Expectations of physiotherapy by Australian adults
In addition to other physiotherapy management of their condition, people expect to receive advice about physical activity and other health behaviours when they attend a physiotherapy clinic. Breanne Kunstler elaborates on the survey.
Your study investigates the issue of how patients would feel about receiving advice to increase physical activity levels, as part of a physiotherapy appointment. What had previous evidence shown on this topic?
Evidence in the space of patient expectations for physiotherapy services (eg, providing physical activity advice), rather than outcomes (eg, pain relief), is scarce. The evidence is even more rare when we get more speciﬁc and explore patient expectations for speciﬁc general health-related services such as advice pertaining to physical activity, diet, smoking, alcohol consumption, sexual function and sleep health from physiotherapists. This study is unique as it focuses on patient expectations for physiotherapy services such as these, turning the attention away from outcomes such as pain relief.
How did your study address the topic? What specific methods did you employ?
We used an online cross-sectional study design to survey 587 Australian adults country-wide. The survey instrument involved asking respondents if it was either important or likely that a physiotherapist would provide certain services to patients. We included a wide range of services in the instrument, but this paper focused speciﬁcally on common services, such as manual therapies, and advice, such as that pertaining to increasing physical activity levels, sleep health, disease prevention, weight loss, healthy eating, sexual function, smoking cessation and safe alcohol consumption.
So, did the adults you surveyed think it is likely and important that physiotherapists provide physical activity advice during an appointment?
The majority of the adults who completed the survey reported that it was both ‘important’ and ‘likely’ that physiotherapists provide physical activity advice to their patients. Adults who have experience seeing a physiotherapist, as well as those who have never seen a physiotherapist, contributed data to this ﬁnding. This suggests the general perception of physiotherapy by Australian adults, rather than just patients, involves them encouraging people to be active.
This ﬁnding is not limited to only physical activity advice. The majority of the adults who completed the survey also reported that it was both important and likely that physiotherapists provide advice on how to improve general health. When explored in more detail, the majority of respondents also reported it was important and likely that physiotherapists would provide advice on disease prevention and healthy eating.
Despite the majority of respondents reporting it was likely that physiotherapists provide weight loss advice, they did not report that it was important for physiotherapists to do this. Furthermore, despite the majority of respondents reporting that it was important that physiotherapists provide sleep advice, they did not report that it was likely that physiotherapists would do this. These ﬁndings might be explained by Australian adults possibly perceiving that providing this advice is the role of other allied health professionals, demonstrating a potential silo-style view of healthcare delivery speciﬁc to these topics (eg, a dietitian is the only health professional who provides weight loss guidance).
We also identiﬁed the number of respondents who reported that physiotherapists providing manual therapies was important and/or likely. The majority of the adults who completed the survey reported that it was both important and likely that physiotherapists provide massage, hot/cold therapy and taping/strapping. However, services such as manipulation, acupuncture and cupping were not reported as important or likely by the majority of respondents.
Overall, Australian adults report several services are important and/or likely to be provided by a physiotherapist. These services do not necessarily belong to one service category but span across several categories (eg, general health and manual therapies). Therefore, Australian adults appear to expect physiotherapists to provide a variety of services that involve their active participation (eg, participating in more physical activity) and those that do not (eg, massage).
Was physical activity advice considered more or less likely or important than other services that people might receive from the physiotherapist during an appointment?
More respondents reported that it was important and likely that physiotherapists provide physical activity advice compared to massage, manipulation, hot/cold therapy, acupuncture, cupping and taping/strapping. However, it must be noted that massage was still perceived as an important and likely service by a large number of respondents.
Physical activity advice was also perceived as more likely to be provided compared to general health advice and more speciﬁc advice pertaining to sleep health, disease prevention, weight loss, smoking cessation, unsafe alcohol consumption, healthy eating and sexual function.
It is interesting to note that more respondents reported that it is important that physiotherapists provide physical activity advice, compared to those who reported it was likely that physiotherapists would provide this advice. Therefore, just because people think it is important that a physiotherapist provides a certain service, they might not think it is likely that they will receive it, potentially influencing their expectation for receiving the service. It is important to further explore why adults do or do not ﬁnd it important or likely to receive some services and not others.
Finally, adults who attended physiotherapy to receive a home exercise program (HEP) were more likely than those who did not attend physiotherapy to receive a HEP to expect physical activity advice from the physiotherapist. Adults who did not attend physiotherapy wanting a HEP were also more likely to expect the physiotherapist would provide massage. It appears that adults who expect the physiotherapist to provide them with a HEP will be more accepting of advice that involves their active participation outside the clinic compared to those who attend physiotherapy without expecting a HEP.
So, what advice would you give physiotherapists who would hesitate to raise the topic of physical activity during an appointment?
Physiotherapists want to keep patients happy so that they return to them in the future; therefore, they might be hesitant to provide a service their patient does not expect.
Australian physiotherapists have been reported to be less likely to provide physical activity advice before providing other services they think patients want, such as manual therapies; however, this current study demonstrates that more Australian adults think that it is both important and likely that physiotherapists provide physical activity advice compared to massage and other manual therapies. These expectations will likely differ based on patient desires (eg, wanting or not wanting a HEP). The ﬁndings from this study suggest that patients choosing to see a physiotherapist are more likely to expect physical activity advice than physiotherapists think. Therefore, physiotherapists should not hesitate to provide physical activity advice when indicated.
Click here to read this survey, published in the Journal of Physiotherapy.
Dr Breanne Kunstler, APAM, is an expert in behaviour change theory and practice in relation to physical activity promotion, using these skills as an early-career research fellow at BehaviourWorks Australia. She is also a co-convenor of Physiotherapists for Physical Activity, an Australian Physiotherapy Association Advisory Group. You can follow this group on Twitter @PhysiosforPA and view useful resources at physiosforpa.com.
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