What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis

Background Musculoskeletal physical therapy involves both specific and nonspecific effects. Nonspecific variables associated with the patient, therapist, and setting may influence clinical outcomes. Recent quantitative research has shown that nonspecific factors, including patient-therapist interactions, can influence treatment outcomes. It remains unclear, however, what factors influence patient-therapist interaction. Purpose This qualitative systematic review and meta-synthesis investigated patients' and physical therapists' perceptions of factors that influence patient-therapist interactions. Data Sources Eleven databases were searched independently. Study Selection Qualitative studies examining physical therapists' and patients' perceptions of factors that influence patient-therapist interactions in musculoskeletal settings were included. Data Extraction Two reviewers independently selected articles, assessed methodological quality using the Critical Appraisal Skills Programme (CASP), and performed the 3 stages of analysis: extraction of findings, grouping of findings (codes), and abstraction of findings. Data Synthesis Thirteen studies were included. Four themes were perceived to influence patient-therapist interactions: (1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication), (2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients), (3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account), and (4) organizational and environmental factors (ie, time and flexibility with care and appointments). Limitations Only studies published in English were included. Conclusions A mix of interpersonal, clinical, and organizational factors are perceived to influence patient-therapist interactions, although research is needed to identify which of these factors actually influence patient-therapist interactions. Physical therapists' awareness of these factors could enhance patient interactions and treatment outcomes. Mechanisms to best enhance these factors in clinical practice warrant further study.

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Physical Therapy 2.0: Leveraging Social Media to Engage Patients in Rehabilitation and Health Promotion

Physical Therapy ◽

10.2522/ptj.20130432 ◽

2015 ◽

Vol 95 (3) ◽

pp. 389-396 ◽

Cited By ~ 14

Author(s):

Emily Knight ◽

Robert J. Werstine ◽

Diane M. Rasmussen-Pennington ◽

Deborah Fitzsimmons ◽

Robert J. Petrella

Keyword(s):

Social Media ◽

Health Promotion ◽

Physical Therapy ◽

Treatment Outcomes ◽

Physical Therapists ◽

Physical Therapist ◽

Care Delivery ◽

Health Care Systems ◽

Noncommunicable Diseases ◽

The Way

Care for chronic conditions and noncommunicable diseases is dominating health systems around the globe. For physical therapists, this strain presents a substantial opportunity for engaging patients in health promotion and disease management in the years to come. Examples of social media being used to engage consumers in the business landscape are pervasive, and research reports suggest that patients are ready for social media to be incorporated into the way health care systems deliver care. We propose that leveraging the power and utility of existing technologies, such as social media, could innovate the way physical therapists engage patients in rehabilitation and health promotion practices, thus contributing to the evolution of the profession: Physical Therapy 2.0. To continue to be relevant in the community, physical therapist practice must respond to patients' needs and expectations. Incorporating social media into how physical therapists are both designing and delivering care holds potential for enhancing patient engagement in prescribed health behaviors and improving treatment outcomes. This conceptual article presents the perspective that physical therapists can utilize social media to enhance care delivery and treatment outcomes.

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Writing Patient-Centered Functional Goals

Physical Therapy ◽

10.1093/ptj/80.12.1197 ◽

2000 ◽

Vol 80 (12) ◽

pp. 1197-1203 ◽

Cited By ~ 61

Author(s):

Kenneth E Randall ◽

Irene R McEwen

Keyword(s):

Health Care ◽

Physical Therapy ◽

Motor Learning ◽

Physical Therapists ◽

Physical Therapist ◽

Patient Centered ◽

Step Process ◽

Care Policies ◽

Health Care Policies ◽

Learning Research

Abstract Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.

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Patient Satisfaction With Musculoskeletal Physical Therapy Care: A Systematic Review

Physical Therapy ◽

10.2522/ptj.20100061 ◽

2011 ◽

Vol 91 (1) ◽

pp. 25-36 ◽

Cited By ~ 94

Author(s):

