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对骨关节炎患者进行以人为中心实践的物理治疗师培训:一项定性案例研究。

Training Physical Therapists in Person-Centered Practice for People With Osteoarthritis: A Qualitative Case Study.

机构信息

University of Melbourne, Melbourne, Victoria, Australia.

HealthChange Australia, Sydney, New South Wales, Australia.

出版信息

Arthritis Care Res (Hoboken). 2018 Apr;70(4):558-570. doi: 10.1002/acr.23314. Epub 2018 Feb 26.

Abstract

OBJECTIVE

To explore physical therapists' experiences with, and the impacts of, a training program in person-centered practice to support exercise adherence in people with knee osteoarthritis.

METHODS

This was a qualitative case study using semi-structured interviews, nested within a clinical trial. Eight Australian physical therapists were interviewed before, and after, training in person-centered practice for people with knee osteoarthritis. Training involved a 2-day workshop, skills practice, and audit of 8 consultations with 4 patients (per therapist), and a final single-day workshop for audit feedback and consolidation. Semi-structured interviews were audio-recorded and transcribed verbatim. Data were thematically analyzed.

RESULTS

Three pretraining themes arose regarding usual communication style, definitions of person-centered care, and sharing exercise adherence responsibility. Three themes related to the training experience emerged: learning a new language, challenging conceptions of practice, and putting it into practice. Post-training, 3 themes arose regarding new knowledge deepening understanding of person-centered care, changing beliefs about sharing responsibilities, and changed conceptions of role.

CONCLUSION

Although physical therapists found training overwhelming initially as they realized the limitations of their current knowledge and clinical practice, they felt more confident and able to provide person-centered care to people with knee osteoarthritis by the end of training. Training in structured person-centered methodology that provides opportunity for skills practice with patients using a restructured consultation framework can change physical therapists' beliefs about their roles when managing patients with osteoarthritis and positively impact their clinical practice.

摘要

目的

探索物理治疗师在参加以患者为中心的实践培训计划方面的经验及其对膝骨关节炎患者坚持锻炼的影响。

方法

这是一项定性案例研究,采用半结构式访谈,嵌套在临床试验中。在对 8 名澳大利亚物理治疗师进行以患者为中心的实践培训之前和之后进行了访谈。培训包括为期 2 天的研讨会、技能实践以及对 4 名患者(每名治疗师 8 次就诊)的 8 次咨询进行审核,最后进行为期 1 天的研讨会,以审核反馈和巩固。对半结构化访谈进行了录音和逐字转录。对数据进行了主题分析。

结果

出现了 3 个与培训前的常规沟通方式、以患者为中心的护理定义以及分担锻炼坚持责任有关的主题。培训经历出现了 3 个主题:学习一种新语言、挑战实践观念以及付诸实践。培训后,出现了 3 个与新知识有关的主题,包括对以患者为中心的护理的深入理解、对分担责任的信念的改变以及对角色的观念改变。

结论

尽管物理治疗师最初发现培训内容令人难以理解,因为他们意识到自己当前知识和临床实践的局限性,但在培训结束时,他们感到更有信心并能够为膝骨关节炎患者提供以患者为中心的护理。通过结构化的以患者为中心的方法进行培训,为治疗师提供了在患者中进行技能实践的机会,并使用重新构建的咨询框架,改变了物理治疗师在管理骨关节炎患者时对其角色的看法,并对其临床实践产生了积极影响。

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