What matters most: a qualitative study of person-centered physiotherapy practice in community rehabilitation

Background: Person-centered approaches to care require physiotherapists to engage in trying to understand the full range of biomedical, psychological, and social factors that people bring to the consultation, along with the client’s individual responses to those factors. If, however, the main issues of importance to people are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving interventions that clinicians think they need, rather than care based on their expressed needs and preferences. Objective: To understand people’s abilities to express the issues of importance to them within a consultation and clinicians’ abilities to acknowledge and address those issues. Design: A qualitative study using an interpretive phenomenological approach. Methods: Eight clients were interviewed before they met their physiotherapist, the initial consultation with their physiotherapist was recorded, and both were interviewed separately afterward. Analysis: The clients frequently do not raise their emotions or feelings as issues of importance, and physiotherapists generally struggle to elicit, or identify as important, such matters. How these were presented to the clinician and subsequently addressed varied. We formulated three themes: 1) managing complex situations; 2) establishing a person-centered agenda; and 3) addressing emotional issues. Conclusions: Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.