Perceptions Of Physiotherapists Research Articles

Perceptions of Patients and Physiotherapists on Patient Participation: A Narrative Synthesis of Qualitative Studies

Patient participation is nowadays considered important for high quality patient care. Although the literature on health care professions provides some insights into this topic, specific aspects in the field of physiotherapy are less known. The objective of this review was to investigate how patients and physiotherapists perceive patient participation, especially in regards to what it means for them and the role patients play during physiotherapy treatment sessions. We used a narrative synthesis of qualitative studies. We conducted a systematic search in six databases using a set of key words, extracted relevant data, performed quality assessment and synthesized findings from the selected studies. Out of 160 studies, 11 were retained. Two main themes emerged: the conceptualization of patient participation and the patients' role preferences. Patient participation included various activities including goal setting, information exchange, decision-making and exercise training and often influenced the power relation between patient and physiotherapist. Patients' willingness to participate varied, and they often did not play their desired role. Patients and physiotherapists perceived participation to be valuable yet challenging. Problems of conceptualization, power inequalities, lack of health professionals' skills and lack of the right attitude to share power and responsibility from both sides were some of the barriers that impeded optimal participation.

The Enhanced Primary Care program and falls prevention: Perceptions of private occupational therapists and physiotherapists

To investigate the processes involved for private occupational therapists (OTs) and physiotherapists (PTs) to implement Medicare items from the Enhanced Primary Care (EPC) program within their practice, for the purpose of falls prevention interventions for older people. Qualitative study using a grounded theory approach employing semistructured interviews with five private occupational therapists and five private physiotherapists from across the Sydney area and the Hunter region. The following key themes emerged in relation to the potential for the EPC to be used to access falls prevention: (i) interdisciplinary communication and communication with consumers; (ii) best practice in community-based falls prevention using the EPC program; and (iii) administrative and organisational challenges of the EPC program. Participants supported the EPC program, and saw its potential for delivering falls prevention interventions in the community. However, findings suggest that the EPC program needs to be further refined to be more effective.

Community ambulation: Perceptions of rehabilitation physiotherapists in rural and regional communities

Research has highlighted the impact of the external environment on the ability to walk in the community but little research exists about the abilities, skills, or contextual factors that physiotherapists identify as important to enable a client to return to walking in their rural or regional community. This article investigates the abilities, skills, and contextual factors that rehabilitation physiotherapists practicing in rural and regional communities in Australia perceive significant in enabling clients post stroke to return to walking in their rural or regional community. Physiotherapists involved in treating clients with stroke were interviewed about their perceptions of the skills and abilities required by clients post stroke with a mobility problem that are significant in enabling a return to walking in the community. Data were interpreted by using a grounded theory methodology that involved coding and analysing observational notes and interview transcripts to develop an understanding of the emergent themes. Six key themes were identified: 1) ability to walk at speed and physical fitness, 2) the ability to negotiate different terrains, 3) ambient conditions, 4) the ability to reason and monitor the environment, 5) to have support of a person or aid, and 6) to have the drive (internal and external) to walk in the community. Some of these abilities are described in the current literature, but others are not. The findings of this research will add to the existing body of knowledge on physiotherapist's decision making around the emerging topic of community ambulation.

Potential roles of the pharmacist in chronic pain management: a multidisciplinary perspective in primary care

Abstract Patients in the community with chronic pain may have poor pain control and use both prescribed and alternative therapies, often inappropriately, to try to optimise pain relief. They may benefit from management by a multidisciplinary primary care team involving a pharmacist. This study used postal questionnaires to determine community pharmacists' attitudes to involvement in pain management and the perceptions of general practitioners and physiotherapists of the current and potential roles of the pharmacist within a chronic pain care team. The three professions' views on factors which could influence chronic pain management were also determined. Sixty-three GPs (63 per cent), 59 community pharmacists (59 per cent) and 33 physiotherapists (66 per cent) responded. None of the pharmacists was currently involved in chronic pain management, but 58 (98 per cent) wanted to develop such a role, especially within pain clinics. Pharmacists and physiotherapists were more likely than GPs to identify that limited opportunity for personal involvement and expertise within a pain team reduced the likelihood of achieving optimal chronic pain management. Only 17 of the GPs had an established multidisciplinary pain care team; two of these had pharmacist involvement. All GPs and physiotherapists agreed that pharmacists had an important role to play in chronic pain management, particularly in the provision of drug information to patients and medication review.

