Professional issues for physiotherapists in family-centred and community-based settings

This paper reports results from a qualitative study of physiotherapists in a community-based and family-centred setting in which a growing awareness of the family-centred approach accompanied the transition from an institutional structure to a predominantly community-based structure. The goal was to gain insight into how a family-centred philosophy was working and to explore the benefits and dilemmas for physiotherapists in such a setting. Semi-structured interviews were conducted with 10 physiotherapists working with children with disabilities. Analysis of the results against a continuum of family control versus physiotherapist control showed that physiotherapists saw their roles as working with the family to discuss shared goals. However, qualitative analyses showed tensions between the policy of family involvement and another influential policy in physiotherapy: evidence-based practice. Further, there were tensions if the desires of the family could not be matched with available resources. The results show benefits and barriers to working in a community-based, family-centred approach. Barriers included practical dilemmas, policy dilemmas, and career dilemmas. This paper argues that, while family-centred practice is supported by the literature and physiotherapists, significant policy and professional issues need to be addressed before such practice can be fully adopted.