Non-communicable diseases are the biggest challenges of the 21st century: What is the physiotherapist's role in global health?

201812_a bcmaVersion of RecordPublishe

‘When do we want the final discharge?’ How the potential tensions between medical expertise and institutional requirements are dealt with in discharge planning

To increase patients’ compliance, clinical guidelines insist on their participation in the entire rehabilitation process, including discharge planning (DP). However, very little is known about how this institutional requirement is implemented in the everyday business of a clinic. Adopting a conversation analytic approach, our paper tackles the question of how patients are involved in DP in one particular rehabilitation clinic in French-speaking Switzerland

Healthcare Service in Hong Kong and its Challenges

The Hong Kong Special Administrative Region combines a British colonial history within a Chinese cultural context and offers its population a dual system with a comprehensive and efficient public health care system in tandem with private hospitals and practitioners. Multiple challenges are looming: increasing demand for health services due to an aging population, staff shortages at all levels, and an underdeveloped primary healthcare system. Health is determined by multiple factors and is defined as a state of complete physical, mental, and social well-being. In recent years, the medical model of health focusing on pathology and disease has been considered insufficient, and a social model of health has been proposed, relying on a more holistic and broad definition of health. Rather than focusing on individual responsibility for health, the social model emphasises collective responsibility for health. This paper analyses the challenges facing Hong Kong in view of the social model of health. The discussion provides some reflections on medical dominance, the reasons behind limited primary care services, and what steps could be recommended to deliver healthcare services in Hong Kong in line with a more holistic view of health

Situation et enjeux des services de santé à Hong Kong

La Région administrative spéciale de Hong Kong est le fruit de l’histoire coloniale britannique dans un contexte culturel chinois. Elle offre à sa population un système de santé dual composé d’un dispositif de santé publique complet et efficace associé à des hôpitaux et des praticiens privés. Ce système doit cependant faire face à plusieurs problèmes : demande croissante de services de santé due au vieillissement démographique, pénurie de personnel à tous les niveaux et sous-développement du système de santé primaire. La santé, déterminée par de multiples facteurs, peut se définir comme un état de complet bien-être sur le plan physique, mental et social. Ces dernières années, le modèle médical de la santé, centré sur les pathologies et les maladies, a montré ses limites, et le modèle social, basé sur une approche plus holistique et plus globale de la santé, a commencé à attirer l’attention. Plutôt que de se concentrer uniquement sur la responsabilité individuelle, le modèle social insiste sur la responsabilité collective en matière de santé. Cet article analyse les défis auxquels Hong Kong doit faire face pour instaurer un tel modèle. La discussion présentera quelques réflexions sur le pouvoir médical, les raisons expliquant la limitation des services de santé primaire et les mesures à envisager afin de fournir à Hong Kong des services de soins correspondant à une vision plus globale de la santé

Influence of interactional structure on patient’s participation during interprofessional discharge planning meetings in rehabilitation centers

Interprofessional practice has become increasingly important. In addition, patients are expected to participate more actively in health-care decisions. While comprehensive discharge planning has been shown to be effective, it is unclear how interactional structure influences patients’ participation during discharge planning meetings. The aims of this qualitative study were to examine the interactional structure of interprofessional meetings in two rehabilitation clinics and to identify patients’ types of communicative involvement (patient participation) during discharge planning meetings. Using an ethnomethodological approach and Conversation Analysis, 121 interprofessional meetings were video-recorded (19 hours of recordings). Twenty-five patients (30– 87 years) with neurological or musculoskeletal disorders and their teams were included. The findings revealed two types of meetings aimed at either (a) exchanging information with team members and patient (“information exchange meeting”) or (b) negotiating care plans with patients and the team. “Negotiation meetings” were often led by allied health professionals or nurses and were characterized by active patient participation. Those meetings offered patients an opportunity to give additional information rather than only ask questions. The discussion includes reflections on how interactional analysis can help understand the social organization of meetings and how patient participation can be enhanced in this context and concludes with practice implications

"What do you expect from physiotherapy?": a conversation analytic approach to goal setting in physiotherapy