Physical Therapistsʼ Perceptions of Physical Therapy in the Emergency Department

Purpose: The purpose of this study was to report the perceptions of physical therapists (PTs) associated with acute care toward practice in the emergency department (ED). A secondary purpose was to generate hypotheses about the relationships between these perceptions and factors such as education and level of training. Methods: PTs involved in acute care were provided an electronic survey regarding demographic information, knowledge of practice in the ED, and opinions on advanced skills such as imaging, lab tests and pharmacology. Univariate logistic regression analyses were performed using a dichotomized version of three questions pertaining to value, confidence and feasibility of PT in the ED. Results: 120 subjects completed the survey. A majority believed that PTs were a valuable asset to the ED (92%) and integrating PTs into the ED is feasible (67.5%). Eighty-four percent were confident in managing patients in the ED. Significant correlations (p<0.01) existed between these perceptions and the therapists' level of education, clinical experience, continuing review of literature and training in the areas of differential diagnosis, diagnostic imaging, lab values and non-steroidal anti-inflammatory drugs (NSAIDs). Conclusion: Positive perceptions exist among PTs regarding practice in the ED. Factors related to these perceptions are stated in the results.

Physical Therapists’ Perceptions of Providing Services to Adults With Childhood-Onset Neuromotor Disabilities

ABSTRACTAdults with childhood-onset neuromotor disabilities face problems accessing health care services. There are often challenges finding primary care providers or specialized providers, such as physical therapists, who are knowledgeable about neuromotor disabilities. The purpose of this study was to determine the perceptions of physical therapists regarding (a) barriers to providing therapy to adults with childhood-onset neuromotor disabilities and (b) resources that would be beneficial for improving and/or providing these services. An online questionnaire was sent to 1,250 therapists licensed in Oregon and Southwest Washington. One hundred fifty-two physical therapists responded resulting in a 12% response rate. The top three barriers to providing therapy were extra time for complex patients, lack of insurance coverage, and lack of experience. The three most frequently cited resource needs included information on equipment, continuing education, and written educational materials. These findings suggest that physical therapists may benefit from further education in working with adults with childhood-onset neuromotor disabilities.

The Utility of a Video Game System in Rehabilitation of Burn and Nonburn Patients: A Survey Among Occupational Therapy and Physiotherapy Practitioners

The objective of this study was to investigate perceptions of occupational therapists and physiotherapists on the use of Nintendo Wii™ (Nintendo of America Inc., Redmond, WA) in rehabilitation. Occupational therapists and physiotherapists in a rehabilitation hospital trialed four Wii games that addressed physical movement, balance, coordination, and cognitive performance. Then, they completed an opinion survey on the utility of Wii in rehabilitation. The results were compared between burn care therapists (BTs) and nonburn care therapists, using chi(2) with a P < .05 considered significant. The participation rate was 79% (63/80), and they agreed that Wii was easy to set up (71%), operate (68%), and safe to use (76%). Participants agreed that Wii would be beneficial in outpatient (76%) and inpatient (65%) settings and that it could improve treatment compliance (73%). Participants recommended 15 to 30-minute Wii intervention (59%) daily (81%) and twice per week (43%). Participants believed that neurologic (71%), trauma (68%), burn (59%), and musculoskeletal (49%) patients would benefit from Wii intervention but not cardiac (43%) or organ transplant patients (18%). Participants believed that outcomes using Wii could be measured reliably (49%), and skills learned while playing could be transferable to daily function (60%). The significant differences between BTs and nonburn care therapists' perceptions are that BT-treated younger patients (21-40 years vs >60 years, P < .05) and BT favored the therapeutic benefit of Wii in rehabilitation (93% vs 58%, P = .02), specifically in burn rehabilitation (85% vs 39%, P = .001). Occupational therapists and physiotherapists favored the use of Wii in rehabilitation as an adjunct to traditional therapy because it is therapeutic, engaging, and may increase patient participation in rehabilitation.

