Walker Andrew, Kantaris Xenya, Chambers Mary
a Faculty of Health, Social Care and Education , Kingston University and St George's University of London , London , UK.
b Health Innovation Network , London , UK.
Disabil Rehabil. 2018 Apr;40(7):829-835. doi: 10.1080/09638288.2016.1277393. Epub 2017 Jan 27.
People with vestibular disorders are typically treated by physiotherapists in vestibular rehabilitation. Anxiety is strongly associated with vestibular disorders; however, there is a lack of understanding about how physiotherapists respond to people presenting with anxiety within vestibular rehabilitation. This study aimed to explore physiotherapists' current practice in assessing and treating patients with anxiety in vestibular rehabilitation.
A qualitative study using semi-structured interviews with 10 specialist physiotherapists in vestibular rehabilitation in three university teaching hospitals in England. Data were analyzed using thematic analysis.
Four themes were identified: (i) The therapeutic relationship, (ii) Adapting assessment and treatment, (iii) Psychological intervention and support, and (iv) Physiotherapists' education and training. Physiotherapists reported using a range of behavioral and cognitive techniques and adapting their therapeutic approach by placing greater emphasis on education, building trust and pacing treatment. Physiotherapists highlighted the need for more specialist psychological support for patients during vestibular rehabilitation and tailored training and guidance on addressing anxiety within vestibular rehabilitation.
Physiotherapists working in vestibular rehabilitation consider managing aspects of anxiety within their scope of practice and describe taking a psychosocial therapeutic approach. There is limited access to expert psychological support for patients with anxiety within vestibular rehabilitation. Implications for rehabilitation Anxiety is strongly associated with vestibular disorders and it is common for these patients to be managed by physiotherapists in vestibular rehabilitation. Vestibular rehabilitation services could improve access to psychological expertise through dedicated psychological input, more effective signposting and referral pathways, and better access to inter-professional support from psychologists and/or CBT practitioners in managing more complex patients. Physiotherapists requested tailored training and guidance to enhance their ability to manage patients with anxiety more effectively in vestibular rehabilitation.
前庭疾病患者通常由物理治疗师进行前庭康复治疗。焦虑与前庭疾病密切相关；然而，对于物理治疗师在前庭康复中如何应对焦虑患者，人们缺乏了解。本研究旨在探讨物理治疗师目前在前庭康复中评估和治疗焦虑患者的实践情况。
采用定性研究方法，对英国三所大学教学医院的10名前庭康复专科物理治疗师进行半结构式访谈。采用主题分析法对数据进行分析。
确定了四个主题：（i）治疗关系，（ii）调整评估和治疗，（iii）心理干预与支持，以及（iv）物理治疗师的教育与培训。物理治疗师报告称，他们使用了一系列行为和认知技术，并通过更加强调教育、建立信任和调整治疗节奏来调整治疗方法。物理治疗师强调，在前庭康复期间，需要为患者提供更多专门的心理支持，以及针对前庭康复中应对焦虑的量身定制的培训和指导。
从事前庭康复工作的物理治疗师认为，在其执业范围内管理焦虑问题，并描述采用社会心理治疗方法。在前庭康复中，焦虑患者获得专家心理支持的机会有限。对康复的启示焦虑与前庭疾病密切相关，这些患者在前庭康复中由物理治疗师管理是很常见的。前庭康复服务可以通过专门的心理投入、更有效的引导和转诊途径，以及更好地获得心理学家和/或认知行为疗法从业者的跨专业支持来改善心理专业知识的获取，以管理更复杂的患者。物理治疗师要求提供量身定制的培训和指导，以提高他们在前庭康复中更有效地管理焦虑患者的能力。
