Physiotherapy 97 (2011) 154162

Patients perspectives of patient-centrem acti

b, M

Box 56Otago,niversity

Abstract

Objective T d physDesign Qua udgemwas used to ry iteraSetting MuParticipantResults Five categories of characteristics relating to patient-centred physiotherapy were generated from the data: the ability to communicate;confidence; knowledge and professionalism; an understanding of people and an ability to relate; and transparency of progress and outcome.These categories did not tend to occur in isolation, but formed a composite picture of patient-centred physiotherapy from the patientsperspective.Conclusions and practice implications This research elucidates and reinforces the importance of patient-centredness in physiotherapy, andsuggests tha 2010 Cha

Keywords: Pa

Introducti

Calls fopatients vition) haveover 40 yeview has vof patientResearch ohas expandcialties [8]over 1000faction [1of patienttive technic

CorresponE-mail ad

0031-9406/$doi:10.1016/jt patients may be the best judges of the affective, non-technical aspects of a given healthcare episode.rtered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

tient care; Patient centredness; Patient satisfaction; Good physiotherapy

on

r those involved in the health professions to seekewpoints regarding their care (or level of satisfac-been evident in various forms in the literature forars [14]. However, interpretation of a patientsaried significantly depending upon the model

satisfaction upon which studies are based [57].n patient satisfaction, as measured by self-report,ed significantly in virtually all healthcare spe-. In 1997, Sitzia and Wood reported a peak ofpublished articles using the term patient satis-]. For example, Nelson identified five domainssatisfaction that focused on access, administra-al management, clinical technical management,

ding author. Tel.: +64 34798436; fax: +64 34798414.dress: martin.kidd@otago.ac.nz (M.O. Kidd).

interpersonal management and continuity of care [9]. In phys-iotherapy, studies of patient satisfaction have been few and,until recently, were predominantly quantitative and question-naire based [1012].

Patient satisfaction with physiotherapy can be influ-enced by an interaction between therapist and patient thatmay involve more physical contact and active involvementof the patient than encounters with other health profes-sionals [11]. Therefore, it is suggested that physiotherapypatients perceptions require a different interpretation [10],as well as a different measurement tool from other healthprofessions [11]. Accordingly, in physiotherapy research,profession-specific satisfaction variables more applicableto physiotherapy settings have been used: time with thepatient; therapist behaviour; physical security; consistencyand logical progression; and the adaptation of the treat-ment programme to the patients problem based on inputfrom physiotherapy professionals [10,11]. In most of the

see front matter 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved..physio.2010.08.002usculoskeletal physiotherapy interMartin O. Kidd a,, Carol H. Bond

a School of Physiotherapy, University of Otago, POb Student Learning Centre, University of

c Department of Preventive and Social Medicine, U

o determine patients perspectives of components of patient-centrelitative study using semi-structured interviews to explore patients jdetermine common themes among the interviews and develop theosculoskeletal outpatient physiotherapy at a provincial city hospital.s Eight individuals who had recently received physiotherapy.dness as important inons: a qualitative studyelanie L. Bell c

, Dunedin, New ZealandNew Zealandof Otago, New Zealand

iotherapy and its essential elements.ents of patient-centred physiotherapy. Grounded theorytively from the data.

M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 155

physiotherapy satisfaction studies, satisfaction with specificencounters has been determined using researcher-derived,patient self-report instruments, which are framed in terms ofinstitutional or professional perspectives rather than those ofthe patient. Therefore, and despite possible intentions to thecontrary, satisfaction research has typically reflected some ofthe attitudes and values of an earlier biomedical model ratherthan a contemporary patient-centred perspective. In researchthat purports to seek patients views of what is important tothem in physiotherapy, such a position is incongruous.

Patient-centred care

In the patient-centred care model, the healthcare episodeis an equal partnership between clinician and patient [13].According to Stewart [14, p. 444], patient-centredness inmedicine may be most commonly understood for what it isnot: technology centred, doctor centred, hospital centred,disease centred (consultation model). Similarly, Cott [15,p. 89] suggests that there is no common definition of client-centred rehabilitation, stating that most available definitionsfocus on acute care from the perspectives of various healthprofessionals rather than the clients. The patient-centred caremodel locates the patient centrally in the professional rela-tionship, and supports the notion that an understanding ofthe patients perspective should underpin good practice in anequal therapeutic relationship (Fig. 1).