Julia M. Hush ◽

Kirsten Cameron ◽

Martin Mackey

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Physical Therapy ◽

Data Extraction ◽

Meta Analysis ◽

Outpatient Setting ◽

Study Patient ◽

Unexpected Finding ◽

Process Of Care ◽

Patient Centered

Background Patient satisfaction is an important patient-centered health outcome. To date, no systematic review of the literature on patient satisfaction with musculoskeletal physical therapy care has been conducted. Purpose The purpose of this study was to systematically and critically review the literature to determine the degree of patient satisfaction with musculoskeletal physical therapy care and factors associated with satisfaction. Data Sources The databases CINAHL, MEDLINE, and EBM Reviews were searched from inception to September 2009. Study Selection Articles were included if the design was a clinical trial, observational study, survey, or qualitative study; patient satisfaction was evaluated; and the study related to the delivery of musculoskeletal physical therapy services conducted in an outpatient setting. The search located 3,790 citations. Fifteen studies met the inclusion criteria. Data Extraction Two authors extracted patient satisfaction data and details of each study. Data Synthesis A meta-analysis of patient satisfaction data from 7 studies was conducted. The pooled estimate of patient satisfaction was 4.44 (95% confidence interval=4.41–4.46) on a scale of 1 to 5, where 5 indicates high satisfaction and 1 indicates high dissatisfaction. Additional data were summarized in tables and critically appraised. Limitations Nonrespondent bias from individual studies may affect the accuracy and representativeness of these data. Conclusion Patients are highly satisfied with musculoskeletal physical therapy care delivered across outpatient settings in northern Europe, North America, the United Kingdom, and Ireland. The interpersonal attributes of the therapist and the process of care are key determinants of patient satisfaction. An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Physical therapists can enhance the quality of patient-centered care by understanding and optimizing these determinants of patient satisfaction.

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The Influence of the Environment on the Patient-Centered Therapeutic Relationship in Physical Therapy: A Qualitative Study

10.20944/preprints202011.0269.v1 ◽

2020 ◽

Author(s):

Jaume Morera-Balaguer ◽

Mari Carmen Martínez-González ◽

Sonia del Río-Medina ◽

Víctor Zamora-Conesa ◽

Marina Leal-Clavel ◽

...

Keyword(s):

Physical Therapy ◽

Qualitative Study ◽

Focus Groups ◽

Therapeutic Relationship ◽

Physical Therapists ◽

Organizational Factors ◽

Physical Factors ◽

Theory Approach ◽

Patient Centered ◽

Communication Impairments

Currently, in the scientific literature there is a great interest on the study of strategies to implement patient-centered care. One of the main tools for this is the therapeutic relationship. Some studies suggest that the perception of the environment in which the physical therapy treatment takes place can influence the perception of its quality. A qualitative study using focus groups was performed. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audio-recorded, transcribed verbatim and analyzed thematically using a modified grounded theory approach. The setting was three hospitals and six public health centers located in Spain. The inclusion criteria were patients who had received a minimum of 15 physical therapy sessions and with no communication impairments. Thirty-one participants in four focus groups. Participants described a series of specific experiences relating to the environment, which they felt were influential in the establishment of therapeutic patient-centered relationships, including eight physical factors and five organizational factors. The results of this study highlight environmental factors that affect the quality of the therapeutic patient-centered relationship in physical therapy and emphasize the need for physical therapists and administrators to rethink the situation and propose strategies for improvement.

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Feasibility of Goal Attainment Scaling in Chronic Low Back Pain: Protocol for Training & Implementation in an Outpatient Physical Therapy Setting (Preprint)

10.2196/preprints.32457 ◽

2021 ◽

Author(s):

Douglas Haladay ◽

Rebecca Edgeworth Ditwiler ◽

Aimee Klein ◽

Rebecca Miro ◽

Matthew Lazinski ◽

...

Keyword(s):

