Persistent Pain: Physiotherapy Student Experiences of Person-Centred Care in Musculoskeletal Outpatient Departments
Person-centred care is championed throughout healthcare and emphasised in the management of persistent pain. Research reports that physiotherapists and physiotherapy students have struggled to integrate person-centred care into their practice and clinical work with people experiencing persistent pain. The aim of the study was to explore physiotherapy students’ experiences of person-centred care with people with persistent pain in a musculoskeletal outpatients’ placement setting, and to understand what affects physiotherapy students’ ability to implement person-centred practice. An interpretive qualitative method was used with data being collected by semi-structured focus groups of a purposive sample of undergraduate final-year physiotherapy students. A thematic approach to data analysis was completed using a cyclical immersive process. Three themes emerged: understanding of person-centred care, learning, and influences on clinical practice. The students showed an understanding of person-centred care in line with current literature. Person-centred care was generally deemed ‘well taught’ at university however this did not translate into their practice in a placement setting. Several factors influenced their ability to implement person-centred care, and this impacted upon their learning and their management of people presenting with persistent pain. In conclusion, physiotherapy students struggled to integrate learning of person-centred care from university into their practice on a musculoskeletal outpatient’s placement. It is recommended that physiotherapy course teams consider their curricula so that university and placement teaching facilitate person-centred learning and improve the management of persistent pain.
Barbour, R. (2007) Doing focus groups. London: Sage https://doi.org/10.4135/9781849208956
Barbour, R. (2014). Introducing qualitative research: a student’s guide. 2nd edn. London: Sage
Bevan Commission (2015) A Prudent Approach To Health: Prudent Health Principles. [online]. available from http://www.bevancommission.org/prudent-healthcare [6 November 2017]
Braun, V., and Clarke, V. (2006) ‘Using thematic analysis in psychology’. Qualitative Research in Psychology, 3 (2), 77–101 https://doi.org/10.1191/1478088706qp063oa
Briggs, E.V., Carrl, E.C.J., and Whittakerl, M.S. (2011) ‘Survey of undergraduate pain curricula in healthcare professionals in the United Kingdom’. European Journal of Pain, 15, 789–795. https://doi.org/10.1016/j.ejpain.2011.01.006
Chartered Society of Physiotherapy. (2017a) Code of Members' Professional Values and Behaviour’. [online]. available from <http://www.csp.org.uk/publications/code-members-professional-values-behaviour> [30 October 2017]
Chartered Society of Physiotherapy (2017b) Quality Assurance Standards for Physiotherapy Service Delivery. [online]. available from <http://www.csp.org.uk/publications/quality-assurance-standards> [30 October 2017]
Colleary, G., O’Sullivan, K., Griffin, D., .Ryan, C.G., and Martin, D.J. (2017). ‘Effect of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: A randomised controlled trial’. Physiotherapy. [preprint] http://dx.doi.org/10.1016/j.physio.2017.01.006
Collins, A. (2014) Measuring What Really Matters: Towards a Coherent Measurement System to Support Person-Centred Care. Health Foundation, Thought Paper. [online]. available from <http://www.health.org.uk/sites/health/files/MeasuringWhatReallyMatters.pdf> [15 March 2017]
Cooper, K., Smith, B.H., and Hancock, E. (2009) ‘Patients’ perceptions of self-management of chronic low back pain: Evidence for enhancing patient education and support’. Physiotherapy, 95 (1) 43–50. https://doi.org/10.1016/j.physio.2008.08.005
Cruz, E.B., Caeiro, C., and Pereira, C. (2014) ‘A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: A qualitative study of final year students’. Physiotherapy Theory and Practice, 30 (4), 254–260. http://dx.doi.org/10.3109/09593985.2013.863415
de Silva, D. (2011) ‘Helping People Help Themselves: A Review of the Evidence Considering Whether it is Worthwhile to Support Self-Management’. Health Foundation Evidence Report. [online]. available from <http://www.health.org.uk/publication/evidence-helping-people-help-themselves> [15 March 2017]
Department of Health (2000) The NHS Plan: A plan for Investment, A Plan for Reform. [online]. available from <http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_118522.pdf> [15 March 2017 ]
Donaldson, L. (2009). 150 Years of the Annual Report of the Chief Medical Officer (2008). [online]. available from <http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_096231.pdf> [15 March 2017]
Etherton, J. and Waterfield, J. (2015) ‘Preparing to manage patients in pain. The student perspective: A pilot’. Pain and Rehabilitation - the Journal of Physiotherapy Pain Association, 38, 27–33
Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office [online]. available from <http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/report> [19 March 2017]
Hunt, A., Adamson, B., and Harris, L. (1998) ‘Physiotherapists' perceptions of the gap between education and practice’. Physiotherapy Theory and Practice, 14 (3), 125–138 http://dx.doi.org/10.3109/09593989809057157
Hunt, A., Adamson, B., Higgs, J. and Harris, L. (1998) ‘University education and the physiotherapy professional’. Physiotherapy 84 (6), 264–273 https://doi.org/10.1016/S0031-9406(05)65527-7
Hunter, J.P. and Simmonds, M.J. (2010) ‘Pain: Putting the whole person at the centre’. Physiotherapy Canada, 62 (1). 1–4. https://doi.org/10.3138/physio.62.1.1
International Association for the Study of Pain (2017) ‘IASP Curriculum Outline on Pain for Physical Therapy’. [online]. available from <http://www.iasp-pain.org/Education/CurriculumDetail.aspx?ItemNumber=2055> [15 March 2017]
Jones, L. (2009) ‘Implications of IASP core curriculum for pre-registration physiotherapy education’. British Journal of Pain, 3 (1), 11–15 https://doi.org/10.1177/204946370900300104
Jones, L. and Hush, J.M. (2011) ‘Pain education for physiotherapists: Is it time for curriculum reform?’ Journal of Physiotherapy [online]. 57 (4), 207–208. available from <http://www.journalofphysiotherapy.com/article/S1836-9553(11)70049-2/abstract> [2 July 2017]
Lindquist, I., Engardt, M., Garnham, L., Poland, F., and Richardson, B. (2006) ‘Physiotherapy students’ professional identity on the edge of working life’. Medical Teacher, 28 (3), 270–276. http://dx.doi.org/10.1080/01421590600605272
Litosseliti, L. (2003) Using Focus Groups in Research. London: Continuum.
