The Patient’s responsibility
Analysis of what makes up good health (based within the modifiable factors) has reported that medical care represents only 20%, with the remainder being divided between economic issues (40%), environmental factors (10%) and behavioural patterns (30%) (Hood, Gennuso, Swain, & Catlin, 2016)
Of these 4 key areas, in some cases, the physiotherapist may only work with the health behaviour aspect and because of this, it is difficult for the health professional (in this case the physiotherapist) to have total influence on all the variables that make up the clinical condition of a patient. That said, involving and encouraging the patient in the value of the treatment is something that should be part of the consultation priorities (World Health Organization, 2003).
Despite all the treatment that can be provided by the physiotherapist, the recovery also very much depends on the patient’s personal desire to improve. If the patient is not aware of the importance of adhering to the therapeutic process (“therapeutic adherence” is the way in which the patient’s behaviours meet the recommendations of the health professional (World Health Organization, 2003), the benefits on the patient’s health in the long term will be reduced (Nicolson, Bennell, Dobson, Ginckel, Holden, & Hinman, 2017). A patient may think they can recover simply by being with the physiotherapist. However, mathematically it is easy to demonstrate that this is not so straight forward. Each session with the physiotherapist will ideally last between 30 minutes to 1 hour and this could be repeated 2 to 3 times in the same week – equal to 2 hours a week minimum. Two hours a week of contact with the physiotherapist is not sufficient for full recovery especially as it leaves 166 hours a week in which this direct contact does not happen.
According to the WCPT (World Confederation of Physical Therapy) physiotherapists, in addition to the technical skills related to the assessment and diagnosis of the clinical condition and the development of a recovery plan, the physiotherapist should be able to instruct the patient in self-management of their condition. Educating the patient and making them aware of the influence that certain behavioural patterns may have on their recovery should be part of the physiotherapist’s normal routine (Bulley, Donaghy, Coppoolse, Bizzini, & van Cingel, 2004).
Programmes that implement patient empowerment promote better communication between the therapist and patient and consecutive gains in patient self-confidence (Kennedy A, 2007). If the patient becomes more capable, the probability of recovery being negatively affected by external factors outside of the physiotherapist’s control will be reduced.
Therefore, it is the responsibility of the physiotherapist to be able to train, instruct and educate, but it is also the responsibility of the patient to commit to the treatment plan.
Although apparently miraculous recovery plans are increasingly available, health improvement tends to occur only with behaviour change rather than medical innovation or specific medical treatments (World Health Organization, 2003) (Schroeder, 2007).
Let physiotherapy be a way and not an end.
A, J., Katula, Sipe, M., Rejeski, W. J., & Focht, B. C. (2005). Strength Training in Older Adults: An Empowering Intervention. MEDICINE & SCIENCE IN SPORTS & EXERCISE.
Bulley, C., Donaghy, M., Coppoolse, R., Bizzini, M., & van Cingel, R. (2004). Sports Physiotherapy Competencies and Standards. Sports Physiotherapy For All Project.
Hood, C. M., Gennuso, K. P., Swain, G. R., & Catlin, B. B. (2016). County Health Rankings- Relationships Between Determinant Factors and Health Outcomes. American Journal of Preventive Medicine.
Kennedy A, R. D. (2007). The effectiveness and cost of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health, 254–261.
Nicolson, P. J., Bennell, K. L., Dobson, F. L., Ginckel, A. V., Holden, M. A., & Hinman, R. S. (2017). Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis. Br J Sports Med.
Schroeder, S. A. (2007). We Can Do Better — Improving the Health of the American People. The new england journal of medicine.