Implication

The aimpatient self

physiotherapists clinical performance in the musculoskeletalarea. The two-stage process began with generation of quali-tative data from patients about what is important to them inencounters with their physiotherapist. With an understandingof patients perspectives of the patient-centred care model, thedata could be used in the development and testing of an instru-ment to measure whether clinicians match those perspectives.This article reports on the first stage.

The few studies that have sought patients views aboutwhat they value in a therapeutic encounter are scattered acrossprofessions, disciplines and services, and use a range of meth-ods [2,1620]. A recurring theme that emerges from thesestudies is the value that patients place on clinicians com-munication with the patient (in terms of listening, explainingand instructing). However, is there more to patient-centredphysiotherapy than the ability to communicate? Rohrer et al.[21] suggest that self-rated health is more related to empow-erment than satisfaction with communication. Stewart arguedthat patient centredness is an important area of study, and isbest defined and assessed by the patients themselves [14].The researchers in this study want to inform clinicians aboutwhich patient values may be at the centre of clinical interac-tions in a patient-centred care context.

Method

n

udio-tgrounives o

Pat

ess

Fig. 1. Comp odel.s for research

of this research programme was to develop a-report instrument to be used in the assessment of

Desig

Awithspect

Traditional consultation model

CLINICIAN

Disease Hierarchical Biomedical Unidirectional

Illn

PATIENT (passive recipient)

arison of the patient-centred care model with the traditional consultation maped semi-structured interviews in conjunctionded theory were used to study patients per-f patient-centred physiotherapy. The interviews

ient-centred care model

CLINICIAN

Therapeutic alliance Biopsychosocial Two-directional

PATIENT (active partner)

156 M.O. Kidd et al. / Physiotherapy 97 (2011) 154162

Table 1Characteristics of the sample (n = 8).Study numbe

12

3

4

567

8a The indig

occurred ahome (n = 1were askedto determinceived asgeneral, wwas explormore?, Wdo you meexplore toptranscribedEthical appEthics Comparticipatio

Participant

A purpothe local hoprocess thaple (see Ttypically at

A muscbecause thtreatment tcontexts, bbecause theteria [24] (sufficient ppossibilitybiased viewNew Zeala[25]. The Agovernmeners most a10 typicallwhich leadmusculosk

Analysis

rounded theory is a useful qualitative method if littleown act a grch rele beiturednome

nt-cene ma

rding ton [28g frow the

rationview (ch treanin

ive anmana

Victo

odednd dicategrganidevel

on puxt, maprepa

views.spect

, axiales andificatikey py buiory]: theiotherar Occupation Age(years)

Gender Ethnicity

Tertiary student 20 Male AsianGovernmentadministrator

52 Female Caucasian

Night worker atwarehouse

61 Male Caucasian

Maintenanceengineer

56 Male Caucasian

Retired priest 65 Female CaucasianRetired 68 Male MaoriaMedical servicemanager

52 Female Caucasian

Home maker 40 Female Maori

enous people of New Zealand.

t the participants place of work (n = 2), at their) or at the researchers workplace (n = 5). Patientshow they judged the treatment they received

e which components of physiotherapy they per-important to them. The last question was: Inhat is good physiotherapy? Each main questioned using neutral probes such as Can you tell mehat are the most important aspects. . .? and Whatan by? to deepen participants responses andics further [22,23]. Interviews were recorded andverbatim and participants were given a number.roval was gained from the Lower South Regionalmittee. Informed consent was obtained prior ton in the research.

s

sive sample of eight patients was recruited fromspital physiotherapy outpatients department by at preserved physiotherapist anonymity. The sam-able 1) resembled the profile of patients whotended the department.uloskeletal outpatient population was selectedeir clinical events have comparatively short

Gis knprediresea

peopstruca phepatie

Thacco

uratiarisinno ne

geneinter

Eathe mparatDataLtd.,data.

