How does patient education fit into physiotherapy?

Patient education is not just an expectation in physiotherapy management, it’s a fundamental skill that shapes how we practice and the outcomes for our patients. Physiotherapists are well-positioned to deliver tailored education, bridging the gap between clinical expertise and patient understanding (Davis & Chesbro, 2003; Jette et al., 2005).

Patient education as part of physiotherapy has developed significantly over time. Historically, educating patients followed a biomedical model in which the social, psychological and behavioural aspects of the patient were not often considered (Engel, 1977). The practitioner tended to make decisions unilaterally for the patient and patients were often viewed as passive receivers of information (Wade & Halligan, 2004). In the last few decades, healthcare practitioners have transitioned to the biopsychosocial model which recognises that disease and suffering result not only from abnormalities at the molecular level, but also at the societal level. This model highlights the importance of the patient’s personal experience to diagnose, and provide positive outcomes and holistic care (Borrell-Carrio et al., 2004).

Building on this transition, shared decision-making and patient-centred care have been increasingly adopted in physiotherapy, further influencing the delivery and content of physiotherapy education (Elwyn et al., 2012; Coulter & Collins, 2011). This model requires a well-rounded and active approach to treatment and demands that education be at the forefront of treatment to enable patients to make informed decisions about their management (Lorig & Holman, 2003). Acknowledging the evolution of patient education is key to deliver collaborative, individualised and relevant instruction.

Patient education has now been integrated into physiotherapy practice standards (Physiotherapy Board of Australia, 2023) and is considered a core component of care across various clinical areas. In musculoskeletal (Koes et al., 2010; Ernstzen et al., 2016), neurological (Nielsen et al., 2014), and cardiorespiratory settings (Bott et al., 2009; Langer et al., 2009), education is embedded in evidence-based clinical guidelines. Research consistently demonstrates that structured education enhances patient knowledge, corrects misconceptions, and improves self-efficacy, ultimately leading to better pain management, improved function, and reduced disability (Clarke et al., 2011; Louw et al., 2011; Van Oosterwijck et al., 2013; King et al., 2016).

The vast majority of physiotherapists recognise education as an essential part of their role, with over 90% incorporating it into daily practice (Roberts et al., 2013; Forbes et al., 2017). Studies estimate that around 12.5% of consultation time is dedicated to education (Roberts et al., 2013), with Australian physiotherapists spending anywhere from 6 to 20 minutes providing education during both initial and follow-up consultations (Forbes et al., 2017).

One of the most useful aspects of patient education is its adaptability, allowing physiotherapists to deliver information or teach skills through various methods such as verbal explanations, written materials, technology, and hands-on demonstrations. This flexibility allows patients to receive information in a format that best suits their needs, making it easier for them to understand and apply in their daily lives (Boland, Pigott & Forbes, 2022; Forbes et al., 2017).

Knowledge and skills needed for effective patient education in physiotherapy

Recognising the central role of education in physiotherapy, a 2018 Delphi study using expert physiotherapists identified core knowledge, skills and abilities or competencies for the profession. These competencies outline what physiotherapists, at all levels of experience, should be able to achieve in patient care, adapted to their specific practice context. They also emphasise the diverse range of skills required to effectively support patient learning and engagement in clinical practice.

These are the ability to:

1. Understand the role of patient education
2. Understand the impact of social, cultural, and behavioural variables on patient learning
3. Understand the principles of adult learning
4. Integrate evidence-based practice into patient education
5. Seek patient perceptions and concerns using appropriate questioning
6. Obtain information from the patient assessment to understand learning needs
7. Utilise reflective questioning
8. Use shared decision-making
9. Select and use a range of appropriate learning content tailored to the patient
10. Provide content that is in the best interests of the patient
11. Use communication styles, language, and materials that are tailored to the patient
12. Effectively explain the patient’s condition
13. Provide self-management education and reinforce the patient’s ability to manage
14. Provide family or caregivers with information (where present)
15. Control attention and engagement throughout the educational intervention
16. Effectively summarise information
17. Consistently and regularly review progress of patient learning
18. Use the “teach-back” method to evaluate understanding
19. Identify when educational needs have been met
20. Recognise and manage barriers to effective education
21. Continue to develop patient education skills
22. Provide education within limits of practice, seeking advice or referring to another professional where appropriate

These competencies can be helpful to think about the knowledge and skills you might need to be able to practice patient education and later on, you will recognise some of these key skills being used.

Are we currently effective in educating patients?

Even though patient education is viewed as a fundamental part of physiotherapy,  its delivery in practice remains inconsistent. Research suggests that education is often unstructured and informally woven into treatment, rather than intentionally planned (Gregor, 2001; Hult et al., 2009; Gahimer et al., 1997; Rindflesch, 2009; Breese & French, 2012).

While physiotherapists recognise the  importance of education, it has traditionally been delivered alongside other treatment modalities. This approach can occasionally allow education to emerge organically and remain patient-centered, but it often results in variability and a lack of structure (Harman et al., 2011). Given the time constraints of clinical practice, an informal approach is often necessary. However, even brief interactions can be made purposeful, structured, and evidence-based (Dunn & Milheim, 2017).

This highlights an important challenge: How can we as physiotherapists deliver education in a way that is both structured and practical within the constraints of a busy clinical setting? Bridging this gap is essential for ensuring that patient education is not just something we do, but something we do well.