Background & Aims

Clinical practice guidelines for musculoskeletal pain conditions consistently recommend person-centred care.(1) However, researchers have identified barriers to the implementation of person-centred care in musculoskeletal physiotherapy.(2,3) Although, person-centred care has been included in some undergraduate physiotherapy curricular,(4) there is a need for contextualised ongoing support and education for qualified physiotherapists. For robust education design, it is important to understand from physiotherapists who work with people with musculoskeletal conditions, their needs and experiences relating to learning to deliver person-centred care.
The aim of this study was to explore the views of physiotherapists on learning to deliver person-centred care to people with musculoskeletal conditions. The secondary aim of the study was to inform the design of an e-learning programme to support musculoskeletal physiotherapists in delivering person-centred care as part of a larger study.

Methods

This qualitative study is set within a larger co-design design-based research project(5) and was one of three research activities used to problematise learning to deliver and the delivery of person-centred care. A qualitative focus group interview was carried out with seven physiotherapists following their participation in an in-person education programme. We took a pragmatic approach to the design of the focus group interview to ensure the data contributed to usable knowledge for the design of an e-learning programme. We used purposive sampling and questions were selected to explore facilitators and barriers, but we considered the physiotherapists to be experts in the learning process and did not hypothesise about the nature of the facilitators and barriers. Data were analysed using a combined inductive and deductive approach. Initial data familiarisation and coding were guided by a reflexive thematic analysis approach(6) followed by a Framework analytical approach.(7)

Results

The thematic framework consists of five categories: 1. ‘How learning happens’: Learning was multi-dimensional in nature – it occurred within and between individuals and varied resources and experiences were needed to access the multiple layers; 2. ‘What is important to learn?’: In addition to skills, techniques, and theoretical understanding, the physiotherapists identified the importance of learning about the unique patient and having a deep knowledge of oneself; 3. ‘What is required of learners?’: The physiotherapists were required to be professionally competent, committed, and brave, and to have self-determination, whilst being compassionate towards themselves; 4. ‘Barriers to learning and implementation’: Barriers exist within the workplace and within the individual, and are linked to the high demands associated with delivering person-centred care; 5. ‘Support for learning and implementation’: Support was required and found in the form of resources, opportunities, and other people.

Conclusions

The physiotherapists in this focus group study describe a multi-dimensional learning process. They highlighted many challenges, not only in relation to barriers of implementation, but also in relation to the level of reflectiveness and reflexiveness that the learning process demands. Physiotherapists need to be brave to engage with the learning process and require a range of support, including supportive others.

The views expressed by the physiotherapists are important to consider in the design of education programmes for the delivery of person-centred care. The supportive factors identified by the participants present specific challenges to the e-learning format where there is not a facilitator to guide the learning process. The requirements and barriers identified by the focus group participants are indicative of reasons why the delivery of person-centred care is not ubiquitous despite person-centred care being considered morally and ethically the right approach to healthcare.

References

1.Lin, I. et al. 2020. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines:systematic review. British Journal of Sports Medicine 54(2), 79-86.
2.Dukhu, S., Purcell, C., & Bulley, C. 2018. Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators. International Practice Development Journal 8(2), 1-27.
3.Naylor, J. et al. 2023. What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies, Disability and Rehabilitation 45(6), 950-961.
4.Killingback, C. et al. 2021. Teaching person-centred practice in physiotherapy curricula: a literature review. Physical Therapy Reviews 27(1), 40-50.
5.Slater, D. et al. 2023. E-learning programme to support physiotherapists in delivering person-centred care for people with musculoskeletal conditions: a design-based research approach. Open Science Framework https://doi.org/10.17605/OSF.IO/WYN2G
6.Braun, V. & Clarke, V. 2021. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology 18(3), 328-352.
7.Ritchie, J., & Spencer, L. 1994. Qualitative data analysis for applied policy research. In A. Bryman & B. Burgess (Eds.) Analyzing qualitative data. Taylor & Francis Group.
8.Institute of Medicine (US) Committee on Quality of Health Care in America, 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US).
9.World Health Organization ?2005?. Preparing a health care workforce for the 21st century: the challenge of chronic conditions. World Health Organization [Accessed online 30 Jan 2024] https://iris.who.int/handle/10665/43044
10.M?cznik, A.K., Ribeiro, D.C., & Baxter, G.D. 2015. Online technology use in physiotherapy teaching and learning: a systematic review of effectiveness and users’ perceptions. BMC Medical Education 28(15), 160.
11.Sinclair, P.M. et al. 2016. The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review. International Journal of Nursing Studies 57, 70-81.

Presenting Author

Diane Slater

Poster Authors

Diane Slater

MSc, PgCert, BSc(Hons)

Aalborg University

Lead Author

Michael Skovdal Rathleff

Research Unit for General Practice at Aalborg University

Lead Author

Ann Bygholm

Aalborg University

Lead Author

Topics

  • Education