Doctor of Philosophy
Health and Rehabilitation Sciences
Walton, David M.
Kinsella. Elizabeth Anne
McGill University and The University of Western Ontario
The qualities and practices of a ‘good’ physiotherapist have not been systematically reviewed nor have practitioners’ perspectives been empirically investigated. Understanding what constitutes a ‘good’ physiotherapist has potentially profound implications that may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions. The research purpose was to examine perceptions of what constitutes a ‘good’ physiotherapist. This dissertation includes four integrated manuscripts. The first is an integrative review to critically examine how physiotherapists and patients describe the qualities of a ‘good’ MSK physiotherapist as depicted in peer-reviewed literature. Six qualities were identified as: responsive, ethical, communicative, caring, competent, and collaborative. The second and third manuscripts are hermeneutic phenomenological investigations that draw on Joan Tronto’s ethic of care theory as a theoretical perspective. The second manuscript is an examination of twelve physiotherapists’ accounts of what constitutes a ‘good’ physiotherapist garnered from semi-structured phenomenological interviews. Seven themes were identified. Two broad themes highlighted an ethical orientation to care and the integration of person-centered care with evidence-based practice. These were underpinned by more specific themes of ‘being’ competent, responsive, reflective, communicative, and ‘using’ reasoning. The third manuscript was a secondary analysis of data arising in the hermeneutic phenomenological study focused on practitioners’ accounts of ‘responsiveness’ in the practice of a ‘good’ physiotherapist. Six identified themes included: being person-centred, being attentive, being open, being a listener, being validating, and being positive. The fourth manuscript is a reflexive account of my transformed understanding of what counts as professional knowledge in physiotherapy. These studies offer perspectives suggesting the qualities and practices of a ‘good’ physiotherapist are a balance of technical competence intertwined with a relational way of being. An ethics of care is proposed to be central to the practice of a ‘good’ physiotherapist and supported by being responsive as a moral imperative. Practicing with a relational approach within a framework of practical wisdom may facilitate integration of person-centred approaches with evidence-based practices. The findings call into question the profession’s predominant emphasis on a technical rationalist approach to practice, education, and research, and invites conversation about balancing technical competence with relational dimensions of practice.
Summary for Lay Audience
When a person requires physiotherapy to aid in recovery from a muscle or joint injury, surgery, or painful condition, they might seek the services of a ‘good’ physiotherapist either by referral from a health professional or based on the recommendation of a friend. Scholars theorize that a physiotherapist’s qualities and behaviours may influence how well the physiotherapist interacts with patients. Beyond a physiotherapist’s knowledge and skills, the physiotherapists’ qualities and ways of interacting, may also influence how well a patient may recovery.
The purpose of this research was to understand what makes a ‘good’ physiotherapist. The first project involved searching and summarizing research articles that examined how patients and physiotherapists describe the qualities of a ‘good’ physiotherapist. Qualities were categorized under the following headings: responsive, ethical communicative, caring, competent, and collaborative. A second project involved interviewing twelve physiotherapists to ask them what they thought made a ‘good’ physiotherapist. Their viewpoints were organized into seven themes: an ethical orientation to care and the integration of person-centered care with evidence-based practice. These appeared to be supported by more specific themes of ‘being’ competent, responsive, reflective, communicative, and ‘using’ reasoning. The third project examined the theme of ‘being responsive’ in more depth. A ‘responsive’ physiotherapist appeared to include being person-centred, being attentive, being open, being a listener, being validating, and being positive. Another chapter of this thesis offers critical reflections on the researcher’s experiences, and new ways of thinking about the physiotherapy profession’s emphasis on scientific experiments to understand illness and injury over peoples’ understandings and experiences, and their preferences for care.
The findings of this research suggests that a ‘good’ physiotherapist is technically competent, practically wise, and relates with people as equals. Caring appears to be at the heart of the practice of a ‘good’ physiotherapist. Being responsive with patients seems to be an important ethical aspect of a physiotherapist’s caring practice. While physiotherapists are trained to be technically competent, the findings call on educators, researchers, and physiotherapists to also include relationship qualities and behaviours in their teaching, research, and when working with patients.
Kleiner, Michelle J., "Searching for the 'Good' in Physiotherapist Practice: Toward an Ethic of Care" (2022). Electronic Thesis and Dissertation Repository. 8441.
Available for download on Wednesday, March 01, 2023