The perceptions of Danish physiotherapists on the ethical issues related to the physiotherapist-patient relationship during the first session: a phenomenological approach

Reciprocity in Low Back Pain Care and Its Role in Power Dynamics: A Give-and-Take Approach

OBJECTIVE

The shift toward patient-centered care in physical therapy fostered a deeper consideration of power-sharing in clinical interactions. Elements of reciprocity may enhance such power considerations between physical therapist and patients, but there has been little investigation into how reciprocity is enacted in physical therapy, its value, and how to improve it if required. This study investigates forms of reciprocity during physical therapist-patient interactions in low back pain (LBP) care with the aim of enhancing patient-centered approaches.

METHODS

The qualitative design involved (1) ethnographic observations at a fee-for-service practice in Australia, and (2) reflexive discussions between researchers and participating clinicians. To understand reciprocity, the analysis drew from the concepts of "accepting'"(or "blocking") "offers" that have been previously applied to physical therapy interactions. The analysis is a sub-study using a larger dataset and analyses in which we partnered with physical therapists and people living with LBP.

RESULTS

Forty-nine observations and 13 reflexive discussions were undertaken with 42 people with LBP and 10 physical therapists. Analysis developed 3 themes suggesting that forms of reciprocity depended on physical therapists accepting or blocking patients' offers, inviting patients to make an offer, and offering personal stories. These elements of reciprocity are relevant to power-sharing during interactions and may impact patient-centered care.

CONCLUSION

Our results suggest that attending to forms of reciprocity can help physical therapists shift power in clinical interactions. By inviting and accepting "offers," physical therapists may build collaborative interactions, support individuals to guide the treatment narrative, and shift away from biomedically centered management approaches. Such recommendations create reciprocal environments that might enhance patient-centered care.

IMPACT

This is one of the few studies to explore how reciprocity is enacted in interactions between physical therapists and s with LBP. Our findings highlight how engaging with the concept of reciprocity could assist with sharing power, improving physical therapist-patient relationships, and enhancing patient-centered care.

Professional values and perception of knowledge regarding professional ethics in physical therapy students: A STROBE compliant cross-sectional study

Undergraduate students start the acquisition of a professional identity, and begin to achieve professional values and consciousness of an ethical behavior as future health professionals. The aim of this study was describe professional values and perception of knowledge regarding professional ethics of physical therapy students. A cross-sectional study was performed. A total of 351 students participated in the study. Professional values and perception of knowledge regarding professional ethics were assessed. Ethical approval was obtained from the University Ethics Review Board. The most important value was equity, while the least one was abnegation. The second educational year showed higher scores in importance of scientific quality (P = .010 vs first year), the third year in respect for life (P = .041 vs first year, respectively), and the fourth year in respect to patient's autonomy (P = .033 vs first year). First-year students showed lower scores in perception of knowledge regarding professional ethics (P < .001 vs second, third, and fourth year), while second-year students had higher scores (P < .001 vs first and third; P = .006 vs fourth year) and no differences between third- and fourth-year students were found. Those professional values highly considered by the students were mainly shared professional values, with equity ranked highest and abnegation lowest. Furthermore, second-year students had a well-established perception of knowledge regarding professional ethics, showing significant higher scores when compared to the rest of the educational years. This is the first cross-sectional study that describes these variables among physical therapy students and it is a starting point for future. Physical therapy educators might want to take into account these findings when teaching and guiding students in developing awareness for their professional values and perception of knowledge regarding professional ethics.

Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis

Despite recommendations to incorporate physical and psychosocial factors when providing care for people with back pain, research suggests that physiotherapists continue to focus on biological aspects. This study investigated how interpersonal and institutional norms influence this continued enactment of the biological aspects of management. We used theoretically-driven analysis, drawing from Foucauldian notions of power, to analyse 28 ethnographic observations of consultations and seven group discussions with physiotherapists. Analysis suggested that physiotherapy training established expectations of what a physiotherapist 'should' focus on, and institutional circumstances strongly drew the attention of physiotherapists towards biological aspects. Resistance to these forces was possible when, for example, physiotherapists reflected upon their practice, used silences and pauses during consultations, and actively collaborated with patients. These circumstances facilitated use of non-biomedical management approaches. Findings may assist physiotherapists to rework the enduring normative focus on biomedical aspects of care when providing care for patients with back pain.

