeigen kumulierte Zustimmungswerte („trifft voll zu“ und „trifft eher zu“) von 83–91 % für die Bereitschaft zur Umsetzung des „science4practice“-Konzepts. Durch die Zusammenführung der quantitativen und qualitativen Daten konnte die Bereitschaft des Teams zur Konzeptumsetzung abschließend als Förderfaktor eingeordnet werden.
Schlussfolgerung Die Studie identifiziert Barrieren und Förderfaktoren aus Sicht der Teilnehmenden mit und ohne Leitungsverantwortung. Einerseits unterstreichen die Daten national und international identifizierte Barrieren wie mangelnde wissenschaftliche Kompetenzen oder unzureichende Zugänge zu wissenschaftlicher Literatur. Andererseits zeigen die Ergebnisse das Potential des Konzepts als EBP-Implementierungsvorhaben in der Physiotherapie in Deutschland. Im nächsten Schritt sollten Studien durchgeführt werden, um die Machbarkeit des Konzepts zu überprüfen.
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Affiliation(s)
| | | | | | - Mieke Wasner
- SRH Hochschule Heidelberg, Heidelberg, Deutschland
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19
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Kleiner MJ, Kinsella EA, Miciak M, Teachman G, McCabe E, Walton DM. An integrative review of the qualities of a 'good' physiotherapist. Physiother Theory Pract 2023; 39:89-116. [PMID: 34881685 DOI: 10.1080/09593985.2021.1999354] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Qualities of a physiotherapist may influence the therapeutic alliance and physiotherapy outcomes. Understanding what qualities constitute a 'good' physiotherapist has yet to be systematically reviewed notwithstanding potentially profound implications for the future practice of physiotherapy. PURPOSE The primary purpose of this review was to critically examine how physiotherapists and their patients describe the qualities of a 'good' musculoskeletal physiotherapist as depicted in peer-reviewed literature. The secondary aim was to synthesize qualities represented in the literature, and to compare patient and physiotherapist perspectives. METHODS An integrative review methodology was used to undertake a comprehensive literature search, quality appraisal of studies, and thematic analysis of findings. An electronic search of CINAHL, EMBASE, Nursing and Allied Health, PsycINFO, PubMed, and Scopus databases was conducted within a time range from database inception to June 14, 2019. RESULTS Twenty-seven studies met the inclusion criteria. Six qualities of a 'good' musculoskeletal physiotherapist were identified as: responsive, ethical, communicative, caring, competent, and collaborative. CONCLUSIONS The qualities of a 'good' physiotherapist identified in the review emphasize the human interaction between physiotherapists and patients and point to the centrality of balancing technical competence with a relational way of being.
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Affiliation(s)
- Michelle J Kleiner
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Elizabeth Anne Kinsella
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada.,Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gail Teachman
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada.,School of Occupational Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - David M Walton
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, ON, Canada.,School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
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Bernhardsson S, Larsson A, Bergenheim A, Ho-Henriksson CM, Ekhammar A, Lange E, Larsson MEH, Nordeman L, Samsson KS, Bornhöft L. Digital physiotherapy assessment vs conventional face-to-face physiotherapy assessment of patients with musculoskeletal disorders: A systematic review. PLoS One 2023; 18:e0283013. [PMID: 36943857 PMCID: PMC10030027 DOI: 10.1371/journal.pone.0283013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND This systematic review aimed to assess the certainty of evidence for digital versus conventional, face-to-face physiotherapy assessment of musculoskeletal disorders, concerning validity, reliability, feasibility, patient satisfaction, physiotherapist satisfaction, adverse events, clinical management, and cost-effectiveness. METHODS Eligibility criteria: Original studies comparing digital physiotherapy assessment with face-to-face physiotherapy assessment of musculoskeletal disorders. Systematic database searches were performed in May 2021, and updated in May 2022, in Medline, Cochrane Library, Cinahl, AMED, and PEDro. Risk of bias and applicability of the included studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Quality Appraisal of Reliability Studies tool. Included studies were synthesised narratively. Certainty of evidence was evaluated for each assessment component using GRADE. RESULTS Ten repeated-measures studies were included, involving 193 participants aged 23-62 years. Reported validity of digital physiotherapy assessment ranged from moderate/acceptable to almost perfect/excellent for clinical tests, range of motion, patient-reported outcome measures (PROMs), pain, neck posture, and management decisions. Reported validity for assessing spinal posture varied and was for clinical observations unacceptably low. Reported validity and reliability for digital diagnosis ranged from moderate to almost perfect for exact+similar agreement, but was considerably lower when constrained to exact agreement. Reported reliability was excellent for digital assessment of clinical tests, range of motion, pain, neck posture, and PROMs. Certainty of evidence varied from very low to high, with PROMs and pain assessment obtaining the highest certainty. Patients were satisfied with their digital assessment, but did not perceive it as good as face-to-face assessment. DISCUSSION Evidence ranging from very low to high certainty suggests that validity and reliability of digital physiotherapy assessments are acceptable to excellent for several assessment components. Digital physiotherapy assessment may be a viable alternative to face-to-face assessment for patients who are likely to benefit from the accessibility and convenience of remote access. TRIAL REGISTRATION The review was registered in the PROSPERO database, CRD42021277624.
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Affiliation(s)
- Susanne Bernhardsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anette Larsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Department of General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Herrljunga Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Herrljunga, Sweden
| | - Anna Bergenheim
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chan-Mei Ho-Henriksson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Lidköping Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Lidköping, Sweden
| | - Annika Ekhammar
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Eriksberg Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Gothenburg, Sweden
| | - Elvira Lange
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Lena Nordeman
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin S Samsson
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Capio Ortho Center Gothenburg, Gothenburg, Sweden
| | - Lena Bornhöft
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Vänersborg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Torslanda Rehabilitation Clinic, Primary Care Rehabilitation, Region Västra Götaland, Gothenburg, Sweden
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Bennell KL, Jones SE, Hinman RS, McManus F, Lamb KE, Quicke JG, Sumithran P, Prendergast J, George ES, Holden MA, Foster NE, Allison K. Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial. BMC Musculoskelet Disord 2022; 23:733. [PMID: 35907828 PMCID: PMC9338658 DOI: 10.1186/s12891-022-05685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is associated with knee osteoarthritis (OA). Weight loss, alongside exercise, is a recommended treatment for individuals with knee OA and overweight/obesity. However, many patients cannot access weight loss specialists such as dietitians. Innovative care models expanding roles of other clinicians may increase access to weight loss support for people with knee OA. Physiotherapists may be well placed to deliver such support. This two-group parallel, superiority randomized controlled trial aims to compare a physiotherapist-delivered diet and exercise program to an exercise program alone, over 6 months. The primary hypothesis is that the physiotherapist-delivered diet plus exercise program will lead to greater weight loss than the exercise program. METHODS 88 participants with painful knee OA and body mass index (BMI) > 27 kg/m2 will be recruited from the community. Following baseline assessment, participants will be randomised to either exercise alone or diet plus exercise groups. Participants in the exercise group will have 6 consultations (20-30 min) via videoconference with a physiotherapist over 6 months for a strengthening exercise program, physical activity plan and educational/exercise resources. Participants in the diet plus exercise group will have 6 consultations (50-75 min) via videoconference with a physiotherapist prescribing a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating, plus the intervention of the exercise only group. Outcomes are measured at baseline and 6 months. The primary outcome is percentage change in body weight measured by a blinded assessor. Secondary outcomes include self-reported knee pain, physical function, global change in knee problems, quality of life, physical activity levels, and internalised weight stigma, as well as BMI, waist circumference, waist-to-hip ratio, physical performance measures and quadriceps strength, measured by a blinded assessor. Additional measures include adherence, adverse events, fidelity and process measures. DISCUSSION This trial will determine whether a physiotherapist-delivered diet plus exercise program is more effective for weight loss than an exercise only program. Findings will inform the development and implementation of innovative health service models addressing weight management and exercise for patients with knee OA and overweight/obesity. TRIAL REGISTRATION NIH US National Library of Medicine, Clinicaltrials.gov NCT04733053 (Feb 1 2021).
