Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators

This is a pre-copyedited, peer-reviewed version of the following article Dukhu, S., Purcell, C. & Bulley, C. (2018) Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators. International Practice Development Journal, 8 (2), [Article 2], which has been published in final form at https://doi.org/10.19043/ipdj.82.002 in the International Journal of Practice Development.Background: In the management of long-term conditions (LTCs), the role of physiotherapy and the construct of person-centred care (PCC) is evolving. Though discussed thoroughly in some disciplines, theorising about PCC is embryonic in physiotherapy literature, with evidence suggesting ambiguity in its conceptualisation and application. Aims: To critically review evidence for barriers to, and facilitators of, PCC in adults living with LTCs within a physiotherapy context and identify components and outcomes of PCC in practice.Method: A systematic electronic search strategy to identify quantitative, qualitative and mixed method studies which collected data relating conceptually to PCC and included physiotherapists working with adults (>19 years) living with one or more LTCs in any setting.Findings: Four quantitative, three qualitative and one mixed methods article, representing six studies, were selected for critique and synthesis. Outcomes identified by the authors included perceived self-management and ‘patient’ centredness, self-efficacy (assessed using Six-Item Chronic Disease Self-Efficacy Scale, Pain Self-Efficacy Questionnaire) and quality of life (assessed using Quality of Life Analogue Scale, Short Form-36). Components of PCC were identified as self-management, on-going care, decision-making, individualisation, information-sharing and goal-setting. Evidence suggests barriers and facilitators may occur at the level of the stakeholder within processes, outcomes and contexts of care delivery.Conclusions: There is limited and mixed quality of evidence in relation to aspects of PCC in physiotherapy practice for management of LTCs. This review synthesises concepts described in physiotherapy literature in a model which is contrasted with others to trigger further discussion.Implications: 1) There is a need to study physiotherapists’ awareness of the complexity of PCC in practice. 2) Quality of evidence is mixed, highlighting a need for further exploration of PCC within physiotherapy contexts. 3) Evidence suggests PCC can be better delivered by physiotherapists when addressing barriers and enhancing facilitators of PCC.8pubpub2 [2

What matters versus what’s the matter – exploring perceptions of person-centred practice in nursing and physiotherapy social media communities: a qualitative study

This is a pre-copyedited, peer-reviewed version of the following article Ward, A., Eng, C., McCue, V., Stewart, R., Strain, K., McCormack, B., Dukhu, S., Thomas, J. & Bulley, C. (2018) What matters versus what’s the matter – exploring perceptions of person-centred practice in nursing and physiotherapy social media communities: a qualitative study. International Practice Development Journal, 8 (2), [Article: 3], which has been published in final form at https://doi.org/10.19043/ipdj.82.003 in the International Journal of Practice Development.Background: Person-centred practice (PCP) is advocated internationally across multiple healthcare contexts and professions. Originating in nursing and medicine, its enactment in physiotherapy requires careful consideration.Aims and Objectives: to explore perceptions of PCP within nursing and physiotherapy online social media communities to gain insight into differences and similarities in how PCP may be enacted professionally.Methods: A large, online focus group was undertaken through an international tweet chat within the existing social media communities: WeNurses and Physiotalk. Participants were fully informed before participation. Tweets from the hour-long tweet chat plus 15 minutes were downloaded via Symplur. Analysis was undertaken using Interpretative Phenomenological Approach with consideration of group development of insight and meaning. Tweets were analysed if by nurses and physiotherapists, related to the research aim, and interpretable.Results: 233 of 504 tweets were analysed, by 38 nurses and 23 physiotherapists. Four themes are discussed here: 1. Relationship between professionals and patients, 2. Perceptions of who holds the power, 3. Treating the condition not the person, and 4. Impacts of organisational demands. Nurses and physiotherapists were seen to share many perceptions of person-centred practice, with the latter demonstrating a focus on informed decision making and education to empower. Discussion also showed a biomedical approach was often taken by physiotherapists. Patient privacy was highlighted by nurses. Explanatory theory was produced to incorporate the views of physiotherapists alongside established perceptions of PCP from nursing literature, expanding insights into profession-specific applications.Conclusions: Perceptions of PCP described by participants were generally supportive of previous PCP frameworks. Insights suggested some physiotherapists may perceive their professional role in a way that is not completely consistent with PCP; this would benefit from further exploration. The importance of education to empower patients within collaborative relationships was emphasised in relation to physiotherapy and may represent key aspects of the role.IMPLICATIONS FOR PRACTICE: • Discussion supported many similarities in the perceptions of PCP between nursing and physiotherapy online communities that resonate with existing frameworks, including prioritisation of what matters to the patient and empowerment through relationship, and the barriers to this resulting from structures and cultures within workplaces. • Participants from both professions emphasised the importance of focusing on the beliefs, values and priorities of the person, in development of a collaborative relationship, with shared decision making. • Physiotherapists involved in the tweetchat placed additional emphasis on the need to empower patients through education, to enable greater participation in informed and shared decision making. • Tweets suggested that there are risks to the enactment of PCP among physiotherapists. Some may focus on the condition rather than the person, and view the professional as expert with greater power in the therapeutic relationship.8pubpub2 [3