Mead, N. and Bower, P. (2000) ‘Patient-centeredness: A conceptual framework and review of the empirical literature’. Social Science & Medicine, 51 (7), 1087–1110 https://doi.org/10.1016/S0277-9536(00)00098-8
Melzack, R. (1999) ‘From the gate to the neuromatrix’. Pain [online]. 82 (supplement 1), S121-S126. available from <http://www.sciencedirect.com/science/article/pii/S0304395999001451> [2 July 2017]
Moseley, G.L. (2003) ‘A pain neuromatrix approach to patients with chronic pain’. Manual Therapy, 8 (3), 130–140 https://doi.org/10.1016/S1356-689X(03)00051-1
Moseley, G.L. (2007) ‘Reconceptualising pain according to modern pain science’ Physical Therapy Reviews, 12, 169–178. http://dx.doi.org/10.1179/108331907X223010
Mudge, S., Stretton, C., and Kayes, N. (2014) ‘Are physiotherapists comfortable with person-centred practice? An autoethnographic insight’. Disability and Rehabilitation, 36 (6), 457–463. http://dx.doi.org/10.3109/09638288.2013.797515
National Institute for Health and Care Excellence (NICE) (2012) ‘Patient Experience in Adult NHS Services’. [online]. available from <https://www.nice.org.uk/guidance/qs15> [15 March 2017]
Neuman, W.L. (2011) Social Research Methods: Qualitative and Quantitative Approaches. 7th edn. London: Pearson.
O’Sullivan, P. (2012) ‘It’s time for change with the management of non-specific chronic low back pain’. British Journal of Sports Medicine, 46, 224–227. http://dx.doi.org/10.1136/bjsm.2010.081638
Pelzang, R. (2010) ‘Time to learn: Understanding patient-centred care’. British Journal of Nursing, 19 (14), 912–917. https://doi.org/10.12968/bjon.2010.19.14.49050
Petty, N.J. (2009) ‘Towards clinical expertise: learning transitions of neuromusculoskeletal physiotherapists’. [online]. Doctoral thesis. University of Brighton. available from<http://eprints.brighton.ac.uk/14076/> [19 March 2017]
Petty, N.J., Scholes, J., and Ellis, L. (2011) ‘Master’s level study: Learning transitions towards clinical expertise in physiotherapy’. Physiotherapy, 97 (3), 218–225. https://doi.org/10.1016/j.physio.2010.11.002
Physiotherapy Pain Association (2014) ‘Physiotherapy framework – Entry level graduate to Expert: Describing the Values, Behaviours, Knowledge and Skills of Physiotherapists Working with People in Pain’. [online]. available from <http://ppa.csp.org.uk/documents/ppa-physiotherapy-framework-entry-level-graduate-expert-describing-values-behaviours> [15 March 2017]
Roskell, C., Hewison, A., and Wildman, S. (1998) ‘The theory-practice gap and physiotherapy in the UK: Insights from the nursing experience’. Physiotherapy Theory and Practice, 14 (4), 223–233. http://dx.doi.org/10.3109/09593989809057168
Roskell, C., White, D. and Bonner, C. (2013) ‘Developing patient-centred care in health professionals: reflections on introducing service-learning into the curriculum’. International Journal of Therapy and Rehabilitation, 19 (8), 448–456. https://doi.org/10.12968/ijtr.2012.19.8.448
Ross, E.F. and Haidet, P. (2011) ‘Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care’. Patient Education and Counseling, 85 (30), 529–532. https://doi.org/10.1016/j.pec.2011.01.034
Sanders, T., Foster, N.E., Bishop, A., and Ong, B.N. (2013) ‘Biopsychosocial care and the physiotherapy encounter: Physiotherapists’ accounts of back pain consultations’. BMC Musculoskeletal Disorders, 14 (65). https://doi.org/10.1186/1471-2474-14-65
Schmitt, J., Akroyd, K., and Akroyd, L. (2012) ‘Perceptions of physiotherapy students of a person-centred approach in rehabilitation’. International Journal of Therapy and Rehabilitation 19 (1), 23–30. https://doi.org/10.12968/IJTR.2012.19.1.23
Synnott, A., O’Keeffe, M., Bunzli, S., Dankaerts, W., O'Sullivan, P., & O'Sullivan, K. (2015) ‘Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: A systematic review’. Journal of Physiotherapy, 61 (2), 68–76. https://doi.org/10.1016/j.jphys.2015.02.016
Watt-Watson, J., McGillion, M., Hunter, J., Choiniere, M., Clark, A.J., Dewar, A., . . . Webber, K. (2009) ‘A survey of prelicensure pain curricula in health science faculties in Canadian universities’. Pain Research and Management, 14, 439–444 https://doi.org/10.1155/2009/307932
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