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Physiotherapy 97 (2011) 154162
Patients perspectives of patient-centrem acti
b, M
Box 56Otago,niversity
Abstract
Objective T d physDesign Qua udgemwas used to ry iteraSetting MuParticipantResults Five categories of characteristics relating to patient-centred physiotherapy were generated from the data: the ability to communicate;confidence; knowledge and professionalism; an understanding of people and an ability to relate; and transparency of progress and outcome.These categories did not tend to occur in isolation, but formed a composite picture of patient-centred physiotherapy from the patientsperspective.Conclusions and practice implications This research elucidates and reinforces the importance of patient-centredness in physiotherapy, andsuggests tha 2010 Cha
Keywords: Pa
Introducti
Calls fopatients vition) haveover 40 yeview has vof patientResearch ohas expandcialties [8]over 1000faction [1of patienttive technic
CorresponE-mail ad
0031-9406/$doi:10.1016/jt patients may be the best judges of the affective, non-technical aspects of a given healthcare episode.rtered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
tient care; Patient centredness; Patient satisfaction; Good physiotherapy
on
r those involved in the health professions to seekewpoints regarding their care (or level of satisfac-been evident in various forms in the literature forars [14]. However, interpretation of a patientsaried significantly depending upon the model
satisfaction upon which studies are based [57].n patient satisfaction, as measured by self-report,ed significantly in virtually all healthcare spe-. In 1997, Sitzia and Wood reported a peak ofpublished articles using the term patient satis-]. For example, Nelson identified five domainssatisfaction that focused on access, administra-al management, clinical technical management,
ding author. Tel.: +64 34798436; fax: +64 34798414.dress: martin.kidd@otago.ac.nz (M.O. Kidd).
interpersonal management and continuity of care [9]. In phys-iotherapy, studies of patient satisfaction have been few and,until recently, were predominantly quantitative and question-naire based [1012].
Patient satisfaction with physiotherapy can be influ-enced by an interaction between therapist and patient thatmay involve more physical contact and active involvementof the patient than encounters with other health profes-sionals [11]. Therefore, it is suggested that physiotherapypatients perceptions require a different interpretation [10],as well as a different measurement tool from other healthprofessions [11]. Accordingly, in physiotherapy research,profession-specific satisfaction variables more applicableto physiotherapy settings have been used: time with thepatient; therapist behaviour; physical security; consistencyand logical progression; and the adaptation of the treat-ment programme to the patients problem based on inputfrom physiotherapy professionals [10,11]. In most of the
see front matter 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved..physio.2010.08.002usculoskeletal physiotherapy interMartin O. Kidd a,, Carol H. Bond
a School of Physiotherapy, University of Otago, POb Student Learning Centre, University of
c Department of Preventive and Social Medicine, U
o determine patients perspectives of components of patient-centrelitative study using semi-structured interviews to explore patients jdetermine common themes among the interviews and develop theosculoskeletal outpatient physiotherapy at a provincial city hospital.s Eight individuals who had recently received physiotherapy.dness as important inons: a qualitative studyelanie L. Bell c
, Dunedin, New ZealandNew Zealandof Otago, New Zealand
iotherapy and its essential elements.ents of patient-centred physiotherapy. Grounded theorytively from the data.
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M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 155
physiotherapy satisfaction studies, satisfaction with specificencounters has been determined using researcher-derived,patient self-report instruments, which are framed in terms ofinstitutional or professional perspectives rather than those ofthe patient. Therefore, and despite possible intentions to thecontrary, satisfaction research has typically reflected some ofthe attitudes and values of an earlier biomedical model ratherthan a contemporary patient-centred perspective. In researchthat purports to seek patients views of what is important tothem in physiotherapy, such a position is incongruous.
Patient-centred care
In the patient-centred care model, the healthcare episodeis an equal partnership between clinician and patient [13].According to Stewart [14, p. 444], patient-centredness inmedicine may be most commonly understood for what it isnot: technology centred, doctor centred, hospital centred,disease centred (consultation model). Similarly, Cott [15,p. 89] suggests that there is no common definition of client-centred rehabilitation, stating that most available definitionsfocus on acute care from the perspectives of various healthprofessionals rather than the clients. The patient-centred caremodel locates the patient centrally in the professional rela-tionship, and supports the notion that an understanding ofthe patients perspective should underpin good practice in anequal therapeutic relationship (Fig. 1).
