'Their role has a lot of purpose beyond being just being about exercises': a qualitative study of patients' experiences of physiotherapy following a mild traumatic brain injury

Abstract

Following a mild traumatic brain injury (mTBI; also known as concussion), physiotherapists may be involved in injury identification, assessment and rehabilitation. However, how people perceive and experience the physiotherapist's role is not well understood. Semistructured interviews were undertaken with patients who saw a physiotherapist individually or as part of a multidisciplinary team following mTBI in New Zealand. Interviews were recorded, transcribed verbatim and analysed using the interpretive descriptive approach. A total of 12 interviews were held with participants aged 19-67 (50% female; mean age 37 (SD=14.8) years) who had a mTBI on average 9 (SD=8) months ago. Thematic coding of interviews generated four themes, each supported by three to five categories representing their experiences: (1) 'How physiotherapy could help me'-representing how the interventions were delivered; (2) 'Empower me to manage my mTBI'-representing participants learnings to self-manage; (3) 'Set me up to get the most out of treatment'-representing considerations needed before, during and after practice to maximise engagement and (4) 'Get to know me and what's important to me'-representing the importance of considering the person as a whole, and preferences for assessment, intervention, communication and culture throughout service delivery. Overall, participants reported variable mTBI care experiences yet perceived the physiotherapist as having a key role in supporting self-management and treating headaches, neck pain and balance issues. mTBI physiotherapy care needs to be more attuned to patients' preferences and circumstances and delivered in a way that maximises rehabilitation outcomes. Building effective therapeutic connections with patients may be key to addressing these concerns simultaneously in practice.

Keywords: concussion; physical therapy; physiotherapy; qualitative research.

Figure 1. Practice points for effective mTBI care, incorporating the themes ‘Empower me to manage my mTBI’, ‘Set me up to get the most out of treatment’ and ‘Get to know me and what’s important to me’ to build-up theme 1: ‘How physiotherapy could help me’. mTBI, mild traumatic brain injury.