The views of physiotherapists on their role in self-management approaches: A qualitative metasynthesis

Purpose

The aim of this qualitative metasynthesis was to synthesise the views of physiotherapists on their role in the delivery of self-management approaches for those with long-term conditions.

Approach

A systematic search was conducted on six electronic bibliographic databases (AMED, Academic Search Premier, CINAHL Complete, MEDLINE, PsycINFO, SPORTDiscus with full text) to identify relevant primary studies. Reference lists of eligible studies were hand searched. No date limiters were applied. Studies were assessed for quality and data extracted. Data were analysed using thematic synthesis.

Outcomes

Results: A total of 1189 studies were identified and screened. Eleven studies met the inclusion criteria. Five themes were identified in understanding physiotherapists’ views of self-management approaches: focus on active participation; the physiotherapist as the expert; patient-therapist relationship; the context of service delivery; and holistic rehabilitation. Boundaries on who is the expert were blurred at times with some physiotherapists struggling to relinquish control. High quality patient-therapist relationships are required to build trust in order to support patients in their self-management. It is also important to consider the context in which a service is delivered as this may facilitate or hinder self-management. Taking a holistic approach to rehabilitation was integral to self-management.

Conclusion(s): If we do not reflect on the shared expertise between patient and therapist, then we run the risk of assuming control and of ‘physiosplaining’ in our therapeutic encounters. Physiotherapists did not perceive themselves to be experts in self-management and felt that they lacked knowledge in this area. Physiotherapists should be encouraged to reflect on their philosophy of physiotherapy. Does their philosophy view approaches to self-management from a narrow perspective of helping people manage their condition well, or is it broader where they see their role as helping people manage well with their condition? These subtle differences in philosophy may lead to very different types of physiotherapy practice. Future work should examine how individual philosophies in self-management impact on supporting patients in self-managing long-term conditions.

Cost and savings

No further data 

Implications

Health systems globally have been challenged by the rising burden of chronic illness and long-term conditions. In response, self-management has become an increasingly important aspect of helping people manage with their long-term conditions. Physiotherapists need to be at the forefront of leading for change in ensuring they work with patients to be co-producers of health. This review adds new knowledge in terms of understanding barriers and enablers to implementing self-management approaches with patients with long-term conditions in physiotherapeutic contexts. Results from this study are of relevance to physiotherapy education providers. It is suggested that approaches to supporting patients in the self-management be taught explicitly as part of pre-registration training to equip the future workforce with the skills needed to empower patients. Self-management training should also be made available to those in practice to ensure they are able to support patients in actively self-managing their long-term conditions.

Top three learning points

No further data 

Funding acknowledgements

This work was unfunded