Copyright World Confederation for Physical Therapy 2011The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care (PCC) has become synonymous with high-quality care and a number of studies have reinforced patient’s desire for, and the positive impact of the approach1. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it2. Physiotherapists have been urged to explore PCC in relation to their practice.Peer reviewedFinal Published versio

Moore, A.

Ramage, C.M.

Sexton, Mary

English

Copyright World Confederation for Physical Therapy 2011The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care (PCC) has become synonymous with high-quality care and a number of studies have reinforced patient’s desire for, and the positive impact of the approach1. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it2. Physiotherapists have been urged to explore PCC in relation to their practice.Peer reviewe

University of Hertfordshire Research Archive

theory6 and strategic action7. Together with the findings they form a composite theory of PCC in musculoskeletal physiotherapy practice (Figure 2). Whilst a number of factors at a macro level serve to constrain the process, it is facilitated by micro factors such as effective communication skills, professional experience and local support. Figure 1: The process of Engaging the patient  Figure 2: Theoretical conceptualisation of Engaging the patientKnowledgeProfessional factorsExperience SocialisationResourcesContextServices SupportWorking alliancePatientwithLBPPhysiotherapistStrategic actionPhysiotherapeutic use of selfPhysiotherapeutic use of selfReciprocal interactionalexchangeDissonanceInterpreting the problemEngaging the patientWorking allianceDeveloping and allianceReconciling perspectivesProcedure Individual semi-structured interviews were used as the method of data collection. The interviews were audio taped and transcribed verbatim. Analysis Analysis consisted of a process of open, axial and selective coding4 resulting in a substantive theory with a core category and three sub-categories. Patient-centredness: a conceptual framework for musculoskeletal physiotherapy Sexton, M. T.1, Moore, A. P.2, Ramage, C. M.2  1University of Hertfordshire, 2University of Brighton The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care (PCC) has become synonymous with high-quality care and a number of studies have reinforced patient’s desire for, and the positive impact of the approach1. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it2. Physiotherapists have been urged to explore PCC in relation to their practice3. PCC in the physiotherapeutic management of low back pain is conceptualised as a process of Engaging the patient. It is a multi-faceted concept that raises a number of issues for physiotherapists. The proposed model may serve to heighten awareness of the interactional processes adopted by physiotherapists, inform the development of interventions and form the basis for further research. BackgroundFindings and discussionThe findings suggest that PCC is a dynamic process of Engaging the patient in a working alliance (Figure 1); a collaborative relationship in which the patient and physiotherapist reach agreement regarding the goals of management and how to achieve them. Three interactions were identified as integral to the success of the process: interpreting the problem, reconciling perspectives and developing a therapeutic alliance. It was evident that engaging patients with low back pain is not always straightforward but associated with a number of issues. This was particularly apparent in relation to incorporating the patient’s perspective into the decision-making process. Drawing on a number of different disciplines and philosophies Engaging the patient is proposed to be underpinned by three main concepts: complex responsive process of relating5; counselling Conclusion and recommendationsAcknowledgementsThe funding provided by the Charitable Trust of the CSP and the MACP for a Doctoral level study award is gratefully acknowledged. PurposeThe aims of this study were:•	 To	explore	musculoskeletal	physiotherapists’	 perceptions of PCC in relation to the  physiotherapeutic management of low back  pain. •	 To	construct	a	theory	of	PCC	based	on	 Grounded Theory methodology. MethodsParticipants Initially purposive sampling was used to select participants. Subsequent sampling was theoretical whereby analysis of the data informed the sample selection. Nine musculoskeletal physiotherapists agreed to participate in the study. References1. Stewart, M. (2001). Towards a global definition of patient centred care. British  Medical Journal, 322, 444-445. 2. Epstein, R., Franks, P., Fiscella, K., Shields, C., Meldrum, S. Kravitz, R.,  Duberstein, P., (2005). Measuring patient-centred communication in patient-  physician consultations: theoretical and practical issues. Social Science and   Medicine, 61, 1516-1528. 3.  Blackledge, C. (2005). Patient-Centred Care: The Bespoke Approach   London: Frontline, Chartered Society of Physiotherapy4. Strauss, A., & Corbin, J. (1998). Basic of Qualitative Research, Techniques and  Procedures for Developing Grounded Theory (2nd ed.). Thousand Oaks Sage5. Suchman, A. (2005). A new theoretical foundation for relationship-centred   care. Complex Responsive Processes of Reasoning Journal of General   Internal Medicine, 21(S40-44).6.  Rowan, J., & Jacobs, M. (2002). The Therapist’s Use of Self. Buckingham:    University Open Press. 7. Grenhalgh, T.,Robb, N., & Scambler, G. (2006). Communicative and strategic  action in interpreted consultations in primary health care: A Habermasian perspective. Social Science and Medicine, 63, 1170-1187. m.t.sexton@herts.ac.uk		 	 University	of	Hertfordshire,	School	of	Health	and	Emergency	Professions,	Hatfield	Herts,	AL10	9AB	 	 Tel	+44(0)	1707	284000	 	 www.herts.ac.ukFD2032_June11

A new theoretical foundation for relationship-centred care.

Measuring patient-centred communication in patientphysician consultations: theoretical and practical issues.

Patient-Centred Care: The Bespoke Approach London: Frontline,

Scambler, G. (2006). Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective. Social Science and Medicine, 63, 1170-1187. m.t.sexton@herts.ac.uk University Tel www.herts.ac.uk FD2032_June11

The Therapist’s Use of Self.

Towards a global definition of patient centred care.

Patient-centredness : a conceptual framework for musculoskeletal physiotherapy

Patient-centredness : a conceptual framework for musculoskeletal physiotherapy

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