The views and experiences of physiotherapists on physiotherapy service provision for people with neurological conditions in primary care in Ireland: A qualitative study
Restricted accessResearch articleFirst published online July 10, 2017
The views and experiences of physiotherapists on physiotherapy service provision for people with neurological conditions in primary care in Ireland: A qualitative study
BACKGROUND: Physiotherapy is associated with positive health outcomes and is highly valued among community dwelling people with neurological conditions (pwNC). However, research highlights a deficiency in the quality of physiotherapy services for pwNC in the community setting in Ireland.
PURPOSE: The aim of this study was to explore physiotherapists’ views and experiences of physiotherapy service provision for pwNC in primary care with a view to providing a platform of knowledge to assist the development and provision of a high quality physiotherapy service.
METHODS: A qualitative study employing semi-structured interviews in four primary care sites in Ireland was chosen. Purposive sampling was used to recruit 10 primary care physiotherapists. Face to face semi-structured interviews were conducted with each participant. Interviews were audio-recorded and transcribed verbatim, respondent validation was sought and thematic data analysis was conducted on each interview transcript.
RESULTS: Physiotherapists identified pwNC as having distinct needs from the general primary care patient population and they reported challenges meeting these needs, resulting in poorer patient outcomes and occupational stress for the physiotherapist. Lack of organisational support from the Health Service Executive (HSE) was the main inhibiting factor and physiotherapy teamwork and line management support were cited as the main factors facilitating the provision of a quality service for people with neurological conditions in primary care.
CONCLUSION: Physiotherapists identified a mismatch between their ideal service standard and the practice reality of physiotherapy service provision for pwNC in primary care in Ireland.
Department of Health. National policy and strategy for the provision of neuro-rehabilitation services in Ireland 2011-2015 [Internet]. Government Publications; 2011 [cited 2012 Sep 14]. Available from http://www.stroke.ie/media/pub/stroke.ie/neuro_rehab_policy.pdf
2.
World Health Organisation. Neurological disorders: Public health challenges [Internet]. WHO Press; 2006 [cited 2012 Sep 14]. Available from http://www.who.int/mental_health/neurology/neurdiso/en
3.
Neurological Alliance of Ireland [Internet]. The future for neurological conditions in Ireland: A challenge for healthcare; an opportunity for change, an essential guide to neurological care in our health services; 2010 [cited 10 Jan 2013]. Available from http://www.thehealthwell.info/node/94310
4.
National Council on Ageing and Older People [Internet]. Population Ageing in Ireland. Projections 2002-2021; 2004 [cited 2013 June 10]. Available from http://www.ncaop.ie/publications/research/reports/81_Pop_Proj.pdf
5.
Council for Stroke. National clinical guidelines and recommendations for the care of people with stroke and transient ischaemic attack (revised version) [Internet]. Irish Heart Foundation; 2009 [cited 2012 Sep 14]. Available from http://www.irishheart.ie/media/pub/strokereports/FinalMarch2010.pdf
6.
TaubE, MillerNE, NovakTA, CookEW, FlemmingWC, NepomuccenoCS, et al. Techniques to improve chronic motor deficit. Arch Phys Med Rehabil1993;74:3347–354.
7.
MehrholzJ, FriisR, KuglerJ, TworkS, StorchA, PohlM. The role of treadmill training for people with Parkinson. Cochrane Database Systematic Review2010;20(1). doi: 10.1002/1465185
8.
KhanF, AmatyaB, Turner-StokesL. Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis. Neurology Research International Volume 2011, Article ID 740505, 22 pages, doi: 10.1155/2011/740505
9.
National Physical and Sensory Disability Database Committee. Annual report of the national physical and sensory disability database committee [Internet]. Health Research Board 2010 [cited 2014 Jan 10]. Available from http://www.hrb.ie/health-information-inhouse. . .disability/npsdd-publications/
10.
HorganF, HickeyA, McGee H, O’NeillD. National audit of stroke care [Internet]. Irish Heart Foundation; 2008 [cited 2013 15 March]. Available from http://www.epub.rcsi/psycholrep/17/
11.
Health Service Executive. National Clinical Programme for Neurology. Model of Care [Internet] Health Service Executive; 2016 [cited 2017 26 April]. Available from http://www.hse.ie/eng/services/publications/Clinical-Strategy-and-Programmes/Neurology-Model-of-Care.pdf
12.
