Carolyn Roskell

A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation

Objective: To map out from the literature the nature, extent and effects of application of patient-centred goal setting in stroke rehabilitation practice. Design: Systematic review. Data sources: A search was conducted in the Cochrane (Wiley), AMED, Medline (EBSCO), Embase, Sports discuss, Medline (Ovid) and CINAHL databases. Secondary search based on references from the preliminary search was undertaken. Review methods: Quantitative and qualitative studies that included aspects of patient-centredness and goal setting in stroke patients from 1980 to June 2010 were collected. Studies were scrutinized for relevance and quality based on published methodology. The findings were synthesized by aggregating the themes from the qualitative studies and relating them to relevant findings from the quantitative studies. Results: Eighteen qualitative and eight quantitative and one mixed method study conducted in stroke rehabilitation services ranging from acute to community rehabilitation were included. Themes that emerged were related to perceptions of patients and professionals regarding patient-centredness, nominal adoption of this concept, consequences of discrepancies in the perceptions and practice, related ethical conflicts, challenges to application and strategies to improve its application. The effects of following patient-centred goal-setting practice have been studied mostly with weak methodologies and studies show some benefit with psychological outcomes. Conclusion: Patient-centred goal setting is minimally adopted in goal-setting practice due to various barriers. Since the effects of incorporating this concept have not been evaluated rigorously it is suggested that further research is essential to investigate its effect on patient outcomes.

Differences in the Clinical Reasoning Process of Expert and Novice Cardiorespiratory Physiotherapists

Summary Through the process of clinical reasoning, physiotherapy practitioners critically evaluate their interventions in the management of patients. This qualitative investigation focused upon the thought processes of two groups of physiotherapists as they engaged in the consideration of a presented respiratory paper case scenario; identifying problems, possible diagnoses, and finally proposing a treatment plan. One group of 15 physiotherapists were designated ‘expert’ in their practice, whereas the second group of 15 were relatively inexperienced junior physiotherapists. The aim of the study was to investigate the differences in the clinical reasoning process of the novice versus the expert group. After considering the presented paper case scenario, each therapist completed an open questionnaire. A corroborated content thematic analysis of the presenting data was performed. Through this analysis common themes were identified across the data, and differences presenting between novice and expert practitioners were explored. A number of differences in the clinical reasoning process were identified between the novice and expert groups. It is postulated that the mechanisms for storage and retrieval of knowledge are more refined in the expert group. This in turn impacts upon practitioner problem-solving ability and hence clinical judgement. These findings support those of previous studies, which have not, however, included a consideration of the clinical reasoning process in the field of cardiorespiratory physiotherapy. Clinically the results provide information on the different thought processes of novice and expert practitioners in the field of respiratory physiotherapy. This has implications for day-to-day management of physiotherapy staff and for the continuing professional development of practitioners.

Identifying the facilitators and processes which influence recovery in individuals with schizophrenia: a systematic review and thematic synthesis

Abstract Background: Research is required to better understand the psychosocial factors that influence the recovery of individuals with schizophrenia. Objective: To conduct a systematic review and thematic synthesis and identify the factors which influence recovery. Methods: Major electronic databases were searched from inception until February 2014. Qualitative articles were included that considered the concept of recovery from individuals with schizophrenia, their caregivers or health care professionals. Methodological quality was assessed and studies were thematically synthesised. Results: Twenty articles involving 585 individuals with schizophrenia, 298 primary care givers or close sources of support and 47 health care professionals were included. The results identified and detailed the psychosocial factors and processes that influenced recovery. The factors which promoted recovery included: (1) adjustment, coping and reappraisal (2) responding to the illness (3) social support, close relationships and belonging. The factors which challenged recovery included: (1) negative interactions and isolation (2) internal barriers (3) uncertainty and hopelessness. Conclusion: Health care professionals and researchers will benefit from a greater understanding of the psychosocial factors which influence recovery for individuals with schizophrenia. Implications are discussed within the text.

The theory-practice gap and physiotherapy in the UK: Insights from the nursing experience

The existence of a theory-practice gap in physiotherapy has not attracted wide attention or been the focus of sustained analysis within the profession. This is in stark contrast to nursing, where consideration of the relationship between theory and practice has received extensive coverage. The argument presented here suggests that it is an appropriate time for an examination of the role of theory and its relationship to practice in the discipline of physiotherapy and to draw on the experience in nursing as a basis for this enterprise. The overall contention is that, if debate and research around these issues is encouraged, subsequent examinations of the physiotherapy knowledge base may become better informed.

Hydrotherapy: Detrimental or beneficial to the respiratory system?

Summary This paper reviews the literature which identifies the physiological effects of immersion on vital capacity and associated respiratory volumes and mechanics. The apparent conflict as to whether immersion is detrimental or beneficial for individuals with small lung volumes is identified. A critical analysis of previous research is made, the implications for clinical practice are identified, and suggestions for future research are given.

Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study

Objective: To explore whether goal-setting for rehabilitation with acute stroke survivors is patient-centred and identify factors which influence the adoption of patient-centredness in goal-setting practice. Setting: Acute stroke unit in a large teaching hospital in England. Participants: Patients with stroke who had no cognitive or significant communication problems and health care professionals who had a significant engagement with an individual patient were approached for participation. Method: Multiple qualitative methods were used. Perceptions and beliefs about patient-centredness, within the context of goal-setting, were collected from patients and corresponding professionals using qualitative semi-structured interviews. Adoption of patient-centred behaviour was triangulated using analysis of patient records and observation of team meetings related to participating patients. Data analysis: Interview transcripts and field notes were coded, clustered under categories and descriptively summarised. Additionally, data from patients’ documents were summarised. These summaries were then mapped on to an a-priori frame work of patient-centredness from which further interpretative themes were derived. Results: Seven patients and seven health-care professionals participated. Goal-setting was not consistently patient-centred as evidenced by a) incongruities between patients and professionals in setting, communicating and prioritising of goals and b) dysfunctional therapeutic relationships. The factors that influenced patient-centred goal-setting were both professional and patient beliefs and attributes, work-culture, practice model, limitations in knowledge and systems that disempowered both professionals and patients. Conclusion: It may be possible to infer that current local practice of goal-setting was inadequately patient-centred. Further research is required to identify strategies to overcome these challenges and to develop patient-centred goal-setting methods.

THE PROBLEMATIC WORLD OF FOLLOWING A RENAL DIET OUTSIDE THE HOME.

BACKGROUND Individuals on peritoneal dialysis are given dietary advice to help reduce disease morbidity and mortality. However, the experience of people who have been given this advice is not well researched. OBJECTIVE To understand the experiences of individuals on peritoneal dialysis when following dietary advice. METHOD A phenomenological approach, using semi-structured in-depth interviews was used to understand the experiences of ten service-users of the renal dietetic service. Data were analysed using Framework Analysis. FINDINGS One theme emerged around difficulty when eating outside the home. Individuals experienced negative emotions when following advice. Individuals ate foods reluctantly, offered excuses as to why meals could not be eaten, or in extreme cases did not attend certain social gatherings in order to avoid the perceived attention and judgement from fellow guests related to their food choices. CONCLUSION A renal diet for peritoneal dialysis may be difficult to follow outside the home. Further support around eating in social situations may need to be offered when giving dietary advice.

The Psychosocial Consequences of Sports Participation for Individuals with Severe Mental Illness: A Metasynthesis Review

The purpose of the current metasynthesis review was to explore the psychosocial benefits of sport and psychosocial factors which impact on sports participation for individuals with severe mental illness. AMED, CINAHL Plus, Medline, EMBASE, ProQuest Nursing & Allied Health Source, and Science Citation Index were searched from inception until January 2014. Articles included use qualitative methods to examine the psychosocial effects of sports participation in people with severe mental illness. Methodological quality was assessed using the Consolidated Criteria for Reporting Qualitative Studies and a case study tool. Included studies were analysed within a metasynthesis approach. Eight articles involving 56 patients met the inclusion criteria. The results identified the broader and direct psychosocial benefits of sport. Sport provided a “normal” environment and interactions that were not associated with an individual’s mental illness. Sport provided individuals with a sense of meaning, purpose, belonging, identity, and achievement. Other findings are discussed. Direct psychosocial benefits are a consequence of sports participation for the vast majority of individuals with severe mental illness. Further to this, sports participation was associated with a reduction in social isolation and an increase in social confidence, autonomy, and independence.

An exploration of the professional identity embedded within UK cardiorespiratory physiotherapy curricula

OBJECTIVES To explore whether consensus exists about content and professional identity represented within pre-registration cardiorespiratory physiotherapy (CPT) curricula, and to establish whether the curricula feature contemporary themes evident in policy and professional guidance in order to test whether CPT education is demonstrating responsiveness and relevance to practice. DESIGN An exploratory qualitative case study design employing documentary analysis of curricula materials related to CPT. PARTICIPANTS Fourteen UK higher education institutions offering undergraduate physiotherapy qualifying programmes agreed to participate. INTERVENTION Relevant curriculum documentation was requested, such as student module guides, programme handbooks and institutional module descriptors, encompassing information including indicative content, teaching and learning methods, and modes of assessment. Document analysis combined deduction (through content analysis) and induction (through thematic analysis). RESULTS Consensus was observed on core content, underpinning philosophy and professional identity across institutions. The projected identity appeared to be strongly biomedical in focus, and was less well influenced by some of the contemporary aspects promoted by the Chartered Society of Physiotherapy, such as promotion of a patient-centred model of practice and acknowledgement of the emotional challenges existing within this area of work. CONCLUSION Continuing critical review of the content and approach promoted within curricula is needed to ensure that learning remains relevant and responsive to current agendas. This study supports the need for course teams to reconsider the emphasis within individual curricula to ensure that responsiveness and relevance to the practice setting are made explicit.

Barriers and enablers of physical activity engagement for patients with COPD in primary care

Background Given that physical activity (PA) has a positive impact on COPD symptoms and prognosis, this study examined the factors that both encourage and limit participation in PA for individuals with COPD in a primary care setting from the perspective of social cognitive theory. Methods A purposive sample of 26 individuals with a range of COPD severity (age range: 50–89 years; males =15) were recruited from primary care to participate in one of four focus groups. Thematic analysis was undertaken to identify key concepts related to their self-efficacy beliefs. Results Several barriers and enablers closely related to self-efficacy beliefs and symptom severity were identified. The main barriers were health related (fatigue, mobility problems, breathing issues caused by the weather), psychological (embarrassment, fear, frustration/disappointment), attitudinal (feeling in control of their condition, PA perception, older age perception), and motivational. The main enabling factors were related to motivation (autonomous or controlled), attitudes, self-regulation, and performance accomplishments. Clinical implications When designing interventions for individuals with COPD, it is important to understand the patient-specific social cognitive influences on PA participation. This information can then inform individually tailored management planning.