Implication
The aimpatient self
physiotherapists clinical performance in the musculoskeletalarea. The two-stage process began with generation of quali-tative data from patients about what is important to them inencounters with their physiotherapist. With an understandingof patients perspectives of the patient-centred care model, thedata could be used in the development and testing of an instru-ment to measure whether clinicians match those perspectives.This article reports on the first stage.
The few studies that have sought patients views aboutwhat they value in a therapeutic encounter are scattered acrossprofessions, disciplines and services, and use a range of meth-ods [2,1620]. A recurring theme that emerges from thesestudies is the value that patients place on clinicians com-munication with the patient (in terms of listening, explainingand instructing). However, is there more to patient-centredphysiotherapy than the ability to communicate? Rohrer et al.[21] suggest that self-rated health is more related to empow-erment than satisfaction with communication. Stewart arguedthat patient centredness is an important area of study, and isbest defined and assessed by the patients themselves [14].The researchers in this study want to inform clinicians aboutwhich patient values may be at the centre of clinical interac-tions in a patient-centred care context.
Method
n
udio-tgrounives o
Pat
ess
Fig. 1. Comp odel.s for research
of this research programme was to develop a-report instrument to be used in the assessment of
Desig
Awithspect
Traditional consultation model
CLINICIAN
Disease Hierarchical Biomedical Unidirectional
Illn
PATIENT (passive recipient)
arison of the patient-centred care model with the traditional consultation maped semi-structured interviews in conjunctionded theory were used to study patients per-f patient-centred physiotherapy. The interviews
ient-centred care model
CLINICIAN
Therapeutic alliance Biopsychosocial Two-directional
PATIENT (active partner)
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156 M.O. Kidd et al. / Physiotherapy 97 (2011) 154162
Table 1Characteristics of the sample (n = 8).Study numbe
12
3
4
567
8a The indig
occurred ahome (n = 1were askedto determinceived asgeneral, wwas explormore?, Wdo you meexplore toptranscribedEthical appEthics Comparticipatio
Participant
A purpothe local hoprocess thaple (see Ttypically at
A muscbecause thtreatment tcontexts, bbecause theteria [24] (sufficient ppossibilitybiased viewNew Zeala[25]. The Agovernmeners most a10 typicallwhich leadmusculosk
Analysis
rounded theory is a useful qualitative method if littleown act a grch rele beiturednome
nt-cene ma
rding ton [28g frow the
rationview (ch treanin
ive anmana
Victo
odednd dicategrganidevel
on puxt, maprepa
views.spect
, axiales andificatikey py buiory]: theiotherar Occupation Age(years)
Gender Ethnicity
Tertiary student 20 Male AsianGovernmentadministrator
52 Female Caucasian
Night worker atwarehouse
61 Male Caucasian
Maintenanceengineer
56 Male Caucasian
Retired priest 65 Female CaucasianRetired 68 Male MaoriaMedical servicemanager
52 Female Caucasian
Home maker 40 Female Maori
enous people of New Zealand.
t the participants place of work (n = 2), at their) or at the researchers workplace (n = 5). Patientshow they judged the treatment they received
e which components of physiotherapy they per-important to them. The last question was: Inhat is good physiotherapy? Each main questioned using neutral probes such as Can you tell mehat are the most important aspects. . .? and Whatan by? to deepen participants responses andics further [22,23]. Interviews were recorded andverbatim and participants were given a number.roval was gained from the Lower South Regionalmittee. Informed consent was obtained prior ton in the research.
s
sive sample of eight patients was recruited fromspital physiotherapy outpatients department by at preserved physiotherapist anonymity. The sam-able 1) resembled the profile of patients whotended the department.uloskeletal outpatient population was selectedeir clinical events have comparatively short
Gis knprediresea
peopstruca phepatie
Thacco
uratiarisinno ne
geneinter
Eathe mparatDataLtd.,data.