Physical Therapistsʼ Perception of Spirituality and Patient Care: Beliefs, Practices, and Perceived Barriers

Background and Purpose. Numerous studies have demonstrated a positive correlation between spirituality and treatment outcomes. Studies have shown that patients consider their spiritual health and physical health equally important and desire to have their physicians inquire about their spiritual needs. There is little information on what the role of the physical therapist is concerning the spiritual health of the patient. Therefore, the purpose of this study was to examine the perceptions of physical therapists (PTs) regarding the role of spirituality in patient care, their beliefs and practices, and perceived barriers to discussion of spiritual issues with patients. Subjects. The CCCEs, directors, or any PT clinician working at the selected clinics were eligible to fill out the survey. Methods. A non-random purposive sampling method was used in selecting clinics across the United States that participated in the clinical education program of the Andrews University Physical Therapy Department and clinics advertised in the American Physical Therapy Association's (APTA) Physical Therapy Journal. A total of 250 clinics were selected and surveys were sent out addressed to either the CCCE or director of the selected clinics. Of the 250 questionnaires that were sent out, 136 (56%) were received. Results. A large majority (96%) of PTs felt that spiritual well-being is an important component of health; however, only 30% believed that spiritual concerns should be addressed by the PT. The most frequently identified barriers to discussion of spirituality with patients were lack of experience taking a spiritual history, uncertainty about how to manage spiritual issues, and lack of time. Discussion and Conclusion. This study found that PTs are aware of the impact of spirituality on patient health but are not certain that spirituality issues with their patients should be addressed by them. A major barrier to the discussion of spirituality with patients is a lack of education in taking a spiritual history and how to manage spiritual issues. Clarification of a physical therapist's role in caring for the spiritual needs of a patient and providing training in the performance of a spiritual assessment may help deal with the uncertainty of addressing spiritual issues and how to manage them.

The perceptions of Athenian physiotherapists on the referral service in Greece and its impact on professional autonomy

The attainment of professional autonomy is considered a priority of any profession. The development of autonomy in physiotherapy has differed among countries, with some achieving a high degree of autonomy while others have struggled. The current literature reveals little about the autonomy of physiotherapists in Greece, although it would appear they face both external and internal threats to autonomous practice and to the development of their profession. This exploratory study investigated Athenian physiotherapists' experiences of the referral system in Greece and its impact on professional autonomy. A qualitative, phenomenological approach was chosen, using a cluster sampling method. Ten physiotherapists participated in a 30-minute, one-to-one, semi-structured interview. The interview audio tapes were transcribed and an inductive analysis was carried out. When all transcripts had been coded, categories and themes were compared to record commonalities and differences to construct a hierarchy of essential themes expressing general views. Physiotherapists were frustrated by the physiotherapy referral system in Greece. They revealed that their practice was restricted by factors, which included a long-standing dominance by the medical profession, bureaucratic process and the public perception of the profession in addition to restrictions from within the profession itself. To overcome the perceived restrictions to practice and the development of autonomy, participants had adopted strategies in an attempt to effectively address the patients' needs. There are clear issues related to the management and delivery of the physiotherapy referral system in Greece which impact on professional autonomy. Physiotherapists are forced to manipulate the referral system to provide a more appropriate level of care, resulting, however, in an inequitable service across the physiotherapy provision. If professional autonomy of physiotherapists in Greece is to move forward, these issues need to be acknowledged by governmental and professional bodies, as therapists can not be expected to undertake this journey alone.

Preparedness of new graduate Australian physiotherapists in the use of electrophysical agents

Objective To determine the perceptions of physiotherapists concerning the preparedness of new graduates to use electrophysical agents (EPAs) in clinical practice. Design An observational cross-sectional questionnaire was developed and demonstrated to be reliable and valid. Participants The questionnaire was mailed to all registered physiotherapists in Australia in 2005 ( n = 12,893). Results In total, 3538 questionnaires were returned complete. Two forms of non-responder analysis indicated that the sample and their associated responses were representative of the Australian physiotherapy population. Eight out of 10 new graduates felt prepared to use EPAs that are common in Australian clinical practice. However, 80% felt underprepared to use a range of other EPAs. Similar trends were found when new graduate preparedness was examined from the perspective of physiotherapists who were working with or mentoring new graduates. However, experienced physiotherapists rated preparedness lower than the new graduates themselves ( χ 2 = 525.7, P < 0.01). Conclusions These findings raise questions about the adequacy of entry-level education and the level of competence expected of new graduates for the safe and effective application of a range of EPAs upon entry to the workforce. The findings indicate the need for clearer guidelines on the levels of competency expected of new graduate physiotherapists in Australia.

