Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators

Background: In the management of long-term conditions, the role of physiotherapy and the construct of person-centred care are evolving. Though it is discussed thoroughly in some disciplines, theorising about person-centred care is embryonic in the physiotherapy literature, with evidence suggesting ambiguity regarding its conceptualisation and application. Aim: To critically review evidence for barriers to, and facilitators of, person-centred care in adults living with long-term conditions in a physiotherapy context, and identify its components and outcomes in practice. Method: A systematic electronic search strategy to identify quantitative, qualitative and mixed-methods studies that collected data relating to the concept of person-centred care and included physiotherapists working with adults (≥18 years) living with long-term conditions in any setting. Findings: Four quantitative studies, three qualitative and one mixed-methods (a total of eight articles), were selected for critique and synthesis. Outcomes identified by the authors included perceived self-management and ‘patient’-centredness, self-efficacy (assessed using the six-item chronic disease self-efficacy scale, and the pain self-efficacy questionnaire) and quality of life (assessed using the short form-36 quality of life questionnaire). Components of person-centred care were identified as self-management, ongoing care, decision making, individualisation, information sharing and goal setting. Evidence suggests barriers and facilitators may be influenced by the key stakeholders in processes, outcomes and contexts of care delivery. Conclusions: There is limited, mixed-quality evidence in relation to person-centred care in physiotherapy practice for management of long-term conditions. This review synthesises concepts described in the physiotherapy literature in a conceptual framework, which is contrasted with existing models and frameworks relating to person-centred care, to trigger further discussion. Implications for practice: There is a need to study physiotherapists’ awareness of the complexity of person-centred care in practice Quality of evidence is mixed, highlighting a need for further exploration within physiotherapy context