Patients', physiotherapists' and other stakeholders' experiences and perceptions about supported home physiotherapy for people with musculoskeletal conditions: a qualitative study

Abstract

Objectives: Exercise, support and advice are the key treatment strategies of musculoskeletal problems. The aims of this study were to determine patients?, physiotherapists?, and other stakeholders? perspectives about supported home physiotherapy for the management of musculoskeletal problems and to identify the barriers and facilitators to rolling out this model of physiotherapy service delivery. Methods: This study was conducted as part of a process evaluation run alongside a large trial designed to determine whether supported home physiotherapy is as good or better than a course of in-person physiotherapy. Forty interviews were conducted with 20 trial participants, 15 physiotherapists, and 5 other stakeholders. The interviews were semi-structured and based on interview guides. Each interview was transcribed and a three-tiered coding tree was developed. Results: Six key themes were identified. Supported home physiotherapy (i) is convenient for some patients, (ii) does not always align with patients? and therapists? expectations about treatment (iii) is suitable for some but not all, (iv) can reduce personal connection and accountability, (v) has implications for physiotherapists? workloads, and (vi) has barriers and facilitators to future implementation. Conclusions: Findings suggest that patients are far more accepting of supported home physiotherapy than physiotherapists assume. This model of service delivery could be rolled out to improve access to physiotherapy and to provide a convenient and effective way of delivering physiotherapy to some patients with musculoskeletal conditions if our trial results indicate that supported home physiotherapy is as good or better than in-person physiotherapy. Clinical trial registry number: ACTRN12619000065190 Contributions of this Paper: ? The findings from this study suggest that supported home physiotherapy is likely to be an acceptable model of service delivery for some musculoskeletal conditions. ? The most notable and perhaps hardest barriers to overcome will be patients? beliefs about the importance of hands-on therapy, and physiotherapists? beliefs that patients will accept nothing less. ? Time will tell whether the recent COVID-19 experience will have a lasting impact on the widespread acceptance of supported home physiotherapy. � 2024 The Author(s)