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Why questioning assumptions is important to discover buried treasures - diving deep into the physio/patient disconnect

Why questioning assumptions is important to discover buried treasures - diving deep into the physio/patient disconnect

Prior to embarking on any behaviour change journey, we must ask ourselves “What is the problem here?”. Knowing what problem you are trying to solve is important to identifying the best way to solve it. Makes sense, right?

You might think, or assume, you know what the problem is. After all, you might work in an industry where the problem occurs everyday, right in front of your face. But wait! Looks can be deceiving. As Dr Brea Kunstler tells us, you might be wrong. 

Maintaining a physically active lifestyle is important for our health and wellbeing. However, studies have shown that adults and many adolescents worldwide are not meeting the minimum required physical activity recommendations. Physiotherapists are suitably skilled and qualified to improve their clients’ (also referred to as patient) physical activity levels, and should offer this advice if they aim to provide the highest quality of service to improve their clients’ physical health… 

So, why aren’t they?

Questioning assumptions

BehaviourWorks Australia Research Fellow, Dr Brea Kunstler, published a study back in 2018 that explored what physiotherapists do when encouraging their clients to become more physically active. What the study found, however, was that physiotherapists were deterred from giving such advice in the first place, as they believed that encouraging increased physical activity was not a service patients wanted from their physio. The problem seemed to sit with the patients. If they did not want advice on physical activity, then what was the physiotherapist to do?

The question still stood: how can physiotherapists encourage patients to become more physically active? And to help physiotherapists: what can be done to convince patients that this advice is valuable to improve their health?

In 2018, Brea was able to explore this question again with co-authors from La Trobe University, RMIT and the University of Melbourne. However, by taking a step back and firstly asking “what do we actually know about what patients expect from their physios”, the research group came to an unexpected finding.

In a paper published in 2019, Brea and her co-authors demonstrated how important it is to question assumptions. According to the survey led by the group, physiotherapists had been wrong in assuming physical activity advice was not what patients wanted. Patients appear to expect physical activity advice from physiotherapists, more so than services like massage, which physiotherapists assume patients want more of. 

A blatant disconnect. So, where did it come from?

Sitting down with Dr Kunstler, she admits she finds these results fascinating. “It’s almost like a bickering couple… one assumes something of the other and hesitates to bring the issue up, and the other doesn’t realise there was anything wrong in the first place! It’s a communication problem.” The hesitation to give physical activity advice felt by physiotherapists could simply be narrowed down to a misunderstanding - a disconnect between the service provider on customer (or patient) expectations, and customer’s actual expectations.

Addressing the hesitancy

Brea and her colleagues explored this disconnect and proposed a theory to explain it in a paper published in 2021. They theorised that hesitation to provide physical activity advice could be due to a possible disconnect between the physio’s perception of the value of physiotherapy services that is co-created in the physiotherapy clinic (“joint sphere”) vs. the outside of the clinic (“customer sphere”).

According to Dr Kunstler, “Whatever advice physios may give to their patients to increase their physical activity involves the client acting on that advice in their own time and environment [without a physiotherapist there, the “customer sphere”]. This extra time could be taken as an extra cost outside of the costs associated with seeing the physio at the clinic [the “joint sphere”], which physios want to avoid as they fear this will dissatisfy their clients.”

So, how do we support physiotherapists in overcoming this hesitancy? How can we help them to not only provide physical activity advice and ignore their assumptions, but to also provide other services that require effort from the client outside of the clinic, such as doing their rehabilitation exercises between appointments? 

One recommendation, offered by Dr Kunstler, could be for physios to find opportunities and capacity to provide services outside of the clinic. “Something that’s become more popular during the pandemic is offering online programs via apps. As a run coach myself, [by offering online programs], I can see when clients have completed a run and when they make comments about their run in real time. So I’m able to offer them my services, outside of the clinic, in real time. So, suddenly, a perceived additional cost [the client’s time going for a run] might in fact become a perceived gain because the client is now getting input from the physio out of session.”

For the patient, this could mean being offered a service that is worthwhile, whilst removing that barrier of hesitancy physios feel when asking a patient to do something in their own time, like acting on advice to become more physically active, ensuring the quality of service patients receive can be at its highest. 

You can read more on explaining hesitancy in physiotherapy here.

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