In direct access physiotherapy, physiotherapists use their competencies to encourage clients with musculoskeletal conditions to actively engage in their self-care

What did you study?

I studied direct access physiotherapy from the perspectives of educators, physiotherapists, and clients. By interviewing educators, I explored their views on the competencies and training of direct access physiotherapists. Through interviews with physiotherapists, I examined how they describe their clinical reasoning when assessing working-age clients with low back pain in direct access physiotherapy. I also investigated the experiences of working adults with low back pain regarding pain, fear of movement, and self-care over a 12-month follow-up period.

What were the key findings of the study?

The core competence of physiotherapists in direct access practice is clinical reasoning, which is constructed through meaningful interactions with the client. The physiotherapists I interviewed applied their clinical reasoning either by forming and testing hypotheses or by using a systematic ‘checklist’ approach. The ability to engage in continuous learning was also considered an essential skill in direct access practice.

Clients described using various strategies to cope with pain, possible fear of movement, and to carry out their self-care. In my study, clients appeared in either a “pilot” or a “passenger” role. “Pilots” reported trusting the physiotherapist’s assessment and explanations of the causes of their pain, and they adopted active strategies to use their back more confidently and to relieve pain. In contrast, “passengers” described seeking medical explanations for their pain, avoiding movements that might cause discomfort, and relying more on passive pain management strategies such as medication and rest.

How can the findings be utilized?

The study has broadened understanding of physiotherapists’ competencies and how these can be used to support clients’ self-care and the adoption of an active role. It is important that clients seeking care for pain receive an understandable explanation of their condition and individualized guidance for self-care.

Based on my findings, direct access physiotherapy is a useful approach to address pain at its early stage. Clients perceive physiotherapy as meaningful in supporting physical activity and in reducing fear of movement.

This dissertation was funded by The Finnish Work Environment Fund, HUS Nursing Research Center, former HUS Hyvinkää hospital district area and Finnish Association of Physiotherapists.

Opponent: Professor Mari Lundberg, Sophiahemmet University (Sweden)

Custos: Senior Lecturer Pirjo Vuoskoski, University of Jyväskylä, phone +358404808054

Defense language: English

More information: mmroine@gmail.com