Physiotherapists’ perceptions of sport psychology intervention in professional soccer

This study investigated the attitudes and perceptions of physiotherapists working in professional soccer toward sport psychology intervention in injury rehabilitation. The Physiotherapist and Sport Psychology Questionnaire (Hemmings & Povey, 2002) was distributed to all professional soccer clubs in England and Wales. Thirty‐nine of the questionnaires were returned fully completed. In addition to this, 10 of the 39 respondents participated in semi‐structured interviews designed to further examine attitudes and perceptions in this area. It was found that the physiotherapists believed that negative psychological reactions to sports injury were fairly commonplace, with stress/anxiety being the most commonly cited reaction. Fifty‐one percent of the physiotherapists reported having referred an athlete to a sport psychologist. The stigma associated with consulting a psychologist was found to be a barrier to referral. It was suggested that more education as to the role of sport psychology in injury rehabilitation is required, along with the development of a sport psychology referral network

Entry-level physiotherapists' strategies to lower occupational injury risk in physiotherapy: A qualitative study

The purpose of this study was to identify entry-level physiotherapists perceptions of workplace injuries in private practice and the strategies they may use to reduce occupational injury risk in physiotherapy. Seventy-nine final year physiotherapy students were presented with a private practice workplace scenario, recent injury statistics, and common job risk factors in physiotherapy and were required to choose between the options of being a salaried employee or contractor and to discuss self-management strategies. This question was part of a substantive written examination that is a compulsory aspect of the final assessment for these students. Students identified nine categories for self-management and reducing injury risk with the majority of students choosing the option of being a contractor in preference to being a salaried employee. Regardless of the preferred employment option, students tended to select self-management strategies that would have a negative impact on income and service delivery and may be reflective of the relative inexperience of these students in private sector workplace settings. Given the high prevalence of work-related musculoskeletal disorders (WRMDs) in the 5 five years postgraduation, the findings from this study highlight the need for educational institutions and employers to address occupational health and risk factors in physiotherapy, which would include education on prevention as well as appropriate self-management strategies within each workplace.

Physiotherapists and human immunodeficiency virus/acquired immune deficiency syndrome: knowledge and prevention: a study in Durban, South Africa.

This study determined what physiotherapists in Durban, South Africa know about human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), their attitudes towards patients and how they cope as individuals. Data were collected using a validated questionnaire. One-hundred-and-fourteen physiotherapists in Durban hospitals participated in the study. Seventy-two per cent of the questionnaires met the criteria for analysis. Ninety per cent of the participants believed that they knew about HIV/AIDS, but only 78% could identify all viral transmission modes. Of the 38 physiotherapists who believed that they knew the stages of an HIV infection, only 11% actually knew the stages, 28% could not explain them and 61% were vaguely aware. Fifty-six per cent of the respondents had treated patients who had died from HIV/AIDS. Only 38% of physiotherapists were completely at ease when treating HIV/AIDS patients despite the fact that 98% believed that physiotherapy was an integral component of the management of an AIDS patient. Fifty-one per cent of the respondents were unaware of support structures provided by their employers. The authors conclude that the perceptions of physiotherapists about their knowledge about HIV/AIDS do not stand up to scrutiny. Significantly more attention should be paid to the development, implementation and evaluation of the effectiveness of educational programmes on HIV/AIDS for physiotherapists in the workplace.

Relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of therapists' behaviors during early intervention.

Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6-35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors.

Nurses' perceptions of physiotherapists as rehabilitation team members.

To investigate nurses' perceptions of physiotherapists as members of the rehabilitation team. This study arose from the current emphasis that is placed on good multidisciplinary teamwork for effective rehabilitation and the awareness that different team members often have different perceptions of their respective roles within the team. Semi-structured interviews, the results of which were then subject to content analysis. Experienced rehabilitation nurses in two rehabilitation wards within a National Health Service Trust. Nurses perceived the role of physiotherapists as being concerned with mobility and movement, and valued the therapists' knowledge and skills in these areas. They felt, however, that physiotherapists had insufficient understanding of the demands and pressures of nursing practice and lacked recognition of the nurses' professional autonomy in decision-making in rehabilitation. Nurses viewed nursing and physiotherapy as two quite distinct and different roles within rehabilitation, despite some role overlap. Physiotherapy was perceived as specific and measurable, while nursing was perceived as generalized and undefined. These perceptions extended to their views on patient-staff interactions and organizational structures. Some of the differences, such as organizational structures, created barriers to rehabilitation. Others, such as physiotherapy expertise in mobility, were valued for their contribution to rehabilitation. Areas were identified where the two professions can assist each other in professional skills. Nurses valued the role and contribution of physiotherapists, but identified areas in which barriers existed to effective interprofessional working, particularly in relation to organizational factors and interprofessional relationships.

