Background:Feedback is information given to a person about their status; this can be in the form of outcome data. Feeding outcome data back to patients has been shown to increase treatment involvement (compliance) and improve therapeutic relationships, however the effect in physiotherapy has not been tested.
Methods: A realist evaluation study was designed to explore patients' experiences of the feedback of outcome data by physiotherapists. Ethical approval was gained from the NHS, local research and university research ethics committees.
Patients with shoulder impingement were recruited and consent gained in one North West NHS trust. Participants attended between one and eight physiotherapy sessions and completed a shoulder-specific outcome measure (QuickDASH) at each one. The score was plotted onto a graph at each appointment and discussed with the participant. 25 semi-structured interviews were conducted with patient participants after completion of treatment. Topics discussed were based on a middle range theory: The Contextualised Feedback Intervention Theory (CFIT, Sapyta, Riemer, & Bickman, 2005). Data were then analysed to test consistency with the Contextualised Feedback Intervention Theory. Interview data were explored and analysed using storyboards, narrative analysis and open coding to develop Context, Mechanism and Outcome configurations.
The three research physiotherapists were then interviewed in line with a realist approach to discuss and modify Context, Mechanism and Outcome configurations based on their experiences of the feedback intervention with patient participants.
Results: Analysis revealed CMO configurations suggesting a two way feedback process: Patients feeding back progress for the benefit of the physiotherapists, whereas the physiotherapists were giving feedback for patient benefit. This two way process linked to improvement in patient shoulder outcome measure scores.
Feedback could have a positive outcome for some patient participants, identifying feedback triggering patient actions showing improvement, whereas for some if the goal was too large or too small, there was disengagement with treatment.
Feedback appeared to be used well by patient participants as a generalised measure of shoulder recovery but for those with specific work and sport related activities, feedback was more often than not discarded.
Conclusion: How participants used feedback was complex. The two way process of feedback between physiotherapist and patient was something undisclosed within the therapeutic relationship and clinic environment, but which influenced the CFIT process being successful. The study suggests the CFIT works for patients with generalised shoulder problems who are motivated, with goals large enough to be problematic, but not small enough to be insignificant to everyday life.
The study results outlining why, who and under what circumstances feedback (specifically the CFIT) works in practice, may assist physiotherapists in selecting specific shoulder pain patients to use feedback intervention with, to essentially aid those patients to achieve their full clinical potential.
Reference: Sapyta, J., Riemer, M., Bickman, L. Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology, 2005. 61(2): 145-153.
Please select one of the following:: Realist evaluation , Please select a maximum of two themes from the following list:: Exploring 'Mechanisms' , Please select a maximum of two themes from the following list:: Theory in Realist Approach
