C. Fryer1, A. Sturm2, I. Edwards1, R. Roth3,2
1University of South Australia, UniSA Allied Health and Human Performance, Adelaide, Australia, 2Interuniversity College for Health and Development Graz, Castle of Seggau, Austria, 3University of Graz, Graz, Austria

Background: Practitioners of all member countries of World Physiotherapy are expected to comply with the organisation’s code of ethics. An international understanding of ethical practice for physiotherapists is needed to inform how all physiotherapists can best be equipped to be moral agents in their practice and society.

Purpose: The primary aim of the study was to understand the type and frequency of ethical situations encountered by physiotherapists internationally. A secondary aim was to understand what participant factors predicted the frequency of experiencing ethical issues in different contexts.

Methods: An online survey in the English language was distributed using purposive and snowball sampling. It contained 60 items in three sections: 13 items requested participant sociodemographic details; 46 items asked the frequency (daily, weekly, monthly, yearly or less, never) that participants experienced specific ethical issues in four categories based on their context:
(A) Physiotherapist and patient interaction,
(B) Physiotherapist and other health professionals including other physiotherapists,
(C) Physiotherapists and the system and
(D) Professional and economic ethical situations; and one item asked participants to describe an ethical situation they had experienced which had not been mentioned.
Sociodemographic characteristics were descriptively analysed. Mean frequencies for each survey item were calculated and the distribution of items responses evaluated. Stepwise multiple regression analyses were calculated for each category of survey items to understand predictors for experiencing ethical issues.

Results: 1,212 individuals from 94 countries participated. The mean age of participants was 35.26 years (range 18-76 years) and most participants were female (67%, male 32%, diverse 1%). Participants had worked in physiotherapy for a mean of 13.5 years (± 11.0). The three most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ ‘Physiotherapy not accessible to all people in society who need it’ and ‘Respecting the patient's therapeutic relationship with other health professionals, when the physiotherapist disagrees with the other health professional's opinion’. Most ethical issues were reported to be experienced between monthly and yearly (30/46 items). The longer participants had worked as physiotherapists and the less fields of physiotherapy practice they worked in predicted the more seldom they experienced ethical issues in all four context categories.  

Conclusion(s): Ethical situations involving societal or organisational systems causing inequity in physiotherapy care are of importance to physiotherapists globally. Physiotherapists are also frequently experiencing ethical issues involving other health professionals which can lead to compromised care. The finding that more experienced practitioners with focused fields of practice experience ethical issues less frequently may suggest that graduate physiotherapists are not yet being prepared well for the ethical challenges of the practice contexts they enter.

Implications: National and international physiotherapy education providers and associations can use these results to tailor professional training and policy for ethical physiotherapy practice. These include skills and support for practitioners to collaborate with professional colleagues and influence the decisions of higher levels of authority. As a profession, we need to examine how we can improve the moral supports available to physiotherapists in training and their early years of practice.

Funding, acknowledgements: The study received funding by the Government of Salzburg/Austria (Land Salzburg), Department Culture and Science.

Keywords: Ethics, Professional, Global

Topic: Professionalism & ethics

Did this work require ethics approval? Yes
Institution: University of South Australia; and IERM, University of Vienna
Committee: for UniSA: Human Ethics Committee; for IERM Dr. Stefan Dinges
Ethics number: UniSA 201295; IERM Ethics Vote 2/2018

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

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