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Sarah E Jones
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Methods and Implementation Support for Clinical Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jonathan G Quicke
- School of Medicine, Keele University, Keele, UK.,Chartered Society of Physiotherapy, Chancery Exchange, London, UK
| | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | | | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | | | - Nadine E Foster
- School of Medicine, Keele University, Keele, UK.,STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia
| | - Kim Allison
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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22
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Hodges PW, Setchell J, Daniel E, Fowler M, Lee AS, Popovich JM, Cholewicki J. How Individuals With Low Back Pain Conceptualize Their Condition: A Collaborative Modeling Approach. THE JOURNAL OF PAIN 2022; 23:1060-1070. [PMID: 35045354 DOI: 10.1016/j.jpain.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Low back pain (LBP) is complex. This study aimed to use collaborative modeling to evaluate conceptual models that individuals with LBP have of their condition, and to compare these models with those of researchers/clinicians. Twenty-eight individuals with LBP were facilitated to generate mental models, using "fuzzy cognitive maps," that represented conceptualization of their own LBP and LBP "in general." "Components" (ie, causes, outcomes and treatments) related to pain, disability and quality of life were proposed, along with the weighted "Connections" between Components. Components were classified into thematic categories. Weighting of Connections were summed for each Component to judge relative importance. Individual models were aggregated into a metamodel. When considering their own condition, participants' models included 19(SD = 6) Components and 43(18) Connections with greatest weight on "Biomechanical" components. When considering LBP in general, models changed slightly. Patient models contrasted the more complex models of researchers/clinicians (25(7) Components; 77(42) Connections), with most weight on "Psychological" components. This study provides unique insight into how individuals with LBP consider their condition, which is largely biomedical and narrower than clinician/researcher perspectives. Findings highlight challenges for changing public perception of LBP, and provide a method with potential utility to understand how individuals conceptualize their condition. PERSPECTIVE: Collaborative modeling was used to understand how individuals with low back pain conceptualize their own condition, the condition in general, and compare this with models of expert researchers/clinicians. Data revealed issues in how individuals with back pain conceptualize their condition, and the method's potential utility for clinical evaluation of patients.
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Affiliation(s)
- Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, Brisbane, Australia.
| | - Jenny Setchell
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, Brisbane, Australia
| | - Emily Daniel
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, Brisbane, Australia
| | - Matt Fowler
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, Brisbane, Australia
| | - Angela S Lee
- Michigan State University, Center for Neuromusculoskeletal Clinical Research, Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, East Lansing, Michigan
| | - John M Popovich
- Michigan State University, Center for Neuromusculoskeletal Clinical Research, Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, East Lansing, Michigan
| | - Jacek Cholewicki
- Michigan State University, Center for Neuromusculoskeletal Clinical Research, Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, East Lansing, Michigan
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23
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Patients' Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106106. [PMID: 35627641 PMCID: PMC9140490 DOI: 10.3390/ijerph19106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen’s d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients’ perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.
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24
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Jensen L, Eva Rasmussen T, Lindahl M. What do patients expect from physiotherapists in private clinics? A classical grounded theory study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2059104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Liselotte Jensen
- Faculty of Physiotherapy, Center of Nutrition and Rehabilitation, University College Absalon, Roskilde, Denmark
| | - Tine Eva Rasmussen
- Faculty of Physiotherapy, Center of Nutrition and Rehabilitation, University College Absalon, Roskilde, Denmark
| | - Marianne Lindahl
- Faculty of Physiotherapy, Center of Nutrition and Rehabilitation, University College Absalon, Roskilde, Denmark
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25
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Shared Decision Making Conceptual Models for Physiotherapy: A Theory Analysis. Physiotherapy 2022; 115:111-118. [DOI: 10.1016/j.physio.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/22/2022]
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26
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Naamanka K, Suhonen R, Tolvanen A, Leino-Kilpi H. Ethical competence - exploring situations in physiotherapy practice. Physiother Theory Pract 2022; 39:1237-1248. [DOI: 10.1080/09593985.2022.2039817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kati Naamanka
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Anna Tolvanen
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
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27
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Suda AJ, Kientopf D, Leithner A, Streeck J, Colshorn T, Dorotka R, Schneider M, Höppchen I. [No Evidence for the Biomechanical and Pathophysiological Explanatory Models of Musculoskeletal Diseases According to Liebscher & Bracht]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:13-18. [PMID: 35144293 PMCID: PMC8831037 DOI: 10.1055/a-1716-2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Arnold J Suda
- AUVA Trauma Center Salzburg, Department of Orthopaedics and Trauma Surgery, Allgemeine Unfallversicherungsanstalt, Salzburg, Austria.,Center for Orthopaedics and Trauma Surgery, Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Dale Kientopf
- Moversity, Fit by Dale, Kaltenkirchen, Germany.,Medical Faculty, Albert-Ludwigs-Universität Freiburg Medizinische Fakultät, Freiburg, Germany
| | - Andreas Leithner
- Department of Orthopedics and Trauma Surgery, Hospital of the Federal State of Styria and University Hospital Graz, Graz, Austria.,President, Österreichische Gesellschaft für Orthopädie und orthopädische Chirurgie, Vienna, Austria
| | - Jesko Streeck
- Physiotherapy, Manumed - Streeck, Bobenheim-Roxheim, Germany
| | - Thomas Colshorn
- Physiotherapist and Sports Science, Physiotherapy, Bremen, Germany
| | - Ronald Dorotka
- Orthopadic Surgery, Orthopädie-Zentrum Innere Stadt, Vienna, Austria.,Präsident, Berufsverband Österreichischer Fachärzte für Orthopädie, Vienna, Austria
| | - Markus Schneider
- Pain Therapy, alphaMED/alphaSPINE, Bamberg, Germany.,Interdisziplinäre Gesellschaft für orthopädisch-unfallchirurgische und allgemeine Schmerztherapie, President of IGOST, Ravensburg, Germany.,Leiter der Sektion Schmerztherapie, DGOOC, Frankfurt/Main, Germany
