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

BACKGROUND: Person-centered approaches to care require physiotherapists to engage in trying to understand the full range of biomedical, psychological, and social factors that people bring to the consultation, along with the client's individual responses to those factors. If, however, the main issues of importance to people are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving interventions that clinicians think they need, rather than care based on their expressed needs and preferences. OBJECTIVE: To understand people's abilities to express the issues of importance to them within a consultation and clinicians' abilities to acknowledge and address those issues. DESIGN: A qualitative study using an interpretive phenomenological approach. METHODS: Eight clients were interviewed before they met their physiotherapist, the initial consultation with their physiotherapist was recorded, and both were interviewed separately afterward. ANALYSIS: The clients frequently do not raise their emotions or feelings as issues of importance, and physiotherapists generally struggle to elicit, or identify as important, such matters. How these were presented to the clinician and subsequently addressed varied. We formulated three themes: 1) managing complex situations; 2) establishing a person-centered agenda; and 3) addressing emotional issues. CONCLUSIONS: Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.

What matters most to people in musculoskeletal physiotherapy consultations? A qualitative study.

BACKGROUND: Person-centred approaches to care require clinicians to engage in trying to understand the full range of problems and concerns, treatment and investigation requests, and emotional and social issues that people bring to the consultation. If, however, the main issues of importance are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving the care that clinicians think they need, rather than care based on individual needs and preferences. OBJECTIVE: To understand people's abilities to express the issues of importance to them within a consultation and clinicians' abilities to acknowledge and address those issues. DESIGN: A qualitative study using an interpretive phenomenological approach. METHODS: Fifteen people and their physiotherapists were interviewed and their consultations recorded. The resulting data sets were analysed to identify and report themes within the data. FINDINGS: The findings revealed that people present with what are often simple issues, but which are sometimes expressed in an unstructured way in clinical encounters and are often difficult for clinicians to establish. Three linked themes emerged: (1) clear versus unstructured agendas; (2) people need information and understanding; and (3) developing a sense of collaboration. CONCLUSIONS: The issues of importance that people bring to a consultation are varied and often vague. This research highlights the importance of communication to elicit, identify and address the issues of importance to people in clinical encounters to ensure a positive experience and outcome for both the individual person and clinician. TWEETABLE ABSTRACT: Achieving desirable health outcomes is more likely when people are supported to think about their priorities and 'what matters to them'.

The construction of professional identity by physiotherapists: a qualitative study.

UNLABELLED: The U.K. Frances Report and increasing societal expectations of healthcare have challenged physiotherapists to reconsider professionalism. Physiotherapy has viewed identity as a fixed entity emphasising coherence, continuity and distinctiveness. Socialisation has required the acquisition of a professional identity as one necessary 'asset' for novices. Yet how do physiotherapists come to be the physiotherapists they are? DESIGN: Qualitative study using Collective Memory Work. Eight physiotherapists in South West England met for two hours, once a fortnight, for six months. Seventeen hours of group discussions were recorded and transcribed. Data were managed via the creation of crafted dialogues and analysed using narrative analysis. RESULTS: Participants shared ethical dilemmas: successes and unresolved anxiety about the limits of personal actions in social situations. These included matters of authenticity, role strain, morality, diversity. Participants made claims about their identity; claims made to support an attitude, belief, motivation or value. CONCLUSIONS: Professional identity in physiotherapy is more complex than traditionally thought; fluid across time and place, co-constructed within changing communities of practice. An ongoing and dynamic process, physiotherapists make sense and (re)interpret their professional self-concept based on evolving attributes, beliefs, values, and motives. Participants co-constructed the meaning of being a physiotherapist within intra-professional and inter-professional communities of practice. Patients informed this, and it was mediated by workplace and institutional discourses, boundaries and hierarchies, through an unfolding career and the contingencies of a life story. More empirical data are required to understand how physiotherapists negotiate the dilemmas they face and enact the values the profession espouses.