Patient Satisfaction with Private Recovery Services and Importance of Physician Behavior during COVID Time

Introduction: Patient satisfaction represents an essential indicator of the quality of care in the medical recuperation sector. This study aimed to identify the degree of satisfaction in patients who benefit from medical recuperation services in one private clinic from Romania and the factors that played a part in this respect. Method: An online questionnaire was completed by 105 patients of a private clinic in the period immediately following the opening of the clinic after the quarantine period due to COVID-19. The following concepts were measured: general satisfaction with clinical recuperation services (SG), physician’s behavior (PB), the impact of interventions on the state of health (IHI), modern equipment (ME), and the intention to return to the clinic (IRC). Based on a linear regression model, the impact of PB, IHI, ME, and IRC variables on general satisfaction (SG) was established. Results: The study results confirm the data from studies carried out in different sociocultural contexts in ordinary time, where physician behavior is the most crucial factor in patients’ satisfaction. Therefore, we can say that the physiotherapist’s behavior has an essential role in determining the patients’ satisfaction both in ordinary time and in COVID-19 time. The data in this study reflect the fact that satisfaction with the services offered by a medical recuperation clinic is a predictor for using the services in the future. Still, our study reflects a moderate relationship in intensity.

Shifting roles: physiotherapists' perception of person-centered care during a pre-implementation phase in the acute hospital setting - A phenomenographic study

BACKGROUND

Person-centered care (PCC) is an acknowledged health care practice involving increased patient influence regarding decisions and deliberation. Research indicates that physiotherapists (PTs) embrace patient participation, but that PCC is difficult to grasp and fully implement.

OBJECTIVE

To contribute to knowledge about how PCC influences physiotherapy by eliciting PTs' experiences from the acute care setting, this study aims to describe and illuminate variations in perceptions of PCC during a pre-implementation phase, among PTs in acute hospital care.

METHODS

Phenomenological approach: individual interviews with PTs in acute care (n = 7) combined with focus group interviews (n = 3).

FINDINGS

The analysis yielded two main categories: 1) Physiotherapists perceived a transformed patient role involved in the transition from patient to person; and 2) Physiotherapists perceived a challenged professional role when departing from the expert role, and entailed restrictions to prescribing the best treatment and, instead, meant aiming for a collaborative and equal relationship with the patient.

CONCLUSION

Although the interviewed PTs embraced PCC in principle, PCC does seem to challenge the professional roles of patient and PT. The findings indicate that theories of power relations need to be considered, and further reflection may facilitate implementation. More research is needed to deepen the knowledge of how PTs perceive PCC during all implementation phases.

Self-evaluated ethical competence of a practicing physiotherapist: a national study in Finland

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.

Goal-setting in physiotherapy: exploring a person-centered perspective

Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described.Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization.Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.

Les enjeux éthiques de la pratique privée de l’ergothérapie : perceptions d’ergothérapeutes

Au Québec, 31% des ergothérapeutes travaillent dans le secteur privé, lequel est en constante croissance. À ce jour, aucune étude n’a spécifiquement répertorié les enjeux éthiques de cette pratique. Cette étude avait pour objectif d’explorer ces enjeux, c’est-à-dire les situations susceptibles de compromettre le respect d’une valeur éthique. Optant pour un devis d’inspiration phénoménologique, sept ergothérapeutes ont été rencontrés dans le cadre d’entrevues individuelles semi-dirigées. Basé sur le cadre conceptuel de Swisher et ses collaborateurs, le canevas d’entrevue a permis d’identifier différents types d’enjeux éthiques. Les résultats attestent que plusieurs valeurs sont susceptibles d’être compromises, soit : le bien-être du patient, l’autonomie du patient, la sécurité publique, la justice distributive, la qualité des interventions, la pratique compétente, l’indépendance professionnelle, l’honnêteté et le professionnalisme. Bien que les ergothérapeutes aient à coeur le bien-être des patients, plusieurs éléments semblent contribuer à cet état de fait, comme les situations de double allégeance vécues par les ergothérapeutes, l’ingérence des tiers payeurs dans le processus clinique et le mode de financement des cliniques. Plus encore, les enjeux éthiques de la pratique privée de l’ergothérapie sont principalement de nature macroscopique. La capacité des ergothérapeutes à percevoir certains de ces enjeux semble être reliée à certaines de leurs caractéristiques, en l’occurrence leur sensibilité éthique et le fait qu’ils soient novices. Les résultats de cette étude rejoignent en général ceux décrits dans les écrits en physiothérapie et montrent le manque de soutien offert aux ergothérapeutes, notamment aux novices, pour surmonter ces enjeux avec aisance et efficacité.

