Home-Based Physiotherapy for the Elderly: A Different World

Abstract

Purpose: Recent changes in health service delivery have resulted in a shift in provision of services from the hospital to the community. These changes require an examination of the knowledge and skills used by physiotherapists working in the home setting. The purpose of this study is to understand the practice of physiotherapy within the context of the elderly client's home. Method: Using semistructured interviews with 12 home-based physiotherapists, a focussed ethnographic approach was used to explore the practice of home care physiotherapy in Ontario. Data were analyzed using a coding/categorizing approach. Results: The client's home as the context in which physiotherapy services are provided has meaning beyond merely the location where the therapeutic intervention occurs. Practicing in the world of the client requires a broad array of knowledge and skills that go far beyond notions of traditional physiotherapy. Physiotherapists in the community rely heavily on their tacit, professional craft knowledge, but, ironically, they often feel that these skills are not “really” physiotherapy. Conclusions: The findings highlight the need to expand our notions of professional knowledge beyond traditional propositional knowledge to include professional craft knowledge.