Cson a
formand owere
ficaticontewere
intertant aNextegoriidentthetheorcateg1095physimeframes compared with other physiotherapyecause of ease of interview scheduling, andse patients were likely to meet the inclusion cri-Table 2). These criteria ensured a sample withhysiotherapy experience while minimising theof comorbidities and dependence resulting ins. The 10-session limit was rationalised through
nds Accident Compensation Corporation policyccident Compensation Corporation is a no-faultst-owned medical insurance scheme which cov-ccident-related rehabilitation, and stipulates thaty represents the maximum number of treatmentss to a satisfactory outcome for a patient receivingeletal physiotherapy care.
Results
Five catphysiotheracategory iscepts (dericross-categ(Fig. 3).
Ability to c
A primathe importabout a topic and few theories exist to explain orroups behaviour [26]. Grounded theory allowssults to be grounded in the social world of theng studied, while comprising a systematic andset of procedures to induce theory [27] aboutnon from the data (i.e. patients perspectives oftred physiotherapy).in study sample of eight patients was determinedo the grounded theory concept of theoretical sat-], which describes when conceptual explanationsm analysis of the data are well developed, andmes emerge from ongoing data collection. Datawas followed by data analysis for each individualFig. 2).anscript was read several times to sensitise togs ascribed to physiotherapy. A constant com-alysis [24] was used in data analysis (Table 2).gement software (NVivo, QSR, International Ptyria, Australia) was used to store and manage the
passages were subjected to continued compari-fferentiation. Similar concepts were clustered toories [24,29]. Categories were continually refinedsed as new data emerged. Criteria for each codeoped and noted as coding proceeded. For veri-rposes, summaries of each transcript includingin themes, impressions and exemplary quotationsred, and compared with memos written during theEach summary represented perceptions of impor-
s of physiotherapy for that particular participant.coding [30] was applied to concepts within cat-across categories. This final coding involved the
on and comparison of inter-relationships betweenroperties of each category and consequentiallding [31]. It was used to construct the core[24, p. 172] or central phenomenon [32, p.theory of patients perspectives of patient-centredpy.
egories of patients perspectives of patient-centredpy were generated from the data (Table 2). Eachdescribed in two parts: the contributing con-
ved from open coding), and within-category andory relationships (derived from axial coding)
ommunicate
ry finding, supported by previous literature, wasnce of the ability to communicate. Patients defined
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M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 157
Table 2Patients views of the characteristics of a good physical therapist.
Characteristics of a goodphysical therapist
Subcategories Exemplary passages No. of passages No. of participantscontributing tonodes (n = 8)
Clear communication Good listening skills theyve got to have good listening skills 4 3Instructions aboutself-help/exercise
she was a really good explainer; shegave you alternatives
55 5
Reassurance about pain I hadnt realised that it was OK for it tobe painful
6 1
Confidence Knowledge/skills/expertise [they] know what theyre talking about;she was obviously spot-on;
15 7
Attitudes someone who knows what theyredoing
6 4
Ability to create confidence theyve got to come across asconfident; I just felt confidence in her
11 3
The nature of the professionalrelationship
Space for patient to suggesttreatment
I really felt that [it] was more to do withthe muscles on [my] spine
12 3
Patient leaves it to the physicaltherapist
theyve got the training, I havent; Ileft everything in the hands of the physio
13 4
An understanding of peopleand an ability to relate
Empathetic a certain amount of empathy; anunderstanding of the pain
5 3
Encouraging the way I was encouraged; they werevery encouraging
10 2
rson; friendl
A concern wioutcome
ure imp
ey re-mreal qu
this as a twand reassurand explainas compon
theyve go52-year-old
Furthermapists be ab
ont k
Fig. 2. ProcesAbility to relate to patients and befriendly
good people peeasy to talk to;her questions
th progress and Focus on progress you can see yo
Use of measurement each time . . . thQuick outcome my hand healed
o-way transfer of information that both informs we d
es the patient: good listening skills, paraphrasinging, and reassurance about pain were all evident
ents of that definition:
t to listen to what youre saying (Participant 2,female)ore, it was considered important that physiother-
le to interpret the lay speech of the patient:
. . . its here56-year-old
Patientsrelayed bac
she listeneto me in a m68-year-old
Interview 1 A
1
Interview 2
Interview 3
A
2
A
i
s of data generation.relaxed and . . .y . . . I could ask
27 4
roving 13 5
easured it 13 3ickly 6 2
now the terminology to use . . . weve just to say
and when I do this, this happens (Participant 4,male)appreciated the correct interpretation being
k to them in a way they understood:
d to what I had to say, then explained things backanner that . . . was easy to follow (Participant 6,male)
nalysis of Transcript
informs Interview 2
nalysis of Transcript
informs Interview 3
nalysis of Interview 3
nforms Interview 4 etc.