| | - Isabel Höppchen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Ludwig Boltzmann Gesellschaft, Wien, Austria.,Center for Human-Computer Interaction, Paris Lodron University of Salzburg, Salzburg, Austria
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28
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People's Experience of Shared Decision Making in Musculoskeletal Physiotherapy: A Systematic Review and Thematic Synthesis. Behav Sci (Basel) 2022; 12:bs12010012. [PMID: 35049623 PMCID: PMC8773142 DOI: 10.3390/bs12010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Shared decision making (SDM) has been advocated as a way of improving prudency in healthcare and has been linked to self-efficacy and empowerment of service users. The evaluation of its use in musculoskeletal (MSK) physiotherapy has been vague, but articles suggest that trust and communication are integral. (2) ENTREQ guidelines informed this systematic review and thematic synthesis. PRISMA recommendations steered a systematic literature search of AHMED, CINAHL, MEDLNE, EMBASE and Cochrane databases from inception to September 2021. COREQ was used for quality appraisal of articles alongside critical discussions. Analysis and synthesis included five stages: outlining study characteristics, coding of data, development of descriptive themes, development of analytical themes and integration and refinement. The review aim was to explore people’s experiences of SDM in MSK physiotherapy and to inform our understanding of the conditions needed for successful SDM. (3) Out of 1508 studies, 9 articles were included. Four main themes (trust, communication, decision preferences and decision ability) demonstrated that the majority of people want to participate in decision-making. As described in the capacity and capability model, three core conditions were needed to facilitate someone’s’ ability to participate. (4) People want to be involved in SDM in MSK physiotherapy. For successful SDM, physiotherapists should look to develop mutual trust, utilise two-way communication and share power.
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Patient perspectives on participation in exercise-based rehabilitation for Achilles tendinopathy: A qualitative study. Musculoskelet Sci Pract 2021; 56:102450. [PMID: 34419889 DOI: 10.1016/j.msksp.2021.102450] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Achilles tendinopathy (AT) is common, and can be traumatic or insidious in onset and short-lasting or persistent in nature. Factors influencing the experience of pain are poorly understood; little is known about mechanisms driving pain and the response (or lack of) to rehabilitation. Despite this, there is a growing body of evidence supporting the use of exercise to manage AT. Interestingly, variation in exercise approach does not appear to significantly impact outcome. Patients' perceptions of factors related to rehabilitation that may influence outcome could provide a valuable addition to help guide future research and practice. OBJECTIVES The aim of this study is to gain an insight into patients' experiences of participating in an exercise-based rehabilitation programme for AT. METHOD A qualitative interpretive description design. Data generated from semi-structured interviews were analysed thematically using the guidelines set out by Braun and Clarke. FINDINGS This is the first study to use a qualitative method of inquiry to gain data on the experiences of people undertaking exercise-based rehabilitation for AT. The four major themes that were identified from the data were: (1) 'understanding the impact' (2) 'expectations' (3) 'what matters' and (4) 'the burden of exercise'. CONCLUSIONS Given the uncertainty surrounding the mechanisms of effect of our treatments, the insights provide a platform from which researchers and clinicians can consider further in the management of people with Achilles tendinopathy. Specifically, it has highlighted that patients value a flexible, supportive approach embracing the biopsychosocial impact of AT on the individual.
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30
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Feldman R, Nudelman Y, Haleva-Amir S, Ben Ami N. Patients' prior perceptions and expectations of the Enhanced Transtheoretical Model Intervention for chronic low back pain: A qualitative study. Musculoskeletal Care 2021; 20:371-382. [PMID: 34726320 DOI: 10.1002/msc.1600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Enhanced Transtheoretical Model Intervention (ETMI) is an approach for treating chronic low back pain (CLBP), which demonstrated clinical and cost-effectiveness outcomes. ETMI highlights reassurance, return to normal activities and encouragement of recreational physical activity. In order to optimally implement ETMI, it is important to gain an understanding of the expectations and perceptions of patients before they engage with the intervention. OBJECTIVES To explore CLBP patients' perceptions and expectations of the ETMI method prior to their first consultation with physiotherapist. METHODS Qualitative semi-structured interviews were conducted with 30 CLBP patients. The interviews were audio-recorded, transcribed, coded, and analysed thematically. Patients were first asked about their expectations of treatment, then they were asked to comment on the ETMI method. RESULTS Three main themes emerged from the interviews: (1) Patient's perceptions of LBP; (2) patient's expectations from current physiotherapy and (3) Patient's expectations from ETMI method. The patients' perceptions of back pain centred on biomechanical causal factors, a desire for diagnostic tests and beliefs that rest cures the pain. Their expectations from current physiotherapy included pain reduction, passive treatment, a structured exercise program and clear information about LBP. In reference to the ETMI method, patients expected pain reduction, practical tools to self-manage, and a combination of ETMI with passive treatment. CONCLUSION addressing issues around patient's perceptions and expectations of current physiotherapy and of the ETMI method, prior to their first consultation with physiotherapist, could be beneficial for understanding how to improve the ETMI implementation in the health care system.
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Affiliation(s)
- Ron Feldman
- Department of Physiotherapy, Ariel University, Ariel, Israel.,Department of Physiotherapy, 'Maccabi' Healthcare Services, Tel-Aviv, Israel
| | - Yaniv Nudelman
- Department of Physiotherapy, Ariel University, Ariel, Israel.,Department of Physiotherapy, 'Maccabi' Healthcare Services, Tel-Aviv, Israel
| | | | - Noa Ben Ami
- Department of Physiotherapy, Ariel University, Ariel, Israel
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31
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Enthoven P, Eddeborn F, Abbott A, Schröder K, Fors M, Öberg B. Patients' experiences of the BetterBack model of care for low back pain in primary care - a qualitative interview study. Int J Qual Stud Health Well-being 2021; 16:1861719. [PMID: 33393455 PMCID: PMC7782354 DOI: 10.1080/17482631.2020.1861719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4–14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; “Participant understanding of their treatment for low back pain and self-management strategies—a matter of support systems”, comprising the following categories: “Knowledge translation”, “Interaction and dialogue”, “The health care professional support” and “Form organization”. Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain.
