Physiotherapists’ views on their role in self-management approaches: A qualitative systematic review

Abstract

Self-management has been an increasingly important aspect of helping people manage their long-term conditions. The aim of this qualitative review was to synthesise the views of physiotherapists concerning their delivery of a self-management approach. A systematic search was conducted on six electronic bibliographic databases to identify relevant primary studies.Studies were assessed for quality and data extracted. Qualitative data were analysed using thematic synthesis. A total of 1189 studies were identified and screened. Eleven studies met the inclusion criteria. Findings suggest that for self-management approaches to work, physiotherapists believe that patients need to actively participate. Boundaries on who is the expert were blurred at times with some physiotherapists struggling to relinquish control. High quality patient-therapist relationships are required to build trust in order to support patients in the self-management of their long-term conditions. It is also important to consider the competing paradigms in which a service is delivered as this may facilitate or hinder self-management.Seeing patients as people is integral to supporting self-management approaches. Physiotherapists are well placed to support self-management but there is still a need for a cultural and paradigmatic shift in the physiotherapy profession and in some environments, this shift as yet is to be realised.

Supporting stroke survivors to meet their personal rehabilitation needs in community-based arm rehabilitation: development of initial programme theories to explore what may work for whom, how and under what circumstances

“…These findings are supported by a study by Doerfler and Kulnik (66) that found that a trusting client-therapist relationship entails showing commitment, shared decision-making and 'to make an effort to get to know the person' (p. 3631) (66). The systematic review by Killingback et al (10) found that when using a self-management approach, physiotherapists liked to be seen as the expert with a desire to be in control. They also found that physiotherapists saw a "high-quality patient-therapist relationship" (p. 8) (10) characterized as being able to listen to patients and having good communication skills as central to working together with patients in a self-management approach (10).…”

“…The systematic review by Killingback et al (10) found that when using a self-management approach, physiotherapists liked to be seen as the expert with a desire to be in control. They also found that physiotherapists saw a "high-quality patient-therapist relationship" (p. 8) (10) characterized as being able to listen to patients and having good communication skills as central to working together with patients in a self-management approach (10). The current study did not find that the therapists had a desire to be in control -but rather perceived themselves to have a coaching role, ready to give advice and share expertise when it was requested by the stroke survivors.…”

“…Enabling stroke survivors to meet their rehabilitation needs is a core aspect of rehabilitation, in which therapists have a role in helping stroke survivors to engage in goal setting, shared decision-making, and self-management (9,10). However, an agreed definition of 'rehabilitation need' does not appear to exist (11).…”

Being more than “just a bog-standard knee”: the role of person-centred practice in physiotherapy: a narrative inquiry

“…In particular, the change from service users being passive recipients to becoming an active participant with a voice. In rehabilitation this presents a cultural change in service user and physiotherapist roles [38][39][40][41][42]. Being mindful of this shift in culture and setting expectations at the beginning of a consultation would enhance the understanding of both parties as they navigate the roles they can play in enabling self-management of long-term health conditions.…”

Advice-giving skills in pre-registration physiotherapy training

“…Despite encouragement to engage in healthy conversations (Bancroft and Moss, 2016;National Health Service, 2016) no consensus has been reported on how physiotherapists promote healthy lifestyles (Killingback et al, 2022;Shore and Hebron, 2020). Approaches used by physiotherapists to deliver advice have been shown to be inconsistent, conflicting and have not addressed long-term health promotion (Lowe, Littlewood, and McLean, 2018;Osborn-Jenkins and Roberts, 2021).…”