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158 M.O. Kidd et al. / Physiotherapy 97 (2011) 154162
Good listening skills
Therapistsself-confidence
Reassuranespeciallyabout pain
Clear explanations and instructions
Input into the treatment plan and decisions about treatment
Putting the patient at
DERSTOPLE LE TO
Fig. 3. Patien presentdotted box is
Therefodirectly relance, and h
. . .tellingcant do . .thing (Par
It was imand that it
. . .the phypainful andthose passimade me rmaintained(Participan
Condence
Some pain explanatshould:
. . .know wabout whamale)
One par
lt ver
ce,
Attitude to patient and treatment
Using strategies to show change and improvement
KNOWLEDGE AND EXPERTISE
ABILITY TO COMMUNICATE
Createsunderstanding
UNPEAB
CONFIDENCE
Creates patients confidence in therapist and process
ts views of good physiotherapy: categories and inter-relationships. Boxes rean inferred concept.
re, the quality of the therapists explanations . . .fe
ated to the patients understanding and reassur-ow they managed their condition:
you . . . what was happening . . . what you can and. they just reassure you that youre doing the rightticipant 4, 56-year-old male)
portant to the patient to be reassured about pain,was alright to feel pain:
siotherapist said to me . . .do it to where it getsjust push it a bit but. . . the importance of doing
ve exercises was really stressed to me and it justealise how important it was to make sure that Imovement in that arm even though it was painful
t 5, 65-year-old female)
rticipants required a therapist who was confidentions and attitude. For example, physiotherapists
hat theyre talking about . . .[and be] confidentt theyre saying. . . (Participant 1, 20-year-old
ticipant:
knew what
and anothe
just workishe was dojust felt con
Across ctheir use ofself-confidpatient shoThe patiendependentconfidence
. . .I hadanything Iinspire concises if yomale)
Knowledge
Knowleelements oexpertise aease
Empathy, encouragement and friendliness
Therapist creates a relationship with patient
Encouragement knowledge of progress motivates engagement in clinical process
TRANSPARENT FOCUS ON PROGRESS AND OUTCOMES
ANDING AND RELATE
Understanding pain
core categories, bold lines represent in-category relationships;
y confident that there was somebody there that
she was doing (Participant 5, 65-year-old female)r stated that:
ng on the thing and not rushing it, explaining whating. . .what she was doing made sense to me . . . Ifident (Participant 4, 56-year-old male)ategories, the therapists ability to communicate,their knowledge and expertise (see below), their
ence, and their ability to create confidence in thew a complex interdependent category relationship.t needed to feel confident in the physiotherapist,on evidence of the physiotherapists own self-and abilities:
confidence in [her] because when I . . . askedgot good, clear answers. . . . Its the ability tofidence, because youre not going to do the exer-u dont believe it (Participant 4, 56-year-old
, expertise and professionalism
dge and expertise were considered to be essentialf good physiotherapy. One participant describeds:
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M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 159
. . .she knew what she was doing. She knew those were theright exercises, . . . and how I should do them and what it wasfor . . . and I experienced the benefit of them. . .. The way Iwas treatedconfident t65-year-old
Knowleof a profetherapist in
They treathings thatthey . . . inlem is. . . g52-year-old
Patientsinvolve a ppatient to rinput into tFor exampanother tre
If I had aneck and bawould haveold male)these sentimtherapist w
theyve gohands of thin your sho
Understand
Patientsdemonstratagement, a
[what matstanding ofa real perso
and that the
able to rel6, 68-year-
Patientspatient at tthem feel u
they made56-year-old
they wereday, they mthey cared
Transparency of progress and outcome
Transparency of progress was important to the partici-, espeld comconfid
progve mo
ested mgave main (wouldfar I ces . . .