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Affiliation(s)
- Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Fredrik Eddeborn
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Rehab West, Region Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Maria Fors
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
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32
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Sibley KM, Gardner P, Bentley DC, Khan M, McGlynn M, Shing P, Shaffer J, O'Hoski S, Salbach NM. Exploring factors influencing physiotherapists' perceptions of measuring reactive balance following a theory-based multi-component intervention: a qualitative descriptive study. Disabil Rehabil 2021; 44:4709-4716. [PMID: 34148468 DOI: 10.1080/09638288.2021.1916840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Reactive balance is a critical consideration for mobility and fall avoidance, but is under-assessed among physiotherapists. The objective of this study was to explore factors influencing physiotherapist perceptions about measuring reactive balance upon completion of a 12-month theory-based, multi-component intervention to increase use of a measure of reactive balance.Methods: A qualitative descriptive approach was used. Semi-structured interviews were conducted with 28 physiotherapists treating adults with balance impairment in three urban Canadian rehabilitation hospitals that participated in the intervention. Interviews explored perceptions of reactive balance measurement and perceived changes in clinical behavior. Thematic analysis involved multiple rounds of coding, review and discussion, theme generation, and interpretation of findings through individual analysis and team meetings.Findings: Participants expressed contrasting views about integrating reactive balance measurement in their practice, despite consistent acknowledgement of the importance of reactive balance for function. Three themes were identified highlighting factors that mediated perceptions about measuring reactive balance: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear.Conclusions: The findings highlight that decision making for measuring reactive balance in rehabilitation settings is complex. There is a need for additional work to facilitate long-term implementation of clinical reactive balance measurement, such as refining patient criteria for administration, ensuring sufficient time to establish a trusting relationship, and developing and testing strategies to address physiotherapist fear.IMPLICATIONS FOR REHABILITATIONReactive balance is important for falls prevention and mobility, but is under-assessed among physiotherapists.This study identified three factors that influenced uptake of reactive balance measurement among physiotherapists in rehabilitation settings: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear.Knowledge of the identified factors may assist with design and use of reactive and other balance measurements.Strategies aimed at developing trusting relationships between physiotherapist and patient along with addressing physiotherapist fear could facilitate the uptake of clinical reactive balance measurement.
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Affiliation(s)
- K M Sibley
- Department ofCommunity Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - P Gardner
- Department of Health Sciences, Brock University, St. Catharines, Canada.,Bridgepoint Active Healthcare - Sinai Health System, Toronto, Canada
| | - D C Bentley
- Toronto Rehabilitation Institute- University Health Network, Toronto, Canada.,Division of Anatomy, University of Toronto, Toronto, Canada
| | - M Khan
- Department ofCommunity Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - M McGlynn
- Toronto Rehabilitation Institute- University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - P Shing
- Bridgepoint Active Healthcare - Sinai Health System, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - J Shaffer
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre - St. John's Rehab, Toronto, Canada
| | - S O'Hoski
- West Park Healthcare Centre, Toronto, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - N M Salbach
- Toronto Rehabilitation Institute- University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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33
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Hansen LS, Præstegaard J, Lehn-Christiansen S. Patient-centeredness in Physiotherapy - A literature mapping review. Physiother Theory Pract 2021; 38:1843-1856. [PMID: 34096445 DOI: 10.1080/09593985.2021.1923095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and purpose: Research on patient-centeredness within physiotherapy points to a need for clarification about what the concept entails in science and practice and how research positions itself within health care. Thus, the aim is to systematically map the characteristics of research on patient-centeredness in physiotherapy and critically discuss the dominant understandings within. Methods: A systematic research mapping was carried out, based on searches in leading bibliographic databases. Four categories were selected in order to characterize the research field: focus, design, theoretical approach and inherent logic. Findings: Of 5,324 studies, 101 were included in the final mapping, pointing to a limited amount of research. The papers included were published in 47 different journals. Two major research foci emerges: one testing or developing technologies (tools) to promote patient-centeredness and one exploring patients' or professionals' experiences related to physiotherapy practice. Most papers reported on empirical research and there seems to be a dearth of conceptual papers. The theoretical approaches applied were mainly psychological, pedagogical and biomedical. The papers included were divided into equal amounts of studies carried out within inherent logics of causality and complexity. Conclusion: The mapping suggests an incipient awareness of patient-centeredness within the research field of physiotherapy. Empirical studies dominate the field, whereas conceptual and critical papers seem in need of wider acknowledgment. The research field is divided into two mutually disconnected trends: one concerned with understanding the complexity of clinical practice and patients' experiences of treatment and illness, and another trend concerned with solving "the problem" of patient involvement.
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Affiliation(s)
- Louise Søgaard Hansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University Roskilde, Denmark
| | - Jeanette Præstegaard
- Centre for Nutrition and Rehabilitation, Department of Physiotherapy, University College Absalon, Roskilde, Denmark
| | - Sine Lehn-Christiansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University Roskilde, Denmark
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34
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Cridland K, Pritchard S, Rathi S, Malliaras P. 'He explains it in a way that I have confidence he knows what he is doing': A qualitative study of patients' experiences and perspectives of rotator-cuff-related shoulder pain education. Musculoskeletal Care 2020; 19:217-231. [PMID: 33258225 DOI: 10.1002/msc.1528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patient education is recommended in clinical practice guidelines for rotator-cuff-related shoulder pain (RCRSP), yet there are no guidelines for clinicians. A gap in the current literature relates to patients' perspectives. AIMS The aim of this study was to explore the experiences and perspectives of people with RCRSP about education for their condition. MATERIALS AND METHODS An inductive qualitative design was adopted. Eight participants with RCRSP participated in individual telephone interviews that were audio-recorded, transcribed and de-identified. Four researchers completed inductive thematic analysis. Institutional ethics approval was obtained. RESULTS Results are detailed as a thematic analysis from the interview responses. Three primary themes were identified: (1) a therapeutic alliance leads to trust of education; (2) education of RCRSP should be individualized and practical; and (3) delivery of educational interventions should be varied and multi-modal. DISCUSSION The results demonstrated that trust in the health professional providing the education facilitates adherence and increases belief that the condition is being effectively treated. Participants believed imaging were necessary for an individual diagnosis despite clinical practice guidelines not recommending imaging for the first 6-12 weeks of initial presentation. There was a general caution about generic online information which may adversely impact the value of exclusively online educational intervention in the future. Participants preferred clear and practical education about RCRSP, including activity modification, timeframes for recovery and potential detriments to their recovery. There was consensus that education is best delivered early in the rehabilitation process, however there were mixed preferences for delivery method between written, video and face-to-face which perhaps reflects different learning styles and indicates that a 'one size fits all' approach is not effective in adult education in this condition. CONCLUSION People with RCRSP believe education about their condition is important and is best delivered by a trusted source early in their rehabilitation. There is a belief that scans are necessary to provide an individualized diagnosis and assists in their understanding of the condition. There is an opportunity for online education; however, this may best be utilised as an adjunct method to face-to-face care.