Professional practice guidelines direct health care professionals to include patients in the decision-making process and to establish collaboration for therapeutic goal setting. Currently, little is known about the interaction between patients and professionals during this process. The aim of this study is to shed light on goal setting practices in physiotherapy. Twenty-eight consenting patients seeking physiotherapy for their musculoskeletal problems and their therapists were videotaped during three consecutive sessions. Sequences related to goal setting were selected, and Conversation Analysis was chosen to analyse patient-therapist interactions. The data comprise fifteen episodes in which therapists enquire explicitly about goals. Findings show that two assumptions underlie these enquiries: a) that patients have a goal in mind, and b) that they are able to articulate it. My data indicate that this is not straightforwardly the case in practice. Patients orient in their responses to epistemic dimensions related to issues of whether they have access to this knowledge, and whether they treat themselves as entitled to know about goals. When patients respond to therapists’ enquiries, they use a variety of interactional resources to convey their epistemic orientation. I further found that therapists use different strategies for following-up patients’ responses: these have different implications for patients’ continued talk. My analysis also shows that a goal can only be treated as acceptable by therapists when it is amenable to improvement by physiotherapy. My study indicates that the process of goal setting is not as straightforward as policy documents suggest. In actual practice it requires addressing and managing underlying assumptions and epistemic dimensions. A better comprehension of the interaction between physiotherapists and patients will contribute to better understand the limitations of current goal setting theory, and how and why current policies on goal setting may not have the desired effect

"What do you expect from physiotherapy?": a conversation analytic approach to goal setting in physiotherapy

Professional practice guidelines direct health care professionals to include patients in the decision-making process and to establish collaboration for therapeutic goal setting. Currently, little is known about the interaction between patients and professionals during this process. The aim of this study is to shed light on goal setting practices in physiotherapy. Twenty-eight consenting patients seeking physiotherapy for their musculoskeletal problems and their therapists were videotaped during three consecutive sessions. Sequences related to goal setting were selected, and Conversation Analysis was chosen to analyse patient-therapist interactions. The data comprise fifteen episodes in which therapists enquire explicitly about goals. Findings show that two assumptions underlie these enquiries: a) that patients have a goal in mind, and b) that they are able to articulate it. My data indicate that this is not straightforwardly the case in practice. Patients orient in their responses to epistemic dimensions related to issues of whether they have access to this knowledge, and whether they treat themselves as entitled to know about goals. When patients respond to therapists’ enquiries, they use a variety of interactional resources to convey their epistemic orientation. I further found that therapists use different strategies for following-up patients’ responses: these have different implications for patients’ continued talk. My analysis also shows that a goal can only be treated as acceptable by therapists when it is amenable to improvement by physiotherapy. My study indicates that the process of goal setting is not as straightforward as policy documents suggest. In actual practice it requires addressing and managing underlying assumptions and epistemic dimensions. A better comprehension of the interaction between physiotherapists and patients will contribute to better understand the limitations of current goal setting theory, and how and why current policies on goal setting may not have the desired effect

Investigating the use of digital health tools in physiotherapy: facilitators and barriers

Background: Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited. Objective: This paper aims to investigate how digital health tools in general, and the mobile health tool physitrackTM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app’s use. Methods: The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics. Results: We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use. Conclusions: We argue that a single factor’s facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app’s compatibility with physiotherapy practice and use in therapist-patient interactions

"What do you expect from physiotherapy?": a detailed analysis of goal setting in physiotherapy

Purpose: Health care practice guidelines require physiotherapists to include patients in goal-setting. However, not much is known about how this process is accomplished in practice. The purpose of this study is to analyse patient–physiotherapist consultations and to identify how physiotherapists enquire about goals and how patients respond to these enquiries. Method: 37 consenting patients and their physiotherapist from outpatient physiotherapy practice settings were videotaped. Conversation analysis was used to transcribe and analyse the data. Results: In 11 cases, physiotherapists enquire explicitly about goals. Patients’ responses indicate that problems can arise when therapists’ questions treat it as expected that the patient has a goal already in mind, and has sufficient understanding about “physiotherapy-relevant” goals. Patients’ difficulties with stating a goal are related to patients’ knowledge to propose a goal and whether they treat consultations as one in which it is appropriate to claim knowledge about goals. Conclusions: Goal-setting is not a straightforward process. Practices that entail asking patients to state their goals neither take into consideration the fact that patients may not know what an achievable goal is nor do they consider so-called social reasons for patients not to make claims to their physiotherapist about what the goals should be