Physical Therapy ◽

Clinical Setting ◽

Goal Attainment ◽

Physical Therapists ◽

The United States ◽

Goal Attainment Scaling ◽

Low Back ◽

Patient Centered ◽

Patient Reported ◽

Qualitative Phase

BACKGROUND Patient engagement in decisions regarding their healthcare may lead to improved outcomes and improved adherence to treatment plans. While there are several options for involving patients in their healthcare, goal setting is a readily accessible method for physical therapists to increase the involvement of patients in healthcare decisions. Physical therapy goals are often provider-generated and based on subjective information or standardized fixed-item patient-reported outcome measures. However, these outcome measures may provide a limited scope of activity and participation limitations which may not capture the needs of individual patients. Goal Attainment Scaling (GAS) is a patient-centered approach to involving patients in setting meaningful goals. While GAS has been shown to be reliable, valid, and sensitive to change in various population, there is limited evidence in the United States about utilizing GAS in the physical therapist management of patients with low back pain (LBP). OBJECTIVE The purpose of this report is to describe the protocol for a study to a) develop an application of GAS procedures to be used by physical therapists treating patients with chronic LBP in the United States and b) to test the feasibility of applying GAS procedures in chronic LBP in an outpatient physical therapy setting. METHODS This study will use a mixed-methods design with two (2) phases (Phase 1: Qualitative, Phase 2: Quantitative). The qualitative phase of the study will employ focus groups of patients with chronic LBP to identify an inventory of goals that are important and measurable. This inventory will be used to develop a series of leading questions that will allow physical therapists to assist patients in establishing goals in the clinical setting. The quantitative phase of the study will pilot-test the inventory developed in the qualitative arm in patients with chronic LBP to determine feasibility, reliability, validity, and responsiveness. We will also compare how well GAS captures change over time as compared to traditional fixed-item patient-reported measures. RESULTS We anticipate that this study will demonstrate that GAS can be implemented successfully by outpatient physical therapists, and it will demonstrate clinically important changes that are important to patients with chronic LBP. CONCLUSIONS GAS represents an opportunity for patient-centered care in the physical therapy management of chronic LBP. While GAS is not new, it has never been studied in a real-world clinical setting for the physical therapy management of chronic LBP which have unique time and productivity constraints. For GAS to be successfully implemented in this environment, we must demonstrate that clinicians can be trained efficiently and reliably, that GAS can be implemented in the clinical setting in under 15 minutes, and that GAS is able to detect clinically meaningful change in patient outcomes. CLINICALTRIAL N/A

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Experiences of living with long COVID and of accessing healthcare services: a qualitative systematic review

BMJ Open ◽

10.1136/bmjopen-2021-050979 ◽

2022 ◽

Vol 12 (1) ◽

pp. e050979

Author(s):

Karen Macpherson ◽

Kay Cooper ◽

Jenny Harbour ◽

Dawn Mahal ◽

Charis Miller ◽

...

Keyword(s):

Systematic Review ◽

Support Groups ◽

Data Extraction ◽

Healthcare Services ◽

Bibliographic Databases ◽

Discussion Forums ◽

Inclusion Criteria ◽

Systematic Map ◽

Qualitative Systematic Review ◽

Review Team

ObjectiveTo explore the experiences of people living with long COVID and how they perceive the healthcare services available to them.DesignQualitative systematic review.Data sourcesElectronic literature searches of websites, bibliographic databases and discussion forums, including PubMed LitCovid, Proquest COVID, EPPI Centre living systematic map of evidence, medRxiv, bioRxiv, Medline, Psychinfo and Web of Science Core Collection were conducted to identify qualitative literature published in English up to 13 January 2021.Inclusion criteriaPapers reporting qualitative or mixed-methods studies that focused on the experiences of long COVID and/or perceptions of accessing healthcare by people with long COVID. Title/abstract and full-text screening were conducted by two reviewers independently, with conflicts resolved by discussion or a third reviewer.Quality appraisalTwo reviewers independently appraised included studies using the qualitative CASP (Critical Appraisal Skills Programme) checklist. Conflicts were resolved by discussion or a third reviewer.Data extraction and synthesisThematic synthesis, involving line-by-line reading, generation of concepts, descriptive and analytical themes, was conducted by the review team with regular discussion.ResultsFive studies published in 2020 met the inclusion criteria, two international surveys and three qualitative studies from the UK. Sample sizes varied from 24 (interview study) to 3762 (survey). Participants were predominantly young white females recruited from social media or online support groups. Three analytical themes were generated: (1) symptoms and self-directed management of long COVID; (2) emotional aspects of living with long COVID and (3) healthcare experiences associated with long COVID.ConclusionsPeople experience long COVID as a heterogeneous condition, with a variety of physical and emotional consequences. It appears that greater knowledge of long COVID is required by a number of stakeholders and that the design of emerging long COVID services or adaptation of existing services for long COVID patients should take account of patients’ experiences in their design.

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Patient Participation in Physical Therapy Goal Setting

Physical Therapy ◽

10.1093/ptj/81.5.1118 ◽

2001 ◽

Vol 81 (5) ◽

pp. 1118-1126 ◽

Cited By ~ 75

Author(s):

Susan M Baker ◽

Helen H Marshak ◽

Gail T Rice ◽

Grenith J Zimmerman

Keyword(s):

Patient Satisfaction ◽

Physical Therapy ◽

Elderly Patients ◽

Goal Setting ◽

Patient Participation ◽

Physical Therapists ◽

Physical Therapist ◽

Assessment Instrument ◽

Initial Examination ◽

Goals And Objectives

Abstract Background and Purpose. An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. Subjects and Methods. Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (X̄=76.4 years of age, SD=7.1, range=65–94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. Results. Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. Discussion and Conclusion. In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.