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Affiliation(s)
- Kate Cridland
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Shane Pritchard
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Sangeeta Rathi
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Peter Malliaras
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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Larsson M, Nordeman L, Holmgren K, Grimby-Ekman A, Hensing G, Björkelund C, Bergman S, Ekhammar A, Dottori M, Bernhardsson S. Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol. BMC Musculoskelet Disord 2020; 21:790. [PMID: 33248457 PMCID: PMC7700707 DOI: 10.1186/s12891-020-03790-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain. METHODS Eligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Västra Götaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants' employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated. DISCUSSION The study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs. TRIAL REGISTRATION ClinicalTrials.gov Protocol ID: NCT03913325 , Registered April 12, 2019. Version 2, 10 July 2020. Version 2 changes: Clarifications regarding trial aim and inclusion process.
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Affiliation(s)
- Meh Larsson
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - L Nordeman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - K Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - A Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - C Björkelund
- Primary Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - S Bergman
- Primary Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - A Ekhammar
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - M Dottori
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - S Bernhardsson
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Worum H, Lillekroken D, Roaldsen KS, Ahlsen B, Bergland A. Reflections of older people about their experience of fall prevention exercise in the community- a qualitative study exploring evidence-based practice. BMC Public Health 2020; 20:1671. [PMID: 33167887 PMCID: PMC7650178 DOI: 10.1186/s12889-020-09630-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) ensures that clinicians use effective interventions to achieve desired outcomes, thereby contributing to the best quality of care. The perspective of the participants is fundamental in EBP, as they have their own individual and meaningful rationale for participating in fall prevention. This study aims to explore community-dwelling older people reflections about their reflections about EBP in physiotherapy based on their experiences of a fall prevention exercise program. METHODS We conducted semi-structured interviews with 16 community-dwelling older people (men = 7; women = 9). Data were analyzed using thematic analysis. RESULTS The analysis revealed three themes: 1) the tension between knowing and doing, 2) the power of the therapist-participant relationship and the process of putting knowledge into action, and 3) research is interwoven with successful therapy and is an integral component of it. EBP was considered as a collective negotiation and learning process of creating knowledge for clinical practice. The negotiation between different types of knowledge must be performed in a transparent dialogue and through interactive collaboration between the persons involved. The participants appreciated that the research findings indicate that practice gives results. CONCLUSIONS EBP was understood and utilized as a seal of approval and a "guarantee of high quality" treatment, and its effects varied based on older people's preferences, needs, and skills. The therapist's relational competence appeared to be crucial for the negotiation of various sources of knowledge relative to the older people's preferences.
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Affiliation(s)
- Hilde Worum
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kirsti Skavberg Roaldsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Neurobiology, Health Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Birgitte Ahlsen
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Hertroijs DFL, Elissen AMJ, Brouwers MCGJ, Hiligsmann M, Schaper NC, Ruwaard D. Preferences of people with Type 2 diabetes for diabetes care: a discrete choice experiment. Diabet Med 2020; 37:1807-1815. [PMID: 31001855 PMCID: PMC7586937 DOI: 10.1111/dme.13969] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 01/05/2023]
Abstract
AIMS Limited knowledge exists on the preferences of people with Type 2 diabetes towards diabetes care. Consequently, these care preferences cannot yet be considered in the development of tailored diabetes care approaches. Therefore, this study aimed to assess care preferences and their determinants in people with Type 2 diabetes. METHODS A discrete choice experiment was conducted to elicit people's preferences. People with Type 2 diabetes, treated in 30 Dutch primary care practices, were asked to choose repeatedly between two hypothetical diabetes care packages, which differed in six attributes: role division in daily diabetes care planning, lifestyle education method, type of medication management support, consultation frequency, emotional support and time spend on self-management. A mixed-logit model was used to estimate the relative importance of the included attributes. Preference heterogeneity among people with different person- and disease-related characteristics was investigated. RESULTS In total, 288 participants completed the experiment. They preferred to plan their daily diabetes care together with a healthcare provider, to receive individual lifestyle education, medication and emotional support from a healthcare provider, one consultation visit every 3 months and to spend less time on self-management. Participants did not prefer to receive emotional support from a psychologist. Heterogeneity in preferences could partly be explained by differences in sex, education level and glucose-lowering drug use. CONCLUSION People with Type 2 diabetes show a preference for traditional care models. Emotional support was identified by participants as the most important attribute. It is therefore important to adequately guide them when changes in diabetes care organization are implemented.
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Affiliation(s)
- D. F. L. Hertroijs
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - A. M. J. Elissen
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. C. G. J. Brouwers
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. Hiligsmann
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - N. C. Schaper
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - D. Ruwaard
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
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38
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Bastemeijer CM, van Ewijk JP, Hazelzet JA, Voogt LP. Patient values in physiotherapy practice, a qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1877. [PMID: 32918372 PMCID: PMC7900966 DOI: 10.1002/pri.1877] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Physiotherapy is, like all healthcare professions, relational and value-laden. Patient-centred care, evidence-based practice and value-based practices are concepts in which patient values lie at the heart of high-quality healthcare practices. Nevertheless, physiotherapists have limited awareness of what patient values are in the physiotherapy encounter. The purpose of this study is to explore these patient values. METHODS A qualitative study design using content analysis was used involving 17 adult participants with chronic or recurrent musculoskeletal pain. Data were collected during July 2015-July 2016 in three primary care physiotherapy facilities in Rotterdam, The Netherlands. Two researchers analysed the interviews and derived relevant codes from the data. After an iterative process of comparing, analysing, conceptualizing, and discussing the data, a pre-existing analytic framework was refined in which distinct values were delineated. RESULTS Emerging patient values were encompassed in three themes, each consisting of two to four elements: (1) values about oneself (uniqueness and autonomy), (2) values regarding actions of the professional (technically skilled professional, conscientious professional, compassionate professional, responsive professional) and (3) values regarding interactions between patients and the professionals (partnership and empowerment). CONCLUSION This study emphasizes the need for discussing patient values in the clinical encounter and helps physiotherapists to understand what deems to be important for patients with musculoskeletal pain in physiotherapy practice. The results of this study contribute to the existing body of knowledge of this important aspect of the quality of physiotherapy practice and may inspire clinicians and educators to actively implement patient values in clinical practice and the physiotherapy education.
