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Enhancing Physical Therapy for Elderly Patients: The Importance of the Therapist-Patient Relationship

Jason A. Dauenhauer, MSW, Paul R. Katz, MD, Jurgis Karuza, Ph.D., Richard Frankel, Ph.D. Finger Lakes Geriatric Education Center at the University of Rochester Ernest Nalette, Ed.D., PT Ithaca College Department of Physical Therapy

Abstract

Objective: Explore ways to enhance the geriatric education of graduate physical therapy students. Methods: A total of four focus groups were conducted between June 1999 and January 2000 with the intent of identifying challenges associated with treating older adults. The groups included practicing physical therapy clinicians and faculty, two groups of Masters-level physical therapy students, and one group of elderly respondents who had received physical therapy services during 1999. As this was an explorative study, focus group participants were selected as part of a convenience sample from a local metropolitan area. Using a semi-structured interview guide, an experienced moderator facilitated each focus group. Questions targeting physical therapy clinicians, faculty, and students were designed to elicit information about the respondents' experiences associated with treating older adults as well as information about enhancing the current training being offered to students. Elderly respondents were asked to describe their physical therapy experience and offer suggestions as to how their experience could have been improved. Audio recordings from each focus group were transcribed and formatted using a qualitative analysis software program. The text was then analyzed using an editing-organizing qualitative research approach. Results: Findings indicate that the role of the physical therapist in the treatment of patients, including the elderly, is one that includes a combination of technical (cold) and relationship-building (warm) competencies. Relationship-building competencies were emphasized by students and patients, and to a lesser degree by clinicians and faculty. Given the current health care environment some therapists were not able to provide the necessary level of services to their patients, of which the therapist-patient relationship is key. Students were unsure if content related to warm competencies belonged in the curricula, commenting that learning these skills through experience is most effective. Faculty also had similar beliefs and questioned whether or not these skills could actually be taught in a classroom setting. Conclusion: The challenge for academic and clinical educators is to prepare students to practice physical therapy in a health care system that does not always value the importance of the therapist-patient relationship.

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