The patient’s perspective of the feasibility of a patient-specific instrument in physiotherapy goal setting: a qualitative study

Abstract

BackgroundPatient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting.MethodWe performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis.ResultsThe PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead.ConclusionThe PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.

Ready for goal setting? Process evaluation of a patient-specific goal-setting method in physiotherapy

“…Although elements of shared decision making were incorporated in the ‘planning treatment’ step, the physiotherapists did not fully involve the patients in this step, as has also been found in other studies [ 6 , 15 , 32 , 34 ]. The physiotherapists reported that not all patients wanted to participate, and this variety as regards patients’ preferences and abilities for participation has also been reported previously [ 6 , 8 , 11 , 35 – 37 ]. On the other hand, we also saw that patients were not always invited to participate, but were nevertheless satisfied about their conversations with the physiotherapists.…”

“…To ensure reliability of the findings, the observations and patient files were scored independently, as recommended by Moore et al [ 39 ]. The intended use of the PSG was assessed by the Theory of Planned Behaviour questionnaire [ 28 , 41 ], with the content of the items being designed on the basis of the previous qualitative analysis [ 6 , 8 ].…”

“…First, a 31-item questionnaire based on the Theory of Planned Behaviour [ 28 ] was used to measure the physiotherapist’s intention to use the PSG. The items were based on our previous analysis of the use of the PSC instrument in practice [ 6 , 8 ]. It comprised four subscales: attitude (14 items), subjective norms (5 items), perceived behaviour control (9 items), and behaviour intention (3 items), which were scored on a 7-point Likert scale (1 = totally disagree, 7 = totally agree).…”

“…It is a frequently used instrument in Dutch physiotherapy practices [ 23 ]. Recent analysis showed, however, that its potential for goal setting was not fully utilized [ 6 , 8 ]. Hence, the existing PSC instrument was optimized in collaboration with patients and physiotherapists.…”

<p>The Applicability of the Patient-Specific Functional Scale (PSFS) in Rehabilitation for Patients with Acquired Brain Injury (ABI) – A Cohort Study</p>

“…Hence, the PSFS could be a tool to increase the patients´ self-awareness. 49 The time spent on the collaborative development of goals and the completion of the PSFS ranged from seven to 75 mins with a mean time on 28 mins. The database of rehabilitation measures states that it takes 4 mins to fill out the PSFS, 16 but this is without the collaborative goal-setting process.…”