Exploring the older patient/physiotherapy clinician relationship

Abstract

This thesis seeks to explore and unpick the essence, rationale and role of the therapeutic relationship that occurs between physiotherapy clinicians and their older patients.  To address the rehabilitation needs of the increasing ageing population, a strong evidence base for both the clinical and non-clinical components of the encounter is required.

Participants agreed that a relationship existed alongside, because of and time limited by the intervention, it being an important part of the physiotherapy encounter.  The relationship had professional, human and intrinsic components brought to it by both parties and the service.  Participants, usually unwittingly, play dual roles in the relationship.  The physiotherapy clinician plays both professional role to direct treatment and a befriender role to humanise the experience for the patient.  Older patients adopt a compliant “sick” role legitimising their illness and willingly submitting to treatment.  However, the current health and societal push towards partnership means that the role of partner is imposed on the older patient.  This attempts to narrow the traditional separation of clinician and patient dictated by professional hierarchy with a move towards equality, something that the older patients appear to neither understand nor want.  There is potential for conflict within and between these roles which clinicians and older patients manage in different ways.  The concept of equality in health care is alien to older people and undermining the power differential in the clinical situation may remove the one predictable element in an otherwise perplexing setting.  The findings are possibly limited to the cohort effects of an older population and medium to long-term rehabilitation.

This thesis contributes to an understanding of the role of this relationship within the physiotherapeutic encounter.  The possible implications for physiotherapy education and service delivery are discussed.

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