Patient education in physiotherapy in total hip arthroplasty – patients’ and physiotherapists’ conceptions

Abstract

Patient education is a part of patient-centered health services and an important, integral part of physiotherapy. Nevertheless, physiotherapists have difficulties to identify themselves as educators. People are increasingly responsible for their health and health choices. At the same time the demand for reducing health care costs shortens hospital stays. The short stays in hospital and often missing follow-ups in physiotherapy challenge patient education in physiotherapy and physiotherapists’ educational skills. The aim of this study was to explore patient education in physiotherapy in total hip arthroplasty (THA) from patients’ and physiotherapists’ viewpoint. The research followed patients’ pathway from home to hospital and back home, in the course of which patients were interviewed four times. Physiotherapists were also interviewed in a group and individually. Qualitative methods, phenomenography and narrative approaches were used in this dissertation, with results published in four scientific articles. The findings showed that in the pre-operative phase the combination of knowledge and practical elements was important as well as the role of interaction in supporting body changes and confidence in the hospital services. At the post-operative phase, the role of moving in helping patients to prepare for going home was central. Widening the perspective to managing at home, issues like exercising, written home exercise instructions and physiotherapists’ guidance to enhance patients’ self-confidence were relevant. Patients’ narratives of patient education changed along the rehabilitation pathway after THA. The narrative analysis produced three story models indicating that there was some need for more information, progression in the training program and follow-up physiotherapy. From physiotherapists’ viewpoint, the role of individuality in exercise advice and interaction, then the role of preparing the patient to manage for the future, were central to the way of coaching home rehabilitation. The research results showed that patient education was constructed from four main issues: knowledge, practical skills, body understanding and interaction with patient and physiotherapist. The results yielded a deeper understanding of the phenomenon, of patient education in physiotherapy. The results and the structure of patient education in physiotherapy, presented at the end, can be used in developing patient education practices, educational skills and continuing education. Keywords: patient education in physiotherapy, counselling, total hip arthroplasty, phenomenography, narrative approach