How do experiences of physiotherapy and osteopathy vary between NHS and private practice?

Abstract

Previous research had shown that experiences of treatments vary between NHS and private practice. It was unclear whether different treatments might vary in the same or in different ways between healthcare sectors. This thesis explored how experiences of physiotherapy and osteopathy vary between NHS and private settings.

Study 1: A systematic review of the literature identified psychosocial factors which are likely to be important within physiotherapy for lower back pain.

Study 2: A qualitative interview study explored the experiences and appraisals of 35 patients who had received NHS or private physiotherapy or osteopathy for lower back pain. This study indicated that physiotherapy and osteopathy do not vary in the same ways between healthcare sectors.

Study 3 and 4: Mixed methods were used to develop and establish the face validity, internal consistency and structural validity of a new measure of treatment appraisal, the Appraisals of Physical Treatments Questionnaire (APTQ).

Study 5: The APTQ and other measures of treatment appraisal were then examined in a cross-sectional questionnaire study (n=91) which explored how and to what extent aspects of treatment appraisal vary between healthcare sectors and treatment types. There were ceiling effects in many of the measures, although some aspects of treatment appraisal varied in ways which were consistent, or partially consistent, with the hypotheses.

Study 6: Finally, study 6 looked at practitioners’ (physiotherapists’ and osteopaths’) experiences of treating lower back pain in the NHS and private practice. Practitioners’ reports largely confirmed those of patients, indicating that physiotherapy and osteopathy do not vary in the same ways between healthcare sectors. Factors that might be responsible for the differences in patients’ experiences of NHS and private physiotherapy and osteopathy were also identified and organised into a model.

Physiotherapy and osteopathy did not appear to vary in the same ways between healthcare sectors, indicating that the healthcare sector might not have a uniform influence on treatments.

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Identifiers

ORCID for Katherine Bradbury: orcid.org/0000-0001-5513-7571

ORCID for Felicity L. Bishop: orcid.org/0000-0002-8737-6662

ORCID for Lucy Yardley: orcid.org/0000-0002-3853-883X

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