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Affiliation(s)
- Carla M Bastemeijer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lennard P Voogt
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Supp G, Schoch W, Baumstark MW, May S. Do patients with low back pain remember physiotherapists' advice? A mixed-methods study on patient-therapist communication. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1868. [PMID: 32776654 DOI: 10.1002/pri.1868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/17/2020] [Accepted: 07/05/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The primary aim of this study was to determine if the advice physiotherapists think they provide to patients with low back pain (LBP) is what the patients remember and take away from the clinical encounter. The secondary aim was to determine which factors may influence the retention of this advice. METHODS The first component of the study used questionnaires completed by patients and therapists after the initial visit. Related questionnaires of patients and therapists were screened for inconsistencies. The second component of the study involved semi-structured interviews. RESULTS Ninety pairs of questionnaires were completed. Therapists provided patients with one (N = 90), two (N = 85) or three (N = 51) items of advice regarding the management of their LBP. All patients remembered the first item of advice, 92% remembered a second, and 67% remembered the third piece of advice. All items of advice were deemed either 'relevant' or 'very relevant' by 97% of the patients. After the analysis of 14 interviews, data saturation was reached. Four themes emerged from the data analysis of the interviews: (a) Evaluation type, (b) Exercise factors, (c) Patient concerns about their diagnosis, and (d) Patient expectations. DISCUSSION In most cases, patients remembered what therapists told them and considered that the advice provided was relevant. Based on the qualitative data, patients were more likely to remember what therapists said when: (a) shared decision making was used during the initial encounter, (b) prescribed exercises were simple to perform and few in number, (c) patients' concerns about their diagnosis were addressed, and (d) patients' expectations were identified and addressed.
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Affiliation(s)
| | | | - Manfred W Baumstark
- Institute for Exercise- and Occupational Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Castellini G, Corbetta D, Cecchetto S, Gianola S. Twenty-five years after the introduction of Evidence-based Medicine: knowledge, use, attitudes and barriers among physiotherapists in Italy - a cross-sectional study. BMJ Open 2020; 10:e037133. [PMID: 32499274 PMCID: PMC7282414 DOI: 10.1136/bmjopen-2020-037133] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To explore the knowledge, use, attitudes towards Evidence-based Medicine, also known as Evidence-based Practice (EBP), and perceived barriers to its dissemination among physiotherapists. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Members of the Italian Association of Physiotherapists (n=2000) were invited to participate in an online survey about EBP knowledge and use. PRIMARY OUTCOME MEASURES The survey questionnaire comprised four sections: (1) respondent characteristics; (2) knowledge of EBP principles; (3) attitude, use and perceived effectiveness of EBP; (4) perceived barriers to implementing EBP in clinical practice. RESULTS Out of 2000 physiotherapists, 1289 participated in the survey (64.5% response rate). Overall, 90% perceived EBP as useful and necessary for their clinical practice. More than 85% stated that they were familiar with the principles of EBP, 75% reported that they were able to search online databases for relevant information and 60% reported that they were able to understand statistical analyses. However, 56% believed that patient preferences and 39% that clinical expertise are not part of the EBP model. Half stated that they understood and could explain the term 'meta-analysis' but only 17% knew what a forest plot is and just 20% correctly judged the finding of a given meta-analysis. Lack of time was reported as the main barrier to EBP. CONCLUSION The majority of Italian physiotherapists overrated their knowledge about EBP, demonstrating a gap between perceived and actual knowledge of EBP in this population.
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Affiliation(s)
- Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Davide Corbetta
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Physiotherapy Degree Course, Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Cecchetto
- Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
- Physiotherapy Degree Course, University of Verona, Verona, Italy
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Kulju K, Suhonen R, Puukka P, Tolvanen A, Leino-Kilpi H. Self-evaluated ethical competence of a practicing physiotherapist: a national study in Finland. BMC Med Ethics 2020; 21:43. [PMID: 32471504 PMCID: PMC7257238 DOI: 10.1186/s12910-020-00469-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background Patients have the right to equal, respectful treatment. Nowadays, one third of patient complaints concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to analyze the ethical competence of practicing physiotherapists. Method A self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation Tool) based on an analysis of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health services or private practice responded to the questionnaire. Results Based on the results, most of the physiotherapists evaluated themselves highly ethically competent in all areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was evaluated as highest, while character strength, including the strength to support ethical processes and speak on behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the international or national ethical codes of conduct. Conclusions This was the first attempt to assess all aspects of ethical competence empirically in a clinical environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’ viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient.
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Affiliation(s)
- Kati Kulju
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
| | - Riitta Suhonen
- Department of Nursing Science/ Turku University Hospital and City of Turku, Welfare Division, University of Turku, Turku, Finland
| | - Pauli Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - Anna Tolvanen
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, Turku University Hospital, University of Turku, Turku, Finland
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Ahmadian Yazdi N, Soltani Arabshahi K, Bigdeli S, Ghaffarifar S. Challenges in promoting clinical empathy skills in medical students: A content analysis study. Med J Islam Repub Iran 2020; 33:104. [PMID: 31934564 PMCID: PMC6946919 DOI: 10.34171/mjiri.33.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Empathy is a key clinical skill in the medical profession, and many studies have reported a decline in it among medical students during their years of education; especially, in the clinical stage, and this affective decline persists in the physician-hood. This study aimed to explore the participants' perceptions about challenges for promoting clinical empathy in training stages. Methods: A qualitative design using content analysis was applied. Semi-structured interviews were applied to obtain data. Individual interviews were conducted with 14 interns and six clinical professors. The data were analyzed through conventional content analysis and the credibility, trustworthiness, and conformability of the data were confirmed. Results: Data analysis led to the extraction of two main categories, including overt and covert challenges, and also four categories and nine sub-categories. Conclusion: Resolving clinical empathy challenges in medical students requires financial and human resources, and training on the principles of effective doctor-patient interactions. Furthermore, professionalism should be strengthened in professors, and both official and hidden curricula should be revised accordingly.
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Affiliation(s)
- Nahid Ahmadian Yazdi
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Soltani Arabshahi
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
| | - Shoaleh Bigdeli
- Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Innes S, Jackson J. Musculoskeletal ultrasound imaging - An exploration of physiotherapists' interests and use in practice. Musculoskelet Sci Pract 2019; 44:102068. [PMID: 31585403 DOI: 10.1016/j.msksp.2019.102068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Musculoskeletal ultrasound imaging (MSKUSI) has gained popularity; several professions have expressed an interest in this application but the clinical use by physiotherapists has not been fully researched. OBJECTIVES To explore physiotherapists' interests and use of MSKUSI in practice. DESIGN Sequential mixed-methods; questionnaire followed by semi-structured interviews. METHOD A questionnaire was developed and distributed to gain initial information, (75 responses). Analysis informed topic-guide development and enabled a purposive-sampling strategy for semi-structured interviews that explored physiotherapists' interests, education and clinical use of MSKUSI (n = 11). Interview data were analysed thematically. RESULTS Five themes were identified: 1. Professional skill set - physiotherapists' suitability for MSKUSI. 2. Factors that have impacted physiotherapists' ability to use MSKUSI. 3. Physiotherapists' motivation to use ultrasound - improving patient focused care. 4. Quality assurance strategies. 5. Application of biopsychosocial model. Themes revealed links between physiotherapists' core skills, knowledge and professional experiences that align with MSKUSI requirements. Some participants reported support accessing education but many described challenges finding appropriate mentorship. Participants observed education did not always reflect practice typical of physiotherapists. Application of clinical reasoning processes utilised by physiotherapists was regarded as integral to patient-focused scanning. CONCLUSIONS Physiotherapists' professional training and musculoskeletal practice are seen as a foundation for education in MSKUSI. Accessing education can be challenging, in particular mentorship that fully incorporates the biopsychosocial model. Proposed roles for MSKUSI for physiotherapists include verification of clinical assessment findings for diagnosis and facilitation of patient education. The potential to streamline patient pathways and optimise resource management warrants investigation.