Cson a

formand owere

ficaticontewere

intertant aNextegoriidentthetheorcateg1095physimeframes compared with other physiotherapyecause of ease of interview scheduling, andse patients were likely to meet the inclusion cri-Table 2). These criteria ensured a sample withhysiotherapy experience while minimising theof comorbidities and dependence resulting ins. The 10-session limit was rationalised through

nds Accident Compensation Corporation policyccident Compensation Corporation is a no-faultst-owned medical insurance scheme which cov-ccident-related rehabilitation, and stipulates thaty represents the maximum number of treatmentss to a satisfactory outcome for a patient receivingeletal physiotherapy care.

Results

Five catphysiotheracategory iscepts (dericross-categ(Fig. 3).

Ability to c

A primathe importabout a topic and few theories exist to explain orroups behaviour [26]. Grounded theory allowssults to be grounded in the social world of theng studied, while comprising a systematic andset of procedures to induce theory [27] aboutnon from the data (i.e. patients perspectives oftred physiotherapy).in study sample of eight patients was determinedo the grounded theory concept of theoretical sat-], which describes when conceptual explanationsm analysis of the data are well developed, andmes emerge from ongoing data collection. Datawas followed by data analysis for each individualFig. 2).anscript was read several times to sensitise togs ascribed to physiotherapy. A constant com-alysis [24] was used in data analysis (Table 2).gement software (NVivo, QSR, International Ptyria, Australia) was used to store and manage the

passages were subjected to continued compari-fferentiation. Similar concepts were clustered toories [24,29]. Categories were continually refinedsed as new data emerged. Criteria for each codeoped and noted as coding proceeded. For veri-rposes, summaries of each transcript includingin themes, impressions and exemplary quotationsred, and compared with memos written during theEach summary represented perceptions of impor-

s of physiotherapy for that particular participant.coding [30] was applied to concepts within cat-across categories. This final coding involved the

on and comparison of inter-relationships betweenroperties of each category and consequentiallding [31]. It was used to construct the core[24, p. 172] or central phenomenon [32, p.theory of patients perspectives of patient-centredpy.

egories of patients perspectives of patient-centredpy were generated from the data (Table 2). Eachdescribed in two parts: the contributing con-

ved from open coding), and within-category andory relationships (derived from axial coding)

ommunicate

ry finding, supported by previous literature, wasnce of the ability to communicate. Patients defined

M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 157

Table 2Patients views of the characteristics of a good physical therapist.

Characteristics of a goodphysical therapist

Subcategories Exemplary passages No. of passages No. of participantscontributing tonodes (n = 8)

Clear communication Good listening skills theyve got to have good listening skills 4 3Instructions aboutself-help/exercise

she was a really good explainer; shegave you alternatives

55 5

Reassurance about pain I hadnt realised that it was OK for it tobe painful

6 1

Confidence Knowledge/skills/expertise [they] know what theyre talking about;she was obviously spot-on;

15 7

Attitudes someone who knows what theyredoing

6 4

Ability to create confidence theyve got to come across asconfident; I just felt confidence in her

11 3

The nature of the professionalrelationship

Space for patient to suggesttreatment

I really felt that [it] was more to do withthe muscles on [my] spine

12 3

Patient leaves it to the physicaltherapist

theyve got the training, I havent; Ileft everything in the hands of the physio

13 4

An understanding of peopleand an ability to relate

Empathetic a certain amount of empathy; anunderstanding of the pain

5 3

Encouraging the way I was encouraged; they werevery encouraging

10 2

rson; friendl

A concern wioutcome

ure imp

ey re-mreal qu

this as a twand reassurand explainas compon

theyve go52-year-old

Furthermapists be ab

ont k

Fig. 2. ProcesAbility to relate to patients and befriendly

good people peeasy to talk to;her questions

th progress and Focus on progress you can see yo

Use of measurement each time . . . thQuick outcome my hand healed

o-way transfer of information that both informs we d

es the patient: good listening skills, paraphrasinging, and reassurance about pain were all evident

ents of that definition:

t to listen to what youre saying (Participant 2,female)ore, it was considered important that physiother-

le to interpret the lay speech of the patient:

