Patient centered care in MSK (FS-01)

Introduction video



N Hutting1, J Caneiro2, M Miciak3, L Roberts4, O Martin Ong’wen5

1HAN University of Applied Sciences, Research Group Occupation & Health, Nijmegen, Netherlands, 2Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 3University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada, 4University of Southampton, School of Health Sciences, Southampton, United Kingdom, 5Kenya Medical Training College, Nairobi, Kenya
Learning objectives:
  1. Participants will gain knowledge of the aspects that constitute patient-centred care for people with musculoskeletal conditions and of the challenges of adopting a patient-centred approach, especially in low- and middle-income  countries.
  2. Participants will gain knowledge, practical insights and tools that will inform clinical decisions with regard to the practical delivery of patient-centred care. This include skills such as: establishing meaningful connections, shared-decision making, and support/coaching towards self-management.
  3. Participants will be able to enhance their current practice with a patient-centred approach and will be better equipped to support people with musculoskeletal conditions.

Description: Musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability globally. Musculoskeletal conditions and injuries are prevalent across the lifespan. Between one in three and one in five people live with a musculoskeletal pain condition.1 Musculoskeletal conditions are typically characterised by pain and limitations in mobility, dexterity and functional ability. These limitations reduce people's ability to work and participate in social roles, having associated impacts on mental and overall health, and at a broader level impacts upon the prosperity of communities.1 Musculoskeletal conditions are often resistant to current treatments, frequently have a multifactorial origin and are influenced by numerous risk factors, including biological, psychosocial, and individual characteristics such as lifetyle, comorbid health and social context.

A common recommendation to improve quality of care in this population is a patient-centred approach that addresses psychosocial factors and provides patients with education/information about their condition and management options, including physical activity and/or exercise.2,3 Moreover, physiotherapists should provide self-management support to patients with musculoskeletal conditions2,3,4 in order to build the individual's self-efficacy to take control and ultimately be responsible for their health.3

There are many definitions of patient-centred care (also called person-centred care), but four dimensions are common to most definitions: patient-as-person, biopsychosocial perspective, sharing power and responsibility, and therapeutic alliance.5 To adopt a patient-centred active approach to treating musculoskeletal conditions and disability, clinicians should: 1) Screen for biopsychosocial factors and health comorbidities, 2) Embrace patient-centred communication, 3) Involve the patient in the goal setting process, 4) Educate beyond using active learning approaches, and 5) Coach towards self-management.2 Shared decision making is integral to high-quality, evidence-based, and patient-centred physiotherapy practice.6 However, there is a lack of understanding surrounding the concept of patient-centredness7, and substantial scope to increase the use of shared decision making6 in physiotherapy, especially in low- and middle-income countries. Moreover, physiotherapists could do more to facilitate self-management.4

Achieving patient-centred and integrated health services is an approach to strengthening health systems in all countries, whether low-, middle- or high-income countries. Fragmentation of care is a worldwide problem irrespective of the country's financial status. In numerous high-income countries, health systems are moving toward meaningful implementation of patient-centred approaches. However, in most low-and middle-income countries, this is not happening yet. Patient-centred care is at least as necessary in low- and middle-income countries where resources are scarce and systems are under pressure to be both integrated and efficient.8

Patient centredness in physiotherapy entails the characteristics of offering: individualized treatment; continuous communication (verbal and non-verbal); education during all aspects of treatment, decision making, and information sharing; self-management support; and working with patient-defined goals. These are applied in a treatment context in which the patient is supported and empowered by a physiotherapist with social skills, professional confidence, and the ability to convey specific knowledge.7

The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes.9 Research has revealed three “ways” of establishing connections: 1) acknowledging the individual, 2) giving-of-self, and 3) using the body as a pivot point.9 Moreover, four conditions were identified as necessary for establishing a therapeutic relationship, being: present, receptive, genuine, and committed.10

In this session, the characteristics of patient-centred care for people with musculoskeletal conditions will be presented. In addition, topics that address meaningful implementation of patient-centred care, specifically, shared decision making, enhanced therapeutic relationship between patient and physiotherapist and physiotherapist provided self-management support will be discussed. Moreover, the perspective of low- and middle income countries will be included to provide important insights into understanding the barriers and opportunities to implement patient-centred care in different socioeconomic contexts.

Implications/conclusions: Contemporary evidence supports physiotherapists to adopt a patient-centred approach in the management of musculoskeletal conditions. This symposium will outline key elements of patient-centred care, present practical strategies for delivering this approach, and discuss barriers and opportunities of patient-centred care in low-and middle-income countries.
1. World Health Organization. Musculoskeletal conditions. 2019.
2. Caneiro JP, Roos EM, Barton CJ, O'Sullivan K, et al. It is time to move beyond 'body region silos' to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med. 2019 Oct 11.
3. Lewis J, O'Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med. 2018 Dec;52(24):1543-1544.
4. Hutting N, Johnston V, Staal JB, Heerkens YF. Promoting the Use of Self-management Strategies for People With Persistent Musculoskeletal Disorders: The Role of Physical Therapists. J Orthop Sports Phys Ther. 2019 Apr;49(4):212-215.
5. Paul-Savoie E, Bourgault P, et al. The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management.Pain Res Manag. 2018 Sep 24;2018:6375713.
6. Jones LE, Roberts LC, Little PS, Mullee MA, et al. Shared decision-making in back pain consultations: An illusion or reality? Eur Spine J. 2014;23 (Suppl 1):S13-S19.
7. Wijma AJ, Bletterman AN, Clark JR, et al. Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies. Physiother Theory Pract. 2017 Nov;33(11):825-840.
8. World Health Organization. People-centred care in low- and middle-income countries. 2010.
9. Miciak M, Mayan M, Brown C, Joyce AS, Gross DP. A framework for establishing connections in physiotherapy practice. Physiother Theory Pract. 2019 Jan;35(1):40-56.
10. Miciak M, Mayan M, Brown C, Joyce AS, Gross DP. The necessary conditions of engagement for the therapeutic relationship in physiotherapy: an interpretive description study. Arch Physiother. 2018 Feb 17;8:3.

Key-words: 1. Patient-centred care 2. Musculoskeletal conditions 3. Physiotherapy

Funding acknowledgements: None

All authors, affiliations and abstracts have been published as submitted.

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