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Grafe M.1,2, Probst A.3, Behrens J.1
1Martin-Luther-University, Institute of Health and Nursing Sciences, Halle-Wittenberg, Germany, 2University of Applied Sciences Muenster, Faculty of Health, Muenster, Germany, 3University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Social Work and Health, Hildesheim, Germany
Background: Former studies indicate that patient-therapist-interaction influences the outcome of physiotherapy interventions. Several factors influence the quality of interaction, like interpersonal and communication factors, practical skills and context factors. With regard to the context of private practice it is described that physiotherapists find it challenging to interact with their patient, e.g. due to unflexible time-frames. It is therefore important to analyse patient-therapist-interaction in the setting of private practice to generate ideas for workplace organisation and education.
Purpose: A study was designed to develop a theoretical understanding of patient-therapist-interaction in private practice. Therefore the analysis focussed on interaction strategies used by physiotherapists. Furthermore a relationship between the observed strategies and the context factors in private practice are determined.
Methods: The study was designed following the Grounded Theory Methodology by Strauss and Corbin. In this tradition data collection and data analysis were simultaneous processes. Coding the data lead to emerging categories that were tested and differentiated by gathering new data. All data were collected by the first author. In total 9 physiotherapists working in the field of musculoskeletal private practice were included in the study. The data collection encompassed video recordings of 8 physiotherapy sessions, think-aloud protocols following the sessions, interviews and field observation. Ethical Approval was obtained from the Ethics Committee of the Medical Faculty of Martin-Luther-University, Halle-Wittenberg.
Results: The overarching objective regarding the treatment process was to always remain in tact. By defining the term tact, three different dimensions were identified:
a) the tact of the organization
b) the tact of the intervention
c) the tact of the relationship.
The core category always remain in tact stands for the attempt of the physiotherapists to match the different tacts. Therefore physiotherapists use different strategies to control interaction, e.g. focusing on technical-medical tasks, switching between everyday and treatment-related conversation and establishing routines.
Conclusion(s): Data analysis lead to a grounded theory that emphasises a relationship between the context of private practice and patient-therapist-interaction. The strategies illustrate, that physiotherapists take control of the process of interaction to remain in tact. This on the other hand inhibits a comprehensive access to client preferences. Concluding from the results it is necessary to develop educational methods that support therapists to match the different tacts in private practice, e.g. role play or reflecting on recorded sessions. There is also need to discuss current workplace organisation, e.g. with regard to a more flexible and patient-oriented time-management.
Implications: This study outlines a theory of physiotherapist-patient-interaction in outpatient physiotherapy practices in Germany. The findings will be useful for education, management purposes and political decisions to generate a deeper understanding of the complexity and meaning of interaction in the treatment process. Thereby, quality of interaction and intervention can be improved.
Funding acknowledgements: PhD Scholarship from the German National Merit Foundation
Topic: Professional practice: other
Ethics approval: Ethical Approval was obtained from the Ethics Committee of the Medical Faculty of Martin-Luther-University, Halle-Wittenberg.
All authors, affiliations and abstracts have been published as submitted.