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Affiliation(s)
- Sue Innes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex. Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom.
| | - Jo Jackson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex. Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom.
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Smith BE, Moffatt F, Hendrick P, Bateman M, Selfe J, Rathleff MS, Smith TO, Logan P. Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study. BMJ Open 2019; 9:e023805. [PMID: 31164360 PMCID: PMC6561411 DOI: 10.1136/bmjopen-2018-023805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES There is an emergent body of evidence supporting exercise therapy and physical activity in the management of musculoskeletal pain. The purpose of this study was to explore potential barriers and facilitators with patients and physiotherapists with patellofemoral pain involved in a feasibility randomised controlled trial (RCT) study. The trial investigated a loaded self-managed exercise intervention, which included education and advice on physical activity versus usual physiotherapy as the control. DESIGN Qualitative study, embedded within a mixed-methods design, using semi-structured interviews. SETTING A UK National Health Service physiotherapy clinic in a large teaching hospital. PARTICIPANTS Purposively sampled 20 participants within a feasibility RCT study; 10 patients with a diagnosis of patellofemoral pain, aged between 18 and 40 years, and 10 physiotherapists delivering the interventions. RESULTS In respect to barriers and facilitators, the five overlapping themes that emerged from the data were: (1) locus of control; (2) belief and attitude to pain; (3) treatment expectations and preference; (4) participants' engagement with the loaded self-managed exercises and (5) physiotherapists' clinical development. Locus of control was one overarching theme that was evident throughout. Contrary to popular concerns relating to painful exercises, all participants in the intervention group reported positive engagement. Both physiotherapists and patients, in the intervention group, viewed the single exercise approach in a positive manner. Participants within the intervention group described narratives demonstrating self-efficacy, with greater internal locus of control compared with those who received usual physiotherapy, particularly in relation to physical activity. CONCLUSIONS Implementation, delivery and evaluation of the intervention in clinical settings may be challenging, but feasible with the appropriate training for physiotherapists. Participants' improvements in pain and function may have been mediated, in some part, by greater self-efficacy and locus of control. TRIAL REGISTRATION NUMBER ISRCTN35272486; Pre-results.
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Affiliation(s)
- Benjamin E Smith
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Marcus Bateman
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Phillipa Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Allison K, Delany C, Setchell J, Egerton T, Holden M, Quicke J, Bennell K. A qualitative study exploring the views of individuals with knee osteoarthritis on the role of physiotherapists in weight management: A complex issue requiring a sophisticated skill set. Musculoskeletal Care 2019; 17:206-214. [PMID: 30821904 DOI: 10.1002/msc.1391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of the present study was to explore the attitudes of individuals with knee osteoarthritis (OA) towards the role of physiotherapists in weight management in knee OA. METHODS The study took the form of a qualitative semi-structured telephone interview study. Participants included 13 purposively sampled individuals with symptomatic knee OA who were overweight or obese by body mass index. Each participated in a semi-structured telephone interview exploring their perspectives regarding the potential role of physiotherapists in weight management in knee OA. Data were transcribed and analysed using a thematic approach. RESULTS Three main themes were identified, which highlighted that individuals with knee OA: (a) recognize that weight management is complex; (b) consider that a special skill set is required by clinicians for weight management; and (c) expressed ambivalence towards physiotherapists' role in weight management, with a focus on the role of exercise prescription. CONCLUSIONS Although participants were open to physiotherapists taking on a weight management role within a multidisciplinary team, they were uncertain about whether physiotherapists had the skills and scope of practice needed to address this complex issue. The findings highlight the importance of engagement by physiotherapists in meaningful dialogue with patients, to understand better their experiences, expectations and preferences, and establish if, when and how to integrate patients in weight management discussions in the treatment plan for their knee OA.
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Affiliation(s)
- Kim Allison
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Clare Delany
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Thorlene Egerton
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Melanie Holden
- Research Institute for Primary Care & Health Science, Keele University, Newcastle-under-Lyme, UK
| | - Jonathan Quicke
- Research Institute for Primary Care & Health Science, Keele University, Newcastle-under-Lyme, UK
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, VIC, Australia
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Aspects influencing clinical reasoning and decision-making when matching treatment to patients with low back pain in primary healthcare. Musculoskelet Sci Pract 2019; 41:6-14. [PMID: 30818071 DOI: 10.1016/j.msksp.2019.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND It is unclear how physiotherapists match treatment to patients with low-back pain (LBP) in primary healthcare. A further exploration of physiotherapists' perspective of matching treatments to the individual patient in this setting is needed. OBJECTIVE The aim of this study was to explore and describe aspects influencing physiotherapists' clinical reasoning in the decision-making on individualized treatment of LBP in primary healthcare. DESIGN This was an explorative study using qualitative content analysis. METHOD Fifteen semi-structured individual interviews were conducted with physiotherapists, men and women, experienced and novice, working in primary healthcare settings in one sparsely populated region and in one larger city in Sweden. FINDINGS Two overarching themes were identified influencing decision-making for individualized treatment of LBP: 1) Matching requires differentiation and adaptation, with categories describing specific patient characteristics, assessment findings and treatment adaptations (classification of pain and bodily findings; patient physical capacity and emotions; patient awareness and motivation; treatment combinations and atypical treatment rationales): and 2) The tension between trust and barriers; with categories describing aspects of physiotherapists' convictions, constraints and working environment (confidence in treatments and oneself; physiotherapists' terms overrule patients' preferences; personal constraints and workplace approach and priorities). CONCLUSION This study describes aspects of the patients, the physiotherapists and their workplaces that influence decisions for individualized treatment of LBP. The findings underpin the need for clinician self-reflection, initiatives for skilled clinical competence and the weight clinician observations carry on the complex treatment selection process which need to be appreciated when implementing evidence-based recommendations in clinical practice.