. . . its here56-year-old

Patientsrelayed bac

she listeneto me in a m68-year-old

Interview 1 A

1

Interview 2

Interview 3

A

2

A

i

s of data generation.relaxed and . . .y . . . I could ask

27 4

roving 13 5

easured it 13 3ickly 6 2

now the terminology to use . . . weve just to say

and when I do this, this happens (Participant 4,male)appreciated the correct interpretation being

k to them in a way they understood:

d to what I had to say, then explained things backanner that . . . was easy to follow (Participant 6,male)

nalysis of Transcript

informs Interview 2

nalysis of Transcript

informs Interview 3

nalysis of Interview 3

nforms Interview 4 etc.

158 M.O. Kidd et al. / Physiotherapy 97 (2011) 154162

Good listening skills

Therapistsself-confidence

Reassuranespeciallyabout pain

Clear explanations and instructions

Input into the treatment plan and decisions about treatment

Putting the patient at

DERSTOPLE LE TO

Fig. 3. Patien presentdotted box is

Therefodirectly relance, and h

. . .tellingcant do . .thing (Par

It was imand that it

. . .the phypainful andthose passimade me rmaintained(Participan

Condence

Some pain explanatshould:

. . .know wabout whamale)

One par

lt ver

ce,

Attitude to patient and treatment

Using strategies to show change and improvement

KNOWLEDGE AND EXPERTISE

ABILITY TO COMMUNICATE

Createsunderstanding

UNPEAB

CONFIDENCE

Creates patients confidence in therapist and process

ts views of good physiotherapy: categories and inter-relationships. Boxes rean inferred concept.

re, the quality of the therapists explanations . . .fe

ated to the patients understanding and reassur-ow they managed their condition:

you . . . what was happening . . . what you can and. they just reassure you that youre doing the rightticipant 4, 56-year-old male)

portant to the patient to be reassured about pain,was alright to feel pain:

siotherapist said to me . . .do it to where it getsjust push it a bit but. . . the importance of doing

ve exercises was really stressed to me and it justealise how important it was to make sure that Imovement in that arm even though it was painful

t 5, 65-year-old female)

rticipants required a therapist who was confidentions and attitude. For example, physiotherapists

hat theyre talking about . . .[and be] confidentt theyre saying. . . (Participant 1, 20-year-old

ticipant:

knew what

and anothe

just workishe was dojust felt con

Across ctheir use ofself-confidpatient shoThe patiendependentconfidence

. . .I hadanything Iinspire concises if yomale)

Knowledge

Knowleelements oexpertise aease

Empathy, encouragement and friendliness

Therapist creates a relationship with patient

Encouragement knowledge of progress motivates engagement in clinical process

TRANSPARENT FOCUS ON PROGRESS AND OUTCOMES

ANDING AND RELATE

Understanding pain

core categories, bold lines represent in-category relationships;

y confident that there was somebody there that

she was doing (Participant 5, 65-year-old female)r stated that:

ng on the thing and not rushing it, explaining whating. . .what she was doing made sense to me . . . Ifident (Participant 4, 56-year-old male)ategories, the therapists ability to communicate,their knowledge and expertise (see below), their

ence, and their ability to create confidence in thew a complex interdependent category relationship.t needed to feel confident in the physiotherapist,on evidence of the physiotherapists own self-and abilities:

confidence in [her] because when I . . . askedgot good, clear answers. . . . Its the ability tofidence, because youre not going to do the exer-u dont believe it (Participant 4, 56-year-old

, expertise and professionalism

dge and expertise were considered to be essentialf good physiotherapy. One participant describeds:

M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 159

. . .she knew what she was doing. She knew those were theright exercises, . . . and how I should do them and what it wasfor . . . and I experienced the benefit of them. . .. The way Iwas treatedconfident t65-year-old

