Naylor John, Killingback Clare, Green Angela
Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, UK.
Faculty of Health Sciences, University of Hull, Hull, UK.
Disabil Rehabil. 2023 Mar;45(6):950-961. doi: 10.1080/09638288.2022.2055165. Epub 2022 Mar 29.
There is a growing expectation of physiotherapists to adopt a person-centred approach to their practice. Person-centredness for musculoskeletal physiotherapy, however, remains an under-researched area. A synthesis of the findings from qualitative studies exploring perceptions of person-centredness in musculoskeletal physiotherapy was conducted to inform future clinical practice.
ENTREQ and PRISMA guidelines were used to develop a protocol for a qualitative systematic review registered with PROSPERO (registration number: CRD42020170762). Five electronic databases were searched to identify relevant primary studies. Studies were assessed for quality and data extracted. Data were analysed using thematic synthesis.
A total of 3250 studies were identified and screened. Nine studies met the inclusion criteria. Four main themes emerged from the data: treating each patient as a unique person, the importance of communication for achieving a therapeutic alliance, necessary physiotherapist traits for person-centredness, and supporting patient empowerment.
Empowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment, with clinical bravery recognised as a specific person-centred physiotherapy trait able to facilitate this. Physiotherapists should also consider the meaningfulness of any treatment activities they provide to maximise the person-centredness of their approach.IMPLICATIONS FOR REHABILITATIONEmpowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment.Clinical bravery is a person-centred physiotherapy trait that facilitates certain conversational freedom to elicit the true patient narrative.Person-centred physiotherapists should reflect on how meaningful their treatment activities are for individual MSK outpatients.
人们越来越期望物理治疗师在实践中采用以患者为中心的方法。然而,肌肉骨骼物理治疗中的以患者为中心仍然是一个研究不足的领域。本研究对探索肌肉骨骼物理治疗中以患者为中心观念的定性研究结果进行了综合分析,以为未来的临床实践提供参考。
采用ENTREQ和PRISMA指南制定了一项定性系统评价方案,并在PROSPERO上进行了注册(注册号:CRD42020170762)。检索了五个电子数据库以识别相关的原始研究。对研究进行质量评估并提取数据。采用主题综合法对数据进行分析。
共识别和筛选出3250项研究。9项研究符合纳入标准。数据中出现了四个主要主题:将每位患者视为独特个体进行治疗、沟通对于建立治疗联盟的重要性、以患者为中心所需的物理治疗师特质以及支持患者赋权。
在肌肉骨骼物理治疗中,通过采用更具叙事性的评估方法可能会提高患者赋权,临床勇气被认为是一种特定的以患者为中心的物理治疗特质,能够促进这一点。物理治疗师还应考虑他们提供的任何治疗活动的意义,以最大限度地提高其方法的以患者为中心程度。
对康复的启示
在肌肉骨骼物理治疗中,通过采用更具叙事性的评估方法可能会提高患者赋权。
临床勇气是以患者为中心的物理治疗特质,有助于获得一定的谈话自由度以引出真实的患者故事。
以患者为中心的物理治疗师应反思其治疗活动对个体肌肉骨骼门诊患者的意义。