Neurological Alliance of Ireland. Living with a Neurological condition in Ireland. A report on the findings of a national survey [Internet] Neurological Alliance of Ireland; 2014 [cited 2015 15 September]. Available from htpp://www.nai.ie/assets/8/ADEF89E9-0845-E6A8-C4AFE69B3E2958C_document/NAI_Survey_A4_1_.pdf.
13.
LonerganR, KinsellaK, FitzpatrickP, DugganM, JordanS, BradleyD, HutchinsonM, TubridyN. Unmet needs of multiple sclerosis patients in the community. Mult Scler Relat Disord2015;4(2):144–50. DOI: 10.1016/j.msard.2015.01.003
14.
ScottS, KeatingL. National survey of stroke services in primary care in Ireland - A study of Allied Health Professionals [Unpublished dissertation]. School of Physiotherapy, Royal College of Surgeons in Ireland;2011.
15.
BeestonS, SimmonsH. Physiotherapy practice: Practitioners’ perspectives. Physiother Theory Pract1996;12:231–41.
16.
DavidsonI, WatersK. Physiotherapists working with stroke patients. A national survey. Physiotherapy2000;86(2):69–80.
17.
BourneJA, DziedzicK, MorrisSJ, JonesPW, SimJ. Survey of the perceived professional, educational and personal needs of physiotherapists in primary care and community settings. Health Soc Care Community2007;15(3):231–7.
18.
SackleyCM, LincolnNB. Physiotherapy treatment for stroke patients: A survey of current practice. Physiother Theory Pract1996;12(2):87–96.
19.
BrownLD, FrancoLM, RafchN, HatzellT. 1992. Quality assurance methodology refinement series [Internet] 1992 [cited 5 June 2013]. Available from http://www.hrhresourcecenter.org/node/796
20.
GubaEG, LincolnYS. Fourth generation evaluation. Beverly Hills, CA: Sage; 1989.
21.
OhmanA. Qualitative methodology for rehabilitation research. J Rehabil Med2005;37(5):273–80.
22.
LuborskyMR, RubensteinRL. Sampling in qualitative research. Res Aging1995;17:89–113.
23.
CarpenterC, SutoM. Qualitative research for occupational and physical therapists: A practical guideOxford: Wiley-Blackwell Publishing; 2008.
24.
Mc CollMA, ForsterD, ShorttSED, HunterD. Physician experiences providing primary care to people with disabilities. Health Policy Care2008;4(1):129–47.
25.
BarbourRS. Checklist for improving rigour in qualitative research: A case of the tail wagging the dog?BMJ2001;322(7294): 1115–1117.
26.
BraunV, ClarkeV. Using thematic analysis in psychology. Qual Res Psychol2006;3(2):77–101.
27.
StraussA, CorbinJ. Basics of qualitative researchLondon: Sage; 1990.
28.
GibsonBE, MartinDK. Qualitative research and evidence-based physiotherapy practice. Physiotherapy2003;89(6):350–8.
29.
Association of British Neurologists. Response to the NSF for long-term conditions [Internet]. 2007[cited 16 Sep 2013]. Available from: http://www.theabn.org/abn/userfiles/file/ABN%20Response%20NSF.pdf.
30.
SuddickKM, De SouzaL. Therapists’ experiences and perceptions of teamwork in neurological rehabilitation: Reasoning behind the team approach, structure and composition of the team and teamworking processes. Physiother Res Int2006;11(2):72–83.
31.
Mc CollMA, ShorttS, GodwinM, SmithK, RoweK, O’BrienP, et al. Models for integrating rehabilitation and primary care: A scoping study. Arch Phys Med Rehabil2009;90:1523–31.
32.
SmithSM, O’KellyS, O’DowdT. GPs and pharmacists’ experiences of managing multimorbidity: A pandora’s box. Br J Gen Pract2010;60(576):285–94. DOI: 10.3399/bjg2010
33.
DarkerC, MartinC, O’DowdT, O’KellyF, O’KellyM, O’SheaB. A national survey of chronic disease management in Irish general practice [Internet]. Department of Public Health and Primary Care. Dublin: Trinity College; 2011[cited 21 Oct 2013]. Available from http://www.icgie/go/library/catalogue/item/BA1CO240-118B-41DF-A1C3AEC1CA71BDEC/.