Knowleof a profetherapist in

They treathings thatthey . . . inlem is. . . g52-year-old

Patientsinvolve a ppatient to rinput into tFor exampanother tre

If I had aneck and bawould haveold male)these sentimtherapist w

theyve gohands of thin your sho

Understand

Patientsdemonstratagement, a

[what matstanding ofa real perso

and that the

able to rel6, 68-year-

Patientspatient at tthem feel u

they made56-year-old

they wereday, they mthey cared

Transparency of progress and outcome

Transparency of progress was important to the partici-, espeld comconfid

progve mo

ested mgave main (wouldfar I ces . . .

old mean im

sitivents, th

hand huicker-year-

t a realicipan

sitiveoveme

will hYou] w-year-

madeakin

profeicipan

therapeek anack 3me wheassur

ar-old

ry ofiother

e connts pe

ndersnd thartant iracticse whto get, the way I was encouraged. The expertise. I felthat the best thing was happening (Participant 5,

female)dge and expertise were linked with patients viewsssional relationship, and how, for example, thetroduced herself:

ted you very well. . .. There are a whole lot ofgo [with professionalism]. Like just in the waytroduce themselves . . . ask you what the prob-o through what youve done. . . (Participant 7,female)

perspectives of patient-centred physiotherapyrofessional relationship that allowed space for theecognise the therapists knowledge, and to havehe treatment plan and decisions about treatment.le, although one participant may have thoughtatment option would help him:

[therapist who] . . . manipulated or massaged meck and shoulder muscles more vigorously . . . thatfixed it quicker or better (Participant 6, 68-year-

ents were not usually communicated because theas perceived as having the training:

t the training, I havent . . . I left everything in thee physio because I dont know what . . . goes onulder (Participant 3, 61-year-old male)

ing people and an ability to relate

considered it important that the physiotherapiste empathy (especially in relation to pain), encour-nd the ability to relate to people and be friendly:

ters is] a certain amount of empathy, an under-the pain, and a feeling that I matter and that Imn (Participant 5, 65-year-old female)physiotherapist should be:

ate to patients . . . to put them at ease (Participantold male)insisted that the physiotherapist should locate the

he centre of the therapeutic encounter, and makenderstood and respected:

you feel as though youre OK (Participant 4,male)

both very friendly. . . .youre number one for theade you feel important . . . like a real person that

about (Participant 2, 52-year-old female)

pantsshouthen

I hadpassiShe tthenthat p

Shehowdegrejust tsuch

Popatie

My. . . q1, 20

I go(Part

Poimpr

. . .iting. [1, 20

theywas m

by a(Partthe [by w. . . btoldand r56-ye

Theophys

Thpatie

An uter aimpointo pbecauthingcially by way of measurement. A physiotherapistmunicate progress with the patient, who could

ently comply with the programme. For example:

ressed to a stage where I could actually go off thevement and get more involved in active lifting . . .

y arm to see at what point it was most painful ande exercises that seemed to relate to . . . improving

Participant 7, 52-year-old female)tell me the progress that I was making. Like . . .

ould bend my finger . . . one week Id bend it 20but the week after Id bend it 40 degrees. . . . She. . . how well I was going and shed say oh thats

provement (Participant 1, 20-year-old male)outcomes were also emphasised. For some

e progress was much quicker than they anticipated:

ealed much quicker than expected by the doctorthan she thought it was going to be (Participant

old male)ly quick outcome here and I was really surprisedt 2, 52-year-old female)

outcomes were desirable, especially whennt was communicated and measurable:

elp the patient if he . . . knows that he . . . is improv-ork better or try harder to get better (Participant

old male)me feel as if I was doing really well. . . that I

g progress . . . it was good to have that reinforcedssional . . . it encourages you to keep doing itt 7, 52-year-old female)ist] . . . was interested in my improvement weekd even went back through the records to say look

or 4 weeks ago you were only getting this . . .theyat it was last time and what the difference wased me that yes it is getting better (Participant 4,male)

patients perspectives of patient-centredapy

cept of what is important to a patient from therspective is encapsulated by the following:

tanding of the pain, . . . and a feeling that I mat-t Im a real person. . . .And then probably mosts the . . .the knowledge that she shares and put[s]e and then the encouragement to do the exercises,at she does is only part of it. You know, theres thatyou doing the rest. . . . and . . . part of that encour-

