Patient-centred care and patient-centred education

Physiotherapy is no longer just about treating conditions; it’s about partnering with patients to guide them in managing their health. In recognition of the role of partnership, healthcare has shifted from a practitioner-centred model, where clinicians tended to make decisions for patients (Byrne & Long, 1976; Levenstein et al., 1986), to a patient-centred model, which prioritises collaboration and shared decision-making (Jette, 1994; Shepard & Jensen, 1997; Mead & Bower, 2000). This shift is widely endorsed across healthcare (Epstein & Street, 2011; Cheng et al., 2016) and is now considered a core professional standard in physiotherapy (Physiotherapy Board of Australia, 2023).

At the heart of a patient-centred approach is the understanding that effective patient education is a partnership, not a one-way transfer of knowledge (Dixon-Woods, 2001; Cheng et al., 2016). Rather than simply providing instructions, physiotherapists take on the role of educators, guides, and facilitators, helping patients actively engage in their own care (Martin & Fell, 1999; Jensen et al., 2000; Bauman, Fardy & Harris, 2003). This “patient-centred” approach aims to move patient education into a more dynamic, goal-oriented process, ensuring it is relevant, meaningful, and tailored to each patient’s individual needs (Skelton, 2001; Anderson & Funnell, 2010).

Core principles of patient-centred education

The patient-centred model builds on key principles that shape best practices in patient education (Mead & Bower, 2000). These include:

1. A biopsychosocial approach to care. Recognising that health is influenced by physical, psychological, and social factors.
2. Building connection. Building trust, open communication, and a sense of collaboration.
3. Respecting the patient as an individual. Acknowledging their unique values, experiences, and preferences and explaining their condition in ways they understand (Miciak et al., 2018; Hutting et al, 2022).
4. Using shared decision-making. Engaging patients through open discussion of treatment choices rather than imposing a plan on them (Elwyn et al., 2012).
5. Supporting self-management. Guiding behaviour change and skill development (Hutting et al., 2019; Hutting et al, 2022).
6. Clinician self-awareness. Being able to reflect on biases, assumptions, and communication styles to ensure patient-centred interactions.

Benefits of patient-centred education

Research shows that clear communication, individualised education, and shared decision-making, all components of a patient-centred approach to education, are critical for improving physiotherapy outcomes (Cooper et al., 2008).

When physiotherapists tailor education to individual patients, the benefits extend beyond gains in knowledge. Patient-centred education has been shown to:

• Improve motivation and adherence to treatment plans (Solomon et al., 2002; Coulter & Ellins, 2007).
• Enhance emotional well-being by reducing anxiety and uncertainty (Friedman et al., 2011; Fredericks & Yau, 2017).
• Increase information retention (Liddle et al., 2009).
• Improve self-management skills and problem-solving, helping patients become more active participants in their care (Barr & Threlkeld, 2000; Lorig & Holman, 2003).

Implementing patient-centred education

To integrate patient-centred education into clinical practice, physiotherapists should:

1. Assess our patient’s learning needs. This includes identifying our patient’s concerns, experiences, and preferences (Ndosi et al., 2015).
2. Create open learning environments. This includes encouraging patient participation and allowing patients to openly express their learning needs.
3. Design education based on patient input. Tailoring content to reflect patient experiences and goals (Barbara Klug Redman, 2004)
4. Develop strong communication skills. Use clear, structured explanations and active listening (Persson & Friberg, 2009).
5. Evaluate patient learning. This includes assessing whether the education has led to changes in knowledge, skills, or behaviours (Kripalani et al., 2008; Falvo, 2011).

This approach reinforces the patient’s role as an active participant in their healthcare, rather than a passive recipient of information.

An example of patient-centred principles in action

Let’s look at an example of where some of these principles might be used in practice:

Building connection

The physiotherapist begins by creating a safe and non-judgmental space for Yasmin to share her experiences and her views. Yasmin explains that she feels embarrassed discussing her symptoms and has started avoiding activities she once enjoyed, like running and yoga. She also expresses frustration that previous advice to “just do Kegel exercises” hasn’t helped her.

Shared decision making

Rather than prescribing a one-size-fits-all treatment plan, the physiotherapist discusses the multiple factors contributing to Yasmin’s experience of incontinence based on their assessment findings, including pelvic floor muscle coordination, bladder habits and lifestyle factors. The physiotherapist presents different management strategies, such as:

• Tailored pelvic floor exercises based on an assessment of Yasmin’s muscle control.
• Bladder training techniques to gradually improve bladder control.
• Lifestyle modifications, such as adjusting fluid intake or avoiding bladder irritants.
• Breath control and coordination techniques for activities that cause leaks, like lifting or jumping.

Yasmin is encouraged to discuss and select strategies that feel realistic and sustainable for her daily routine. She expresses interest in practical strategies that allow her to return to yoga without fear of leakage. The physiotherapist ensures she is an active participant in decision-making, increasing her commitment to the plan.

Supporting self-management

To help Yasmin confidently manage her symptoms, the physiotherapist provides clear, tailored education on:

• The role of the pelvic floor muscles and how they interact with breathing, posture, and movement. She relates this directly to Yasmin’s experience and links it to the factors that have specifically contributed in Yasmin’s case such as recent childbirth.

•  How to identify early signs of bladder urgency and strategies to regain control and how Yasmin can implement these effectively into her day.

• How stress and tension affect the pelvic floor, and how relaxation techniques can help, linking this back to experiences that Yasmin has already expressed.

Rather than just sending Yasmin home with exercises, the physiotherapist integrates them into her daily life, teaching her:

  The skills of how to engage her pelvic floor correctly during daily tasks, such as lifting groceries or laughing. Teaching these skills in a gradual and scaffolded way where Yasmin can practice them in the clinic with feedback to make sure she has the hang of it.

  How to modify high-impact activities to reduce leakage while staying active. The physiotherapist explores what these activities might be and problem-solves with Yasmin some strategies that she could use.

  How to track symptoms and progress using a simple bladder diary, empowering her to self-monitor and see improvements over time.

At the end of the session, Yasmin leaves with a sense of control and confidence, rather than frustration and uncertainty. By prioritising Yasmin’s experiences, and preferences, the physiotherapist has allowed the education to be more meaningful, relevant, and practical.

This case highlights how patient-centred education transforms patient education from a prescriptive approach to a collaborative process. Instead of simply telling patients what to do, effective patient education aims to also support and empower, ensuring patients are active participants in their care.