old mean im
sitivents, th
hand huicker-year-
t a realicipan
sitiveoveme
will hYou] w-year-
madeakin
profeicipan
therapeek anack 3me wheassur
ar-old
ry ofiother
e connts pe
ndersnd thartant iracticse whto get, the way I was encouraged. The expertise. I felthat the best thing was happening (Participant 5,
female)dge and expertise were linked with patients viewsssional relationship, and how, for example, thetroduced herself:
ted you very well. . .. There are a whole lot ofgo [with professionalism]. Like just in the waytroduce themselves . . . ask you what the prob-o through what youve done. . . (Participant 7,female)
perspectives of patient-centred physiotherapyrofessional relationship that allowed space for theecognise the therapists knowledge, and to havehe treatment plan and decisions about treatment.le, although one participant may have thoughtatment option would help him:
[therapist who] . . . manipulated or massaged meck and shoulder muscles more vigorously . . . thatfixed it quicker or better (Participant 6, 68-year-
ents were not usually communicated because theas perceived as having the training:
t the training, I havent . . . I left everything in thee physio because I dont know what . . . goes onulder (Participant 3, 61-year-old male)
ing people and an ability to relate
considered it important that the physiotherapiste empathy (especially in relation to pain), encour-nd the ability to relate to people and be friendly:
ters is] a certain amount of empathy, an under-the pain, and a feeling that I matter and that Imn (Participant 5, 65-year-old female)physiotherapist should be:
ate to patients . . . to put them at ease (Participantold male)insisted that the physiotherapist should locate the
he centre of the therapeutic encounter, and makenderstood and respected:
you feel as though youre OK (Participant 4,male)
both very friendly. . . .youre number one for theade you feel important . . . like a real person that
about (Participant 2, 52-year-old female)
pantsshouthen
I hadpassiShe tthenthat p
Shehowdegrejust tsuch
Popatie
My. . . q1, 20
I go(Part
Poimpr
. . .iting. [1, 20
theywas m
by a(Partthe [by w. . . btoldand r56-ye
Theophys
Thpatie
An uter aimpointo pbecauthingcially by way of measurement. A physiotherapistmunicate progress with the patient, who could
ently comply with the programme. For example:
ressed to a stage where I could actually go off thevement and get more involved in active lifting . . .
y arm to see at what point it was most painful ande exercises that seemed to relate to . . . improving
Participant 7, 52-year-old female)tell me the progress that I was making. Like . . .
ould bend my finger . . . one week Id bend it 20but the week after Id bend it 40 degrees. . . . She. . . how well I was going and shed say oh thats
provement (Participant 1, 20-year-old male)outcomes were also emphasised. For some
e progress was much quicker than they anticipated:
ealed much quicker than expected by the doctorthan she thought it was going to be (Participant
old male)ly quick outcome here and I was really surprisedt 2, 52-year-old female)
outcomes were desirable, especially whennt was communicated and measurable:
elp the patient if he . . . knows that he . . . is improv-ork better or try harder to get better (Participant
old male)me feel as if I was doing really well. . . that I
g progress . . . it was good to have that reinforcedssional . . . it encourages you to keep doing itt 7, 52-year-old female)ist] . . . was interested in my improvement weekd even went back through the records to say look
or 4 weeks ago you were only getting this . . .theyat it was last time and what the difference wased me that yes it is getting better (Participant 4,male)
patients perspectives of patient-centredapy
cept of what is important to a patient from therspective is encapsulated by the following:
tanding of the pain, . . . and a feeling that I mat-t Im a real person. . . .And then probably mosts the . . .the knowledge that she shares and put[s]e and then the encouragement to do the exercises,at she does is only part of it. You know, theres thatyou doing the rest. . . . and . . . part of that encour-
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160 M.O. Kidd et al. / Physiotherapy 97 (2011) 154162
agement is actually the ability . . . [to] answer questions and. . . I think its. . .about taking the person seriously. . . .it wasrespecting the questions and being prepared to answer themand . . . that gives you, that confidence. . . .its ability to inspireconfidence (Participant 5, 65-year-old female)
The therapists self-confidence and knowledge affect thepatients confidence in both the therapist and the therapy, andthese concepts are linked to good communication, reassur-ance and progress. The cross-concept relationship resemblesa transformative spiral of increasing confidence, motivationand progress.
