Exploring the COMFORT Model for Complex Communication for Physiotherapists in Neurorehabilitation: A Critical Review

Abstract

Literature has evaluated the level of accomplishment of the Patient-centred care (PCC) model from physiotherapists working in Neurorehabilitation. Reviewing the literature has revealed a lack of kills, confidence and training by physiotherapists to communicate difficult or complex information, such as poor prognosis or shared goal- setting, leading patients and families to complain about the need for more empathy, encouragement for patients to foster autonomy and rapport with physiotherapists. This problem is not unique to physiotherapists in neurorehabilitation and can be found in other medical disciplines. Many frameworks have been designed in order to teach how to successfully lead communication in stressful situations. However, the COMFORT model, which is an acronym for seven key principles of effective communication, is a grounded framework based on PCC ideals. This study aims to review the evidence of the effectiveness of the COMFORT model used by other health care professionals (HCPs) to implement it for physiotherapists in neurorehabilitation to explore patients' multifactorial lives, break bad news (BBN) effectively, and manage the emotional labour implied in complex scenarios such as discharging or setting treatment goals. Numerous databases were electronically searched and through a critical realist approach, six studies that applied this communication framework in different medical specialities have been reviewed. Through the scope of the self-efficacy theory, the COMFORT model can be considered a suitable communication framework to be used by physiotherapists due to increasing their confidence, teaching how to approach the emotional dimension implied in neurorehabilitation and having the potential to change clinical practice. Recommendations are to conduct studies on physiotherapists working in Neurorehabilitation in order to display the effectiveness of the COMFORT curriculum but also, to design specific communication frameworks tailored for physiotherapists working in a challenging setting as neurorehabilitation.