160 M.O. Kidd et al. / Physiotherapy 97 (2011) 154162

agement is actually the ability . . . [to] answer questions and. . . I think its. . .about taking the person seriously. . . .it wasrespecting the questions and being prepared to answer themand . . . that gives you, that confidence. . . .its ability to inspireconfidence (Participant 5, 65-year-old female)

The therapists self-confidence and knowledge affect thepatients confidence in both the therapist and the therapy, andthese concepts are linked to good communication, reassur-ance and progress. The cross-concept relationship resemblesa transformative spiral of increasing confidence, motivationand progress.

Discussion

The five categories, supporting concepts and theory pro-vide a picture of patients perspectives of patient-centredphysiotherapy (Fig. 3). The findings complement other recentresearch on patient satisfaction and patient-centred care,especially about the importance of communication [4,19,33].The categories and resulting theory are generated from datathat derive directly from patients experiences, and findingsfocus solely on aspects of care that are important to the patient(the focus oever, the travation andby the biopand provid(Figs. 1 ancation undeno single dwithout its

Patientscurrent stu

domain. Although previous literature does not mention con-fidence per se as a component of patient-centred care, tosome patients, confidence in the physiotherapist was depen-dent on good communication, which is recognised [1719]as a component of the patient-centred care model. Many ofthe concepts strongly reflected Mead and Bowers dimen-sions of patient-centredness including a professional view ofthe patient-as-person [34, p. 1088]; the sharing of powerand responsibility in the care relationship; and a therapeuticalliance in which the goals and requirements of treatment areclearly understood [4,34,35]. In the current study, most par-ticipants emphasised this professional relationship betweentherapist and patient. The passing of decision making to thetherapist because of a perceived view of professional knowl-edge by some patients was balanced by views of others whowere encouraged to have input into treatment decisions. Stew-art et al. called this relationship the common ground [36,p. 444]; the space in which, rather than abdicating control tothe patient, clinicians use their understanding to respond tothe unique needs of the patient. Stewart reported that patientswho perceived the patient/physician relationship in terms ofcommon ground received fewer diagnostic tests and refer-rals in the subsequent 2 months than patients who perceivedotherwise [14].

thisng tohrasining. Hof clea, inforts of

ed ant carolated

abou

Fig. 4. Goodf the interview questions). Most importantly, how-nsformative spiral of increasing confidence, moti-

progress extends the two-way relationship impliedsychosocial model of patient-centred care [34],

es more depth to the communicative relationshipd 4). The implication is that although communi-rpins patient-centred care in physiotherapy [19],imension of patient-centred physiotherapy existsreliance on the other dimensions. views of patient-centred physiotherapy in thedy were situated almost entirely in the affective

Inrelatiparapstandroletionsaspecformpatieof isideas

physiotherapy: a transformative inter-relationship.study, most participants emphasised conceptsthe ability to communicate, such as listening,g, explaining, reassuring and ensuring under-owever, patients additionally focused on the

r and transparent communication about instruc-mation and progress when talking about othercare. Therefore, in this study, the categories

composite picture of interdependent aspects ofe. Just as Little et al. [17] found scant evidencedomains of patient care, in this study, patientst ideal treatment were part of a spectrum of

M.O. Kidd et al. / Physiotherapy 97 (2011) 154162 161

care that generally related to mutual discussion and partner-ship.

Two categories the ability to communicate, and trans-parency ofrecent reseever, few pconstruct tThis variatstudy, partwhich in thexpectation

you cometreated like

The releapy can beperspectivecare modeliotherapiststheory metleagues whtherapists wto care. Infrom the intherapist knstyle of pradefining sucollectiveonly focusviews.