Discussion
The five categories, supporting concepts and theory pro-vide a picture of patients perspectives of patient-centredphysiotherapy (Fig. 3). The findings complement other recentresearch on patient satisfaction and patient-centred care,especially about the importance of communication [4,19,33].The categories and resulting theory are generated from datathat derive directly from patients experiences, and findingsfocus solely on aspects of care that are important to the patient(the focus oever, the travation andby the biopand provid(Figs. 1 ancation undeno single dwithout its
Patientscurrent stu
domain. Although previous literature does not mention con-fidence per se as a component of patient-centred care, tosome patients, confidence in the physiotherapist was depen-dent on good communication, which is recognised [1719]as a component of the patient-centred care model. Many ofthe concepts strongly reflected Mead and Bowers dimen-sions of patient-centredness including a professional view ofthe patient-as-person [34, p. 1088]; the sharing of powerand responsibility in the care relationship; and a therapeuticalliance in which the goals and requirements of treatment areclearly understood [4,34,35]. In the current study, most par-ticipants emphasised this professional relationship betweentherapist and patient. The passing of decision making to thetherapist because of a perceived view of professional knowl-edge by some patients was balanced by views of others whowere encouraged to have input into treatment decisions. Stew-art et al. called this relationship the common ground [36,p. 444]; the space in which, rather than abdicating control tothe patient, clinicians use their understanding to respond tothe unique needs of the patient. Stewart reported that patientswho perceived the patient/physician relationship in terms ofcommon ground received fewer diagnostic tests and refer-rals in the subsequent 2 months than patients who perceivedotherwise [14].
thisng tohrasining. Hof clea, inforts of
ed ant carolated
abou
Fig. 4. Goodf the interview questions). Most importantly, how-nsformative spiral of increasing confidence, moti-
progress extends the two-way relationship impliedsychosocial model of patient-centred care [34],
es more depth to the communicative relationshipd 4). The implication is that although communi-rpins patient-centred care in physiotherapy [19],imension of patient-centred physiotherapy existsreliance on the other dimensions. views of patient-centred physiotherapy in thedy were situated almost entirely in the affective
Inrelatiparapstandroletionsaspecformpatieof isideas
physiotherapy: a transformative inter-relationship.study, most participants emphasised conceptsthe ability to communicate, such as listening,g, explaining, reassuring and ensuring under-owever, patients additionally focused on the
r and transparent communication about instruc-mation and progress when talking about othercare. Therefore, in this study, the categories
composite picture of interdependent aspects ofe. Just as Little et al. [17] found scant evidencedomains of patient care, in this study, patientst ideal treatment were part of a spectrum of
-
M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 161
care that generally related to mutual discussion and partner-ship.
Two categories the ability to communicate, and trans-parency ofrecent reseever, few pconstruct tThis variatstudy, partwhich in thexpectation
you cometreated like
The releapy can beperspectivecare modeliotherapiststheory metleagues whtherapists wto care. Infrom the intherapist knstyle of pradefining sucollectiveonly focusviews.