How physiotherapists perceive, interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for "in the moment" ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.

Comparison of Responsiveness Level in Iranian Public and Private Physiotherapy Clinics: a Cross-Sectional Multi-center Study

Introduction:

Responsiveness is a main goal of health systems. Responsiveness focus on the non-medical aspects of health services delivery. This study was aimed to assess responsiveness level in public and private physiography clinics.

Methods:

In this multicenter cross sectional study, 403 patients refers to 16 public and 64 private physical therapy clinics were studied randomly in Ahvaz, Iran, from 2013 to 2014. Data were collected based on a valid health system responsiveness questionnaire that was developed by WHO. Health system responsiveness questionnaire for outpatients care includes seven components and 25 questions. Statistical relationship between responsiveness level of centers and patients characteristics was analyzed using Pearson coefficient, Independent t-test and one-way ANOVA.

Results:

Out of 403 patients, 299 (74.19%) patients were women. The mean (±SD) age of the patients was 42(±14.18) years and 92.1% of patients were 65> years. Responsiveness status in private and public physiotherapy clinics was assessed excellent (26.93±5.2) and very well (21.08±5.8) respectively. In private clinics, the mean score of communication dimension (3.96±1) and autonomy dimension (3.95±0.9) was higher than other dimensions. In public clinics the mean score of dignity (3.30±0.8), autonomy (3.16±0.9), and prompt attention (3.12±1) was higher than other areas respectively. In public and private clinics, quality of basic amenities area had the lowest score.

Conclusions:

The results showed that the some patients and center characteristics such as gender and work shift were factors affecting assessment of responsiveness. Responsiveness level in private centers was better than publics.

How do they feel? Patients' perspectives on draping and dignity in a physiotherapy outpatient setting: A pilot study

BACKGROUND

Research to date has focused on dignity within the hospital rather than outpatient settings which is likely to raise different issues from the patients' perspective.

PURPOSE

To investigate patients' views relating to draping and dignity and their choice of dressing options in the physiotherapy outpatient setting.

METHOD

A custom-designed questionnaire was developed including feedback from a focus group of 10 individuals attending a physiotherapy outpatient clinic. The final version of the questionnaire comprised 14 items covering issues regarding privacy, draping, respect and communication. Patients attending outpatient physiotherapy for musculoskeletal treatment were invited to complete the questionnaire which was administered over a period of seven weeks.

RESULTS

Of the 31 respondents completing the questionnaire (n = 23 females, n = 8 males), the majority of males (87.5% n = 7) felt very confident removing their clothing whereas 26.1% of females (n = 6) reported feeling confident when asked to remove their clothing. Female respondents also considered the gender of their physiotherapist (87% n = 21) as well as physical privacy (73.9% n = 17) to be important factors related to patient dignity. All male respondents (100%) expressed a preference for exposing the bare back whereas the females expressed mixed dressing preferences. The preferred dressing option for the lower body for both males and female respondent was sport shorts (87.5% n = 7; 81.8% n = 18 respectively).

CONCLUSION

The patients' perspective of dignity and draping in a physiotherapy musculoskeletal settings is seen in terms of physical space, the provision of a range of draping options in conjunction with clear communication by their physiotherapist.

Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review

PURPOSE

Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues.

METHOD

After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed.

RESULTS

A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized.

CONCLUSIONS

The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.

Theoretical frameworks used to discuss ethical issues in private physiotherapy practice and proposal of a new ethical tool

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

Practicing physiotherapy in Danish private practice: an ethical perspective

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur's textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging 'to be' and 'ought to be'.