Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators
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Dukhu, S., Purcell, C. & Bulley, C. (2018) Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators. International Practice Development Journal, 8 (2), [Article: 2].
Background: In the management of long-term conditions (LTCs), the role of physiotherapy and the construct of person-centred care (PCC) is evolving. Though discussed thoroughly in some disciplines, theorising about PCC is embryonic in physiotherapy literature, with evidence suggesting ambiguity in its conceptualisation and application. Aims: To critically review evidence for barriers to, and facilitators of, PCC in adults living with LTCs within a physiotherapy context and identify components and outcomes of PCC in practice.Method: A systematic electronic search strategy to identify quantitative, qualitative and mixed method studies which collected data relating conceptually to PCC and included physiotherapists working with adults (>19 years) living with one or more LTCs in any setting.Findings: Four quantitative, three qualitative and one mixed methods article, representing six studies, were selected for critique and synthesis. Outcomes identified by the authors included perceived self-management and ‘patient’ centredness, self-efficacy (assessed using Six-Item Chronic Disease Self-Efficacy Scale, Pain Self-Efficacy Questionnaire) and quality of life (assessed using Quality of Life Analogue Scale, Short Form-36). Components of PCC were identified as self-management, on-going care, decision-making, individualisation, information-sharing and goal-setting. Evidence suggests barriers and facilitators may occur at the level of the stakeholder within processes, outcomes and contexts of care delivery.Conclusions: There is limited and mixed quality of evidence in relation to aspects of PCC in physiotherapy practice for management of LTCs. This review synthesises concepts described in physiotherapy literature in a model which is contrasted with others to trigger further discussion.Implications: 1) There is a need to study physiotherapists’ awareness of the complexity of PCC in practice. 2) Quality of evidence is mixed, highlighting a need for further exploration of PCC within physiotherapy contexts. 3) Evidence suggests PCC can be better delivered by physiotherapists when addressing barriers and enhancing facilitators of PCC.