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Analysis of patient-physiotherapist interaction in an orthopaedic outpatient setting

Applicant Schoeb Veronika
Number 124565
Funding scheme DORE project funding
Research institution Filière Physiothérapie Haute école de santé vaud
Institution of higher education University of Applied Sciences and Arts Western Switzerland - HES-SO
Main discipline Health
Start/End 01.07.2009 - 31.03.2011
Approved amount 101'077.00
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All Disciplines (2)

Discipline
Health
Sociology

Keywords (6)

decision-making; goal setting; orthopaedic; physiotherapy; patient-physiotherapist interaction; conversation analysis

Lay Summary (English)

Lead
Lay summary

Introduction: Research in health care communication has become increasingly important. Some of the reasons are related to patient autonomy and expectations regarding quality of care. Professional practice guidelines prescribe physiotherapists to include patients into the decision-making process and to establish collaboration in order to elaborate treatment goals and treatment plans. Many scientific studies show the importance of verbal and non-verbal communication for positive results in physiotherapy. However, not much is known about how this is done in practice. The aim of this study is to shed light on patient-physiotherapist interaction during initial encounters in musculo-skeletal physiotherapy, and in particular on the goal-setting process and how decisions are made concerning the choice of treatment modalities.

Method: Three different physiotherapy practice settings participated in the study (outpatient clinic in a public hospital, private practice in the outskirt of a city and private practice in a small village). 37 consenting patients and their therapists were videotaped during five sessions. Conversation analysis (CA) - the chosen method - helps describe the interaction. CA has its intellectual framework from ethnomethodology and provides an understanding of how sequences of interaction shape the encounter.

Results: Three different ways of inquiring about goals have been detected: (1) physiotherapists inquire explicitly about patients' expectations; (2) patients present their ideas about physiotherapy services, and (3) oblique goal setting which is an alternative format to establish goals. Our data shows that interactional difficulties can arise during this process due to the assumptions that every patient "must" have a goal and that they know what a "physiotherapy-relevant" goal is. Our results also indicate that questions about expectations need to be contextualized. In addition to that, we found that the way physiotherapists use documentation forms has an impact on the interaction. Explicit treatment proposals are less frequent in our data. When present, physiotherapists provide either a detailed statement at the end of the session summarizing elements from the examination, or propose a certain action by linking it to a detected problem (e.g. decreased mobility, reduced force).

Conclusion: This study provides insights into the process of goal setting and treatment planning in physiotherapy. Our results indicate that standards of practice advocating active patient participation do not take into consideration the delicacy of patient-physiotherapist interaction. A less direct approach to goal setting might reduce some of the interactional difficulties arising from explicit inquiry. The influence of documentation on the interaction should be explored further. As shown in other health contexts, patients tend to participate less if professionals focus on forms rather than on patients' needs.

Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Project partner

Publications

Publication
The impact of documentation on communication during patient-physiotherapist interactions: A qualitative observational study
Schoeb Veronika, Hiller Amy (2018), The impact of documentation on communication during patient-physiotherapist interactions: A qualitative observational study, in Physiotherapy Theory and Practice, 1-11.
‘Tell Me About Your Troubles’: Description of Patient-Physiotherapist Interaction During Initial EncountersTell Me About Your Troubles
Opsommer Emmanuelle, Schoeb Veronika (2014), ‘Tell Me About Your Troubles’: Description of Patient-Physiotherapist Interaction During Initial EncountersTell Me About Your Troubles, in Physiotherapy Research International, 19(4), 205-221.
"What do you expect from physiotherapy?": a detailed analysis of goal setting in physiotherapy.
Schoeb Veronika, Staffoni Liliana, Parry Ruth, Pilnick Alison (2013), "What do you expect from physiotherapy?": a detailed analysis of goal setting in physiotherapy., in Disability and rehabilitation, epub.
La recherche qualitative en physiothérapie : quelle place mérite-t-elle ?
Schoeb Veronika (2012), La recherche qualitative en physiothérapie : quelle place mérite-t-elle ?, in Kinésithérapie - La Revue, 12(127), 85-93.

Collaboration

Group / person Country
Types of collaboration
Researchers involved in research group Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Associated projects

Number Title Start Funding scheme
108451 Elaboration d'objectifs physiothérapeutiques en partenariat avec le patient: quels effets sur la satisfaction et les résultats fonctionnels? 01.09.2005 DORE project funding
159327 Interprofessional Collaboration: How do health professionals interact with each other in collaborative practice situations? 01.01.2016 Project funding (Div. I-III)
134835 Discharge planning in rehabilitation centers: what about patient participation? 01.02.2012 DORE project funding

Abstract

Introduction: Research in health care communication has gained importance in recent years. Reasons are found in increasing patient autonomy and expectations regarding quality of care. Professional practice guidelines prescribe health care professionals in general and physiotherapists in particular to include patients into the decision-making process and to establish collaboration in order to elaborate therapeutic goals and treatment plans. Clinical decision-making is defined in the literature as either an intellectual process of clinicians seeking to arrive at a diagnosis or management plan for patients, or as a phenomenon that requires social and linguistic skills. Social skills have been recognised by researchers investigating clinical reasoning strategies. Decision-making including patients' preferences is promoted as there is evidence that it improves clinical outcome. Evidence on goal setting shows some benefits perceived by patients and professionals regarding involvement in care. Most of the studies, however, are based on personal accounts rather than on observations during consultations. Some evidence of patient involvement in goal setting exist in neurologic physiotherapy which contradicts some of the basic assumptions of patient participation. Nothing is known in the context of orthopaedic outpatient physiotherapy. In summary, there is a need to know more about the way the interaction between patients and professionals takes place. The interactive nature of physiotherapy (using verbal and non-verbal communication) has not yet been fully described. This study will offer some insight into the clinical decision-making process in general, and in goal-setting and treatment planning in particular.Objective: The aim of this research is to shed light on patient-physiotherapist interaction during initial encounters in musculo-skeletal physiotherapy, and in particular on the goal-setting process and how decisions are made concerning the choice of treatment modalities. Method: Three different physiotherapy practice settings participate in the study: an outpatient clinic based in a public hospital, a private practice in in the outskirt of a city and a private practice in a small village. 60 consenting outpatients seeking physiotherapy for their musculo-skeletal problem and their therapists will be videotaped during five consecutive sessions. Conversation analysis (CA) is chosen as a method to help describe actual interaction. CA has its intellectual framework from ethnomethodology and provides an understanding of how sequences of interaction shape the encounter in an institutional setting. Its underlying assumptions are that talk (or any social action) is context shaped, context-renewing and that there is a mutual understanding between participants through sequential architecture of intersubjectivity. The video data (150 hours) will be watched, and sequences related to goal setting and treatment planning will be selected. The analysis will focus on how turns are design, what vocabulary is used, what type of corrections (verbal or in action) are used and how sequences of talk or movement are organised. Conclusion: A better comprehension of the interaction between physiotherapists and patients could help reconsider, confirm or refute some of the policies advocated in physiotherapy regarding patient participation in physiotherapy. A deeper understanding of how patients and physiotherapists communicate in an outpatient physiotherapy practice could lead to sensitising professionals on their communication skills.
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