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Calner T, Isaksson G, Michaelson P. Physiotherapy treatment experiences of persons with persistent musculoskeletal pain: A qualitative study. Physiother Theory Pract 2019; 37:28-37. [PMID: 31131673 DOI: 10.1080/09593985.2019.1622162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to explore and describe the physiotherapy treatment experiences of persons with persistent musculoskeletal pain. Eleven participants with persistent musculoskeletal pain in the back, neck, or shoulders were included in the study. Data was collected via semi-structured interviews and were analysed with qualitative content analysis. The analysis resulted in the theme "Towards acceptance and management of pain", comprising four sub-themes: 1) Establishing and maintaining a therapeutic alliance; 2) Being active, taking initiative and facing challenges; 3) Appreciating guidance, incentive and having a sounding board; and 4) Acquired knowledge and new body awareness change behaviours. The theme and sub-themes describe how the participants used increased knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies for managing pain and the process of acceptance. A trusting relationship and continual dialogue with the physiotherapist was considered to be important. The participants were actively involved in the process as exercises, activities and other treatment modalities were individualized. This was rewarding but also challenging and required effort on their part. The physiotherapist's initiatives and actions were an important incentive and means of support.
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Affiliation(s)
- Tommy Calner
- Department of Health Sciences, Lulea University of Technology , Lulea, Sweden
| | - Gunilla Isaksson
- Department of Health Sciences, Lulea University of Technology , Lulea, Sweden
| | - Peter Michaelson
- Department of Health Sciences, Lulea University of Technology , Lulea, Sweden
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Mengshoel AM, Bjorbækmo WS, Sallinen M, Wahl AK. 'It takes time, but recovering makes it worthwhile'- A qualitative study of long-term users' experiences of physiotherapy in primary health care. Physiother Theory Pract 2019; 37:6-16. [PMID: 31081435 DOI: 10.1080/09593985.2019.1616343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In several European countries, patients with chronic pain conditions are high consumers of physicians' and physiotherapists' health services in primary health care. This study aimed to explore how patients in a Norwegian context make sense of their long-term use of physiotherapy. Narrative interviews were conducted with six long-term users. The data material was subjected to a narrative analysis with a focus on the stories' content and how health professionals and informants were inscribed in the stories. The stories provide rich and varied information about the informants' experiences with prior and present health services inscribed in their experiences of illness and recovery. The narrative's introduction portrays a shared illness narrative, centered around negative experiences as illustrated by the theme 'A long time searching for explanations and solutions to recover'. The narrative's plot describes a gradually ascending story of recovery where abilities overshadowed disabilities, as the informants are 'Learning their own meaningful ways to proceed'. The narrative has no definite ending, but instead depicts an 'Uncertainty about future and own ability to reverse relapse'. The shared narrative's storyline is that 'It takes time, but recovering makes it worthwhile'.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway
| | - Wenche Schrøder Bjorbækmo
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University , Oslo, Norway
| | - Merja Sallinen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway.,Faculty of Health and Wellbeing, Satakunta University of Applied Sciences , Pori, Finland
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway
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Page MJ, O'Connor DA, Malek M, Haas R, Beaton D, Huang H, Ramiro S, Richards P, Voshaar MJH, Shea B, Verhagen AP, Whittle SL, van der Windt DA, Gagnier JJ, Buchbinder R. Patients' experience of shoulder disorders: a systematic review of qualitative studies for the OMERACT Shoulder Core Domain Set. Rheumatology (Oxford) 2019; 58:kez046. [PMID: 30843587 DOI: 10.1093/rheumatology/kez046] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/27/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the experiences (including symptoms and perceived impacts on daily living) of people with a shoulder disorder. METHODS Systematic review of qualitative studies. We searched for eligible qualitative studies indexed in Ovid MEDLINE, Ovid Embase, CINAHL (EBSCO), SportDiscus (EBSCO) and Ovid PsycINFO up until November 2017. Two authors independently screened studies for inclusion, appraised their methodological quality using the Critical Appraisal Skills Programme checklist, used thematic synthesis methods to generate themes describing the experiences reported by participants and assessed the confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. RESULTS The inclusion criteria were met by eight studies, which included 133 participants (49 females and 84 males) with either rotator cuff disease, adhesive capsulitis, proximal humeral fracture, shoulder instability or unspecified shoulder pain. We generated seven themes to describe what people in the included studies reported experiencing: pain; physical function/activity limitations; participation restriction; sleep disruption; cognitive dysfunction; emotional distress; and other pathophysiological manifestations (other than pain). There were interactions between the themes, with particular experiences impacting on others (e.g. pain leading to reduced activities and sleep disruption). Following grading of the evidence, we considered it likely that most of the review findings were a reasonable representation of the experiences of people with shoulder disorders. CONCLUSION Patients with shoulder disorders contend with considerable disruption to their life. The experiences described should be considered by researchers seeking to select the most appropriate outcomes to measure in clinical trials and other research studies in people with shoulder disorders.
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Affiliation(s)
- Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Mary Malek
- Monash University, Clayton, Victoria, Australia
| | - Romi Haas
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Dorcas Beaton
- Institute of Health & Work and the University of Toronto, Toronto, Ontario, Canada
| | - Hsiaomin Huang
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Pamela Richards
- Academic Rheumatology Bristol, University of Bristol, Bristol, UK
| | - Marieke J H Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Beverley Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Samuel L Whittle
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Danielle A van der Windt
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne
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50
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Serpanou I, Sakellari E, Psychogiou M, Zyga S, Sapountzi-Krepia D. Physical therapists' perceptions about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises: a qualitative study. Braz J Phys Ther 2019; 23:33-40. [PMID: 29914857 PMCID: PMC6546837 DOI: 10.1016/j.bjpt.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/29/2018] [Accepted: 05/28/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The overall purpose of physical therapy for patients with spinal cord injury is to improve health-related quality of life. However, poor adherence is a problem in physical therapy and may have negative impact on outcomes. OBJECTIVES To explore the physical therapists' perspectives about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. METHODS A qualitative content analysis was conducted. Data were collected in a convenience sample using semi-structured interviews. Thirteen registered physical therapists in Athens area participated in the study. RESULTS Five categories emerged from the data: (1) reasons to recommend home exercise by the physical therapist; (2) obstacles to recommend home exercise by the physical therapist; (3) methods addressing these obstacles; (4) the family's role in the adherence to recommended home exercise; and (5) the impact of financial crisis in adherence to recommended home exercise. All participants found the recommended home exercises essential to rehabilitation and health maintenance, and they value their benefits. They also expressed the obstacles that need to be faced during rehabilitation process in order to promote adherence. CONCLUSION Physical therapists should take into account the different obstacles that may prevent patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. These involve the patients and their families, while, financial crisis has also an impact in adherence. In order to overcome these obstacles and increase adherence, communication with patient and family while taking into account the individual's needs, capacities, and resources are essential.
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Affiliation(s)
| | - Evanthia Sakellari
- Department of Public and Community Health, University of West Attica, Athens, Greece; Department of Nursing Science, University of Turku, Turku, Finland.
| | - Maria Psychogiou
- Department of Nursing Science, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Sofia Zyga
- School of Human Movement and Quality of Life Sciences, Faculty of Nursing, University of Peloponnese, Sparta, Greece
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