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Contributions of Non-professional Local Physical Therapist In the Promotion of Community Health Activities in the Arsi Zone, Southeast Ethiopia (Preprint)

10.2196/preprints.27789 ◽

2021 ◽

Author(s):

Leta Melaku

Keyword(s):

Health Promotion ◽

Physical Therapy ◽

Physical Therapists ◽

Physical Therapist ◽

Sampling Technique ◽

Cross Sectional Study ◽

Cross Sectional ◽

Arsi Zone ◽

Southeast Ethiopia ◽

The Impact

BACKGROUND Physical activity is a first-line therapy and secures against persistent illnesses. Essential medical care professionals are obviously situated to advance actual action. Active recuperation mediations focused on advancement and upkeep of wellbeing, personal satisfaction, and wellness. There is, notwithstanding, a deficiency of such examination proof in Ethiopia. OBJECTIVE We planned to assess the degree of KAP of nonprofessional local physical therapists' towards wellbeing advancement in Arsi zone of Oromia, Southeast Ethiopia. METHODS Community based cross sectional study was conducted in April 2018 among 45 physical therapists. Data were collected using pre-tested, structured and self-administrative questionnaires. Participants were selected by quota sampling technique. The questionnaire was drafted specifically to test the KAP. Data were double entered and analyzed by SPSS Version 20.0 program. Descriptive statistics were used. The KAP were estimated using proportion. RESULTS In present response rate is 90.0%. Ages of respondents ranged between 24 – 87 years. 57.8% of participants got initial physical therapy knowledge from either of their parents. 53.3% of the respondents hear about health promotion from families and friends. 57.8% of them provided health promotion at their workplace. The overall percentage of all the respondents’ KAP in health promotion was 60.1%. CONCLUSIONS The respondents’ have good KAP towards health promotion. However there is still room for improvement. Also there is a lack of proper guide lines in determining the impact physical therapy.

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Awareness and Perception of Physical Therapy Education, Role in Patient Management and Health Promotion Held by Senior Medical Practitioners

Asian Journal of Allied Health Sciences (AJAHS) ◽

10.52229/ajahs.v2i3.299 ◽

2020 ◽

pp. 13-17

Author(s):

OJS Admin

Keyword(s):

Health Promotion ◽

Physical Therapy ◽

Patient Management ◽

Physical Therapists ◽

Physical Therapist ◽

Well Being ◽

Physical Therapy Education ◽

Health Providers ◽

Medical Practitioners ◽

Therapy Education

Physical therapists are integral part of health care system. In collaboration with other health providers, physical therapist can play an effective role in patient handling and well-being of individuals. The awareness and perception of senior medical practitioners is less known regarding physical therapy education, role in patient management and health promotion.

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Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver?

Physical Therapy ◽

10.1093/ptj/pzz171 ◽

2019 ◽

Vol 100 (4) ◽

pp. 621-632 ◽

Cited By ~ 1

Author(s):

Trevor A Lentz ◽

Adam P Goode ◽

Charles A Thigpen ◽

Steven Z George

Keyword(s):

Health Care ◽

Physical Therapy ◽

Musculoskeletal Pain ◽

Clinical Decision Making ◽

Physical Therapists ◽

Physical Therapist ◽

Great Promise ◽

Health Care Environment ◽

Early Physical Therapy ◽

Analytical Approaches

Abstract Early physical therapy models hold great promise for delivering high-value care for individuals with musculoskeletal pain. However, existing physical therapist practice and research standards are misaligned with value-based principles, which limits the potential for growth and sustainability of these models. This Perspective describes how the value proposition of early physical therapy can be improved by redefining harm, embracing a prognostic approach to clinical decision making, and advocating for system-wide guideline-adherent pain care. It also outlines the need to adopt a common language to describe these models and embrace new, rigorous study designs and analytical approaches to better understand where and how early physical therapy delivers value. The goal is to define a clear path forward to ensure physical therapists are aligned within health care systems to deliver on the American Physical Therapy Association’s vision of high-value care in a rapidly changing health care environment.

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