The occupational prestige of physiotherapy: Perceptions of student physiotherapists in Australia

Within the framework of occupational prestige assessment, this survey was carried out amongst future physiotherapists in Australia to determine their perceived standing of physiotherapy relative to a range of occupations including several within the medical field. A questionnaire was administered to 258 undergraduate physiotherapy students. Twelve occupations were rated on six dimensions, ie levels of income, education, social standing, responsibility and usefulness, and the proportion of women. The results indicate that amongst future physiotherapists in Australia, their profession possesses relatively high status, together with solicitor, doctor and judge, and is differentiated from the proximate professions of nurse and chiropractor. These results are similar to those obtained from the Australian public, and are in distinct contrast to the perceptions of the profession that emerged amongst physiotherapy students in England. Physiotherapy in Australia is held in high esteem - it has a clear identity and professional status, and is likely to be seen as a desirable future occupation for both genders.

Perceptions of physical therapists toward patient education.

The purpose of this study was to assess the perceptions of physical therapists regarding their involvement in patient education. We developed a questionnaire to assess procedures or activities taught, methods or tools used, important physical therapist behaviors, techniques used to assess the effectiveness of teaching, barriers to delivering effective education, relative value of patient care activities as compared with other activities, and factors contributing to the development of teaching skills. The questionnaire was sent to 300 American Physical Therapy Association members nationwide chosen by a random sample. Two hundred questionnaires, or 69% of the eligible responses were used in the data analysis. Most respondents indicated they teach 80% to 100% of their patients. Nearly all respondents teach range-of-motion techniques, home programs, and treatment rationale through the use of demonstration and verbal discussion. Most respondents recognize the importance of many therapist behaviors related to patient teaching and use observation and evaluation to assess the effectiveness of their teaching. Barriers to patient education most frequently cited were psychological factors of the patient. Interaction with patients was considered most important to the development of respondents' teaching skills. Implications and suggestions for further research are discussed.

Perceptions of acute care physical therapy practice: issues for physical therapist preparation.

Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. A survey questionnaire was mailed to 500 randomly selected physical therapists employed in acute care facilities. The therapists answered questions regarding the frequency of various physical therapy evaluation and treatment practices, problems encountered in delivering physical therapy services, coordination of the discharge planning process, and perceptions of staffing trends in the acute care setting. The responses of 188 physical therapists who completed the survey were compared by their experience levels and the size of the institutions in which they practiced. Subjects reported that patient factors, such as medical complications and cooperation; organizational factors, such as staffing shortages and large caseloads; and health care system constraints, such as difficulty changing orders and limited time in which to work with the patient interfered with patients reaching physical therapy goals. Inadequate skills for successful acute care practice and maladaptive therapist beliefs about acute care career possibilities may adversely affect physical therapist career longevity in the acute care setting.

Attitudes Don't Just Hang in the Air …': Disabled People's Perceptions of Physiotherapists

Summary This study investigates and describes disabled people's perceptions of physiotherapy and the attitudes of physiotherapists towards them. There is concern that social discrimination against disabled people is reinforced by the attitudes of health care workers. These attitudes have been poorly researched, especially within the physiotherapy profession. Informal interviews were conducted with four disabled people who live in the community. The interviews revealed a high level of dissatisfaction with physiotherapy. Although good personal relationships developed with some physiotherapists, insensitive and condescending attitudes were a common experience. Physiotherapy was perceived as ‘problem-centred’ rather than ‘client-centred’, with little relevance to independent living. The findings of this study have significant implications for clinical practice and give rise to recommendations for further research.

Obstetric Physiotherapists and breastfeeding

This study determined the perceptions of obstetric physiotherapists on the state of breast-feeding in South Africa and their contribution to breast-feeding education. A questionnaire to the 134 members of the Obstetric Association of the South African Society of Physiotherapy was completed by 36 practising respondents and 23 non-practitioners. The total response rate was 44%. A significantly larger group of practising respondents who had completed their training in the seventies returned the questionnaire. About 93% of respondents felt their basic training in breast-feeding had been inadequate. Almost 56% has received further training in breast-feeding during the previous five years. Regarding the impact of the South African national breast-feeding week campaign, 47% of respondents perceived a change in attitudes toward breastfeeding and 22% a change in breast-feeding practices. It is concluded that the perceptions of other groups of health professionals, the educational needs of parents and effective educational strategies also need investigation.