A framework for establishing connections in physiotherapy practice

Abstract

The therapeutic relationship between practitioner and patient is embedded in the clinical interaction. Research using self-report tools has illustrated that positively evaluated therapeutic relationships can have favorable impacts on patient satisfaction with services and clinical outcomes. However, little is known about how physiotherapists develop the connections, or positive attachments, that help establish the therapeutic relationship. This study aimed to identify the various ways that physiotherapists establish meaningful connections with their patients. Interpretive description, a qualitative methodology, was used to structure the inductive and iterative design. Eleven physiotherapists and 7 patients from private practice clinics participated in semi-structured interviews to describe their experiences of the therapeutic relationship. Textual data were analyzed using qualitative content analysis and constant comparison. The iterative data generation and analysis process resulted in a framework composed of three "ways" (i.e. categories) of establishing connections: (1) acknowledging the individual, (2) giving-of-self, and (3) using the body as a pivot point. Findings were supported by various rigor strategies including peer debrief and external audit. This framework demonstrates that establishing connections is a multi-faceted endeavor with personal and professional characteristics. The findings provide practical knowledge that can be used to guide clinicians, educators, and researchers in addressing the therapeutic relationship.

Measuring therapeutic relationship in the care of patients with haemophilia: A scoping review

“…The ways of establishing connections describe the actions and behaviours of the health‐care provider and patient within a clinical encounter. Connections involve using the body as a pivot point (ie health‐care provider and patient connecting through the patient's body, physiological health condition or physical symptoms), giving‐of‐self and acknowledging the individual (ie validating, individualizing treatment) . The elements of the bond —caring, trust, respect and nature of the rapport—describe the emotional or affective resonance between the patient and provider .…”

Development of the Physiotherapy Therapeutic Relationship Measure

“…Ways of establishing connections are the actions the physiotherapist and patient 'do' together that are part of the relationship and include acknowledging the individual, using the body as a pivot point (i.e. physiotherapist and patient connecting through the patient's body, physiological health condition, or physical symptoms), and giving-of-self [9]. Caring, trust, respect and nature of the rapport make up the Elements of the bond, which are the feelings that exist between the physiotherapist and patient [1].…”

“…Specifically, in physiotherapy, the patient and physiotherapist often connect or relate through the patient's physical body, including connecting through physical contact (i.e. touch) [9].…”

Der physiotherapeutische Takt

“…Folgen wir einem von Nicholls [35] beschriebenen Verständnis des "Body as Machine", passt dies zur derzeitigen Arbeitsorganisation in ambulanten Praxen und befördert ein therapeutenzentriertes Vorgehen. Verstehen wir den Körper jedoch eher als "Body as a Pivot Point" [44], also als Kern der Begegnung, über und mit dem wir eine Verbindung zu unseren Patienten herstellen, erfordert dies Interaktion, die zum einen in einem reflexiven und erfahrungsgeleiteten Prozess gelernt sein will und zum anderen gute Rahmenbedingungen benötigt. Der physiotherapeutische Takt kann dabei ein heuristisches Modell darstellen, um die eigene Arbeit zu reflektieren, Unwägbarkeiten als solche zu erkennen und damit umzugehen und dadurch die eigene Professionalität zu steigern.…”