Exploring the experiences, perceptions and attitudes of therapists delivering physical rehabilitation in a group format

Annemieke Clark, Lorrie Mohsen, Dr Jayanthi Raman, Prof. Michael Pollack, Bosiljka Vukovic, Kaitlin Bonner, Jennifer King, Rebecca Jepson

Background

Group-based therapy has become a feasible option for delivering rehabilitation economically and efficiently in an overstretched health system1. Emerging evidence also supports many patientreported benefits and acceptance2 . However, research is limited in exploring the opinions and attitudes of therapists involved in delivering group rehabilitation. This study sought to address this gap and identify therapist-reported barriers and enablers impacting effective delivery of physical rehabilitation in a group format.

Methods

This qualitative study used focus group interviews conducted at two private rehabilitation hospitals. Eleven allied health professionals (exercise physiologists, physiotherapists, occupational therapists and allied health assistants) who provide physical therapy to rehab patients consented to participate in the focus groups. The interviews were audiotaped, transcribed verbatim and analysed using a primarily reflexive approach to thematic analysis (TA) (Braun and Clarke, 2006)3 .

Results

The following four major themes were identified:

1. Social benefit: Therapists highlighted that companionship between patients made therapy more enjoyable and motivating. Therapists felt group cohesiveness was essential for success, but sometimes difficult to manage. 2. Acuity matters: Therapists reported that grouping patients with homogenous ability, common goals and needs was favourable. Achieving this in the acute stages of rehabilitation was considered difficult.

3. Factors informing practice: Discussion found a large variance of undergraduate training and education between allied health disciplines, and even academic institutions, on how to facilitate group-based therapy, and knowledge of literature or clinical guidelines to help inform practice was vague. Therapists spoke of organisational and health system pressure to utilise group therapy, conceding that the use of groups was primarily financially driven.

4. Rhetoric vs reality: Therapists reported a belief that groups weren’t always more efficient and could lead to more burden on therapists than conducting treatment one-to-one. Of note, all therapists valued patient-centred care, and there was consensus that a group format may not, by nature, be individualised enough in order to achieve personal goals for some patients.

Discussion

With an expected increase in group utilisation for delivery of physical therapy, it is important to ensure allied health professionals facilitating such groups offer patients treatment that is as effective and person-centred as individual therapy. This study supports that therapists are accepting of group therapy utilisation and favour the psychosocial benefits arising in the group context. Therapists believed group therapy was more successful in the later stages of rehabilitation, and with a more homogenous cohort focused on common goals. With a high variability of undergraduate training and education on group therapy facilitation, organisations would benefit from increasing support and training within the workplace. The development of processes, systems and resources were reported to enable therapists to deliver efficient and effective group therapy at the point of care.

Tips for practice

• Group therapy has many psychosocial benefits for rehabilitation. • Group therapy may be more successful for patients with lower acuity, common goals and similar function. • Therapists benefit from education and training on group management. • According to therapists, a combination of individual and group therapy is the preferred model of therapy delivery

Acknowledgements

This study was partially funded by the Ramsay Hospital Research Foundation Enable Grant and supported by the Hospital Network Research Committee. The time and contribution by the participants of the study are gratefully acknowledged. HREC: Ramsay Health Care NSW/VIC Research Ethics Committee 2021/ETH/0009

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