Qualitatof the procechoice of mquestion. Gperspectiveapy. This sphysiotheratives ratherresponse tothemselvesmethod thacific particviews of aysis ensureand interprbeyond theate, and isthis study pods used bthrough the
Practice im
Reportinpatients pe
Cooper et al. [19] suggested that further research was requiredto confirm their findings with different patient groups. Thecurrent study extended the scope of participants to general
uloskomponell toe clinction
c relatdencerstandcy ofian thatientis stuof carnses os clinit whate theont ofted el
owled
e autd Baxtdin, Nal appcs refeing: Hof Predin, Nict of
rence
itzia J,oc Sci Marr JK,K. Usprove
damsof patienixed mheppardthe em
vailablinder-P982;16:itzpatri54175ohanssoare in t002;16:progress and outcome aligned with outcomes ofarch on patient satisfaction [4,8,11,18,35]. How-atients in this study referred to expectations; a
hat features in some satisfaction literature [4,7].ion may be due to the fact that, in the currenticipants were attending a public hospital clinic,e New Zealand context may have created differents compared with fee-paying patients:
here and youre not even paying but you are reallya real person (Participant 2, 52-year-old female)
vance of this study to the profession of physiother-considered with the question: How do patientss of important components of the patient-centredin physiotherapy match the components that phys-
consider to be important? Using a groundedhodology, Resnik and Jensen [32] found that col-o considered themselves or others to be goodere distinguished by a patient-centred approach
particular, the patient-centred approach resultedterplay of clinical reasoning, values, virtues andowledge, and permeates and guides the cliniciansctice [32, p. 1095]. However, by operationallych distinguishing characteristics on the basis of
patient outcomes, Resnik and Jensens researched on professionals views rather than patients
ive research methodologies rely on the credibilityss and product. The rigour of this study lies in theethodology that is congruent with the researchrounded theory was used to establish patientss of patient-centred musculoskeletal physiother-tudy argues that patient satisfaction measures ofpy should be developed from patients perspec-than those of physiotherapists, and is in part aStewart et al.s challenge [36] to ask patients
to define patient-centred care. This study used at generated rich and descriptive data from a spe-ipant group sampled to saturation. Although thesmall group are just that, robust audit and anal-d that the results can be viewed with confidenceeted credibly. The generalisability of the resultsmusculoskeletal field of practice is not appropri-
an area warranting further research. In particular,oints to the need for more research on the meth-y clinicians to bring about favourable outcomestherapeutic relationship.
plications
g their study on patient-centredness from therspective in chronic low back pain populations,
musc
ing cdo wof thinterapeuticonfiundeparenclinicthe p
Thtivesrespoin thiabou
Thopmerepor
Ackn
ThDaviDune
Ethic(EthiFundmentDune
Con
Refe
[1] SS
[2] BMim
[3] Ao
m
[4] SinA
[5] L1
[6] F1
[7] Jc
2eletal conditions, and suggests that, in consider-ents of clinical expertise, physiotherapists would
consider the value that patients place on aspectsical interaction. In particular, clinician/patient
s that place the patient at the centre of the thera-ionship are based on: the ability to communicate;; knowledge, expertise and professionalism; aning of people and an ability to relate; and trans-progress and outcome. According to this study, aat fulfils a combination of these dimensions placesat the centre of the healthcare experience.dy is among the first to explore patients perspec-e in a musculoskeletal physiotherapy setting. Thef the patients support patient-centred care, at leastcal setting, and send a clear message to clinicianspatients prefer in a clinical partnership.ry generated in this study was tested in the devel-
a patient perception questionnaire which is to besewhere.
gements
hors wish to thank Dr Leigh Hale and Professorer, School of Physiotherapy, University of Otago,ew Zealand.roval: Lower South Regional Ethics Committeerence number OTA/04/02/CPD).igher Education Development Unit, and Depart-ventive and Social Medicine, University of Otago,ew Zealand.interest: None declared.
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t.com
Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative studyIntroductionPatient-centred careImplications for research
MethodDesignParticipantsAnalysis
ResultsAbility to communicateConfidenceKnowledge, expertise and professionalismUnderstanding people and an ability to relateTransparency of progress and outcome
Theory of patients' perspectives of patient-centred physiotherapyDiscussionPractice implicationsAcknowledgementsReferences
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