Qualitatof the procechoice of mquestion. Gperspectiveapy. This sphysiotheratives ratherresponse tothemselvesmethod thacific particviews of aysis ensureand interprbeyond theate, and isthis study pods used bthrough the

Practice im

Reportinpatients pe

Cooper et al. [19] suggested that further research was requiredto confirm their findings with different patient groups. Thecurrent study extended the scope of participants to general

uloskomponell toe clinction

c relatdencerstandcy ofian thatientis stuof carnses os clinit whate theont ofted el

owled

e autd Baxtdin, Nal appcs refeing: Hof Predin, Nict of

rence

itzia J,oc Sci Marr JK,K. Usprove

damsof patienixed mheppardthe em

vailablinder-P982;16:itzpatri54175ohanssoare in t002;16:progress and outcome aligned with outcomes ofarch on patient satisfaction [4,8,11,18,35]. How-atients in this study referred to expectations; a

hat features in some satisfaction literature [4,7].ion may be due to the fact that, in the currenticipants were attending a public hospital clinic,e New Zealand context may have created differents compared with fee-paying patients:

here and youre not even paying but you are reallya real person (Participant 2, 52-year-old female)

vance of this study to the profession of physiother-considered with the question: How do patientss of important components of the patient-centredin physiotherapy match the components that phys-

consider to be important? Using a groundedhodology, Resnik and Jensen [32] found that col-o considered themselves or others to be goodere distinguished by a patient-centred approach

particular, the patient-centred approach resultedterplay of clinical reasoning, values, virtues andowledge, and permeates and guides the cliniciansctice [32, p. 1095]. However, by operationallych distinguishing characteristics on the basis of

patient outcomes, Resnik and Jensens researched on professionals views rather than patients

ive research methodologies rely on the credibilityss and product. The rigour of this study lies in theethodology that is congruent with the researchrounded theory was used to establish patientss of patient-centred musculoskeletal physiother-tudy argues that patient satisfaction measures ofpy should be developed from patients perspec-than those of physiotherapists, and is in part aStewart et al.s challenge [36] to ask patients

to define patient-centred care. This study used at generated rich and descriptive data from a spe-ipant group sampled to saturation. Although thesmall group are just that, robust audit and anal-d that the results can be viewed with confidenceeted credibly. The generalisability of the resultsmusculoskeletal field of practice is not appropri-

an area warranting further research. In particular,oints to the need for more research on the meth-y clinicians to bring about favourable outcomestherapeutic relationship.

plications

g their study on patient-centredness from therspective in chronic low back pain populations,

musc

ing cdo wof thinterapeuticonfiundeparenclinicthe p

Thtivesrespoin thiabou

Thopmerepor

Ackn

ThDaviDune

Ethic(EthiFundmentDune

Con

Refe

[1] SS

[2] BMim

[3] Ao

m

[4] SinA

[5] L1

[6] F1

[7] Jc

2eletal conditions, and suggests that, in consider-ents of clinical expertise, physiotherapists would

consider the value that patients place on aspectsical interaction. In particular, clinician/patient

s that place the patient at the centre of the thera-ionship are based on: the ability to communicate;; knowledge, expertise and professionalism; aning of people and an ability to relate; and trans-progress and outcome. According to this study, aat fulfils a combination of these dimensions placesat the centre of the healthcare experience.dy is among the first to explore patients perspec-e in a musculoskeletal physiotherapy setting. Thef the patients support patient-centred care, at leastcal setting, and send a clear message to clinicianspatients prefer in a clinical partnership.ry generated in this study was tested in the devel-

a patient perception questionnaire which is to besewhere.

gements

hors wish to thank Dr Leigh Hale and Professorer, School of Physiotherapy, University of Otago,ew Zealand.roval: Lower South Regional Ethics Committeerence number OTA/04/02/CPD).igher Education Development Unit, and Depart-ventive and Social Medicine, University of Otago,ew Zealand.interest: None declared.

s

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t.com

Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative studyIntroductionPatient-centred careImplications for research

MethodDesignParticipantsAnalysis

ResultsAbility to communicateConfidenceKnowledge, expertise and professionalismUnderstanding people and an ability to relateTransparency of progress and outcome

Theory of patients' perspectives of patient-centred physiotherapyDiscussionPractice implicationsAcknowledgementsReferences