“I Don’t Have a Magic Wand”: The Why and How of Patient Education in Outpatient Physical Rehabilitation

PURPOSE: The present study aimed to explore occupational therapists’ perspectives of patient education in outpatient physical rehabilitation. Patient education is an intervention that influences both health care processes and outcomes. It is particularly significant in outpatient rehabilitation because of a low ratio of clients’ time under medical supervision to unsupervised time outside the clinic. The nature of patient education is evolving with shifting conceptualizations of health and provider-patient relationships. Specifically, the rising incidence of chronic conditions has promoted a shift from unidirectional instruction towards collaborative models of empowerment. Studies of health care professionals illustrate a spectrum of perspectives of patient education that influence intervention planning and implementation. However, to date, there is limited understanding of occupational therapists’ conceptualization of patient education and how they engage with the shifting intervention within the larger philosophical basis of occupational therapy.

DESIGN: The present preliminary investigation used an interpretive descriptive design. Four occupational therapists ages 31-41 volunteered to participate. Their clinical experience ranged from 8-18 years. All were employed in outpatient physical rehabilitation with a practice emphasis on upper extremity musculoskeletal conditions.

METHOD: Each participant engaged in one semi-structured interview with a pair of graduate students via Skype. A responsive interviewing model was used, including an interview guide with open-ended questions and probes. Audio recordings of the interviews were transcribed using intelligent verbatim transcription. Data were thematically analyzed using open hierarchical coding. Visual diagramming was used to reflect on the themes and their relationships. Emerging findings were discussed as a group to achieve interpretive consensus and increase trustworthiness.

RESULTS: The central category that emerged from the data was “I don’t have a magic wand,” a response that drove the purpose and process of patient education by respectively acknowledging the complexity of facilitating health outcomes and instructing clients. Participants recognized the value of patient education to share responsibilities with the client during recovery and to gain client buy-in to increase adherence. They also identified customization based on clients’ personal and diagnostic factors as critical in maximizing the intervention’s impact. They reported evolution of the why and how of patient education within the context of their own professional development.

CONCLUSION: Participants perceived a collaborative approach as the hallmark of both the purpose and process of patient education. Their perspective is consistent with the departure from paternalistic models of health care in chronic conditions and aligns with occupational therapy’s agentic and client-centered philosophy. Despite the limitation of the small homogeneous sample, the novelty of the findings is strengthened by considering the participants’ practice emphasis. Findings support participants’ use of patient education in ways that resist traditional biomedical models of care often attributed to clinicians treating musculoskeletal conditions. In addition, the finding that participants perceived the skill of collaborative patient education as exceeding their entry-level training demands critical investigation of professional and post-professional training for this intervention. The present study highlights the need for additional investigation of patient education as an occupational therapy intervention as it evolves beyond instruction to facilitation and support for client self-determination.

References

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Mroz, T. M., Pitonyak, J. S. Fogelberg, D., & Leland, N. E. (2015). Client centeredness and health reform: Key issues for occupational therapy. American Journal of Occupational Therapy, 69, 1-8. https://doi.org/10.5014/ajot.2015.695001

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