Discharge from Outpatient Orthopaedic Physiotherapy: A Qualitative Descriptive Study of Physiotherapists' Practices

Abstract

Purpose: To describe the clinical and contextual factors that influence physiotherapists' discharge decision-making processes in outpatient orthopaedic settings. Methods: The study used a descriptive qualitative design that included three key-informant interviews and two focus groups (n ¼ 7) of orthopaedic physiotherapists (total n ¼ 10) working in the Greater Toronto Area. Interviews and focus groups followed a semi-structured interview guide that included questions pertaining to participants' discharge decision-making processes, salient contextual factors, and challenges. Data were coded and analyzed for emerging categories and themes using constant comparison techniques and group analyses. Results: Participants indicated that a combination of factors and strategies were brought to bear on discharge decision making but that the process changed with clinical experience. Over time, further emphasis was attributed to the patient's role in his or her rehabilitation, and self-management goals were increasingly promoted. Experience affected how therapists conceptualized their roles in discharge decisions and how they negotiated goals with patients. Conclusions: Discharge decision making is a complex process that requires integrating numerous factors and negotiating with patients. Physiotherapists' decision-making practices evolve with experience and reveal the complexity of implementing models of ''client-centred care'' in practice. Further research is needed to explore these findings in other settings. RÉ SUMÉObjectif : Dé crire les facteurs cliniques et contextuels qui influencent le processus de dé cision d'un physiothé rapeute quand vient le temps de donner congé à un patient en consultation externe en milieu orthopé dique. Mé thode : L'é tude a eu recours à une structure descriptive qualitative qui a né cessité trois entrevues informatives principales et deux groupes de discussion (n ¼ 7) formé s de physiothé rapeutes en orthopé die (n total ¼ 10) qui travaillent dans la ré gion du Grand Toronto. Un guide d'entrevues semistructuré es comprenant des questions portant sur le processus de dé cision de donner congé à un patient, sur les facteurs contextuels pré dominants et sur les dé fis propres à de telles dé cisions fut suivi pour les entrevues et les groupes de discussion. Les donné es furent codé es puis analysé es pour que puissent ê tre dé gagé s les caté gories et les thè mes é mergents à l'aide de techniques de comparaison constantes et d'analyses groupé es. Ré sultats : Les participants furent valoir qu'une combinaison de facteurs et de straté gies é tait prise en compte dans la dé cision de donner congé , mais que le processus é voluait suivant l'expé rience clinique. Avec le temps, l'accent é tait davantage mis sur le rô le du patient dans sa ré adaptation, et les objectifs d'autogestion é taient de plus en plus favorisé s. Le nombre d'anné es d'expé rience influait sur la faç on dont les thé rapeutes percevaient leur rô le dans les dé cisions de donner congé et dans leur maniè re de né gocier ...

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