'Tell me about your troubles': description of patient-physiotherapist interaction during initial encounters.
OBJECTIVE
Communication skills are essential for physiotherapy practice. It has been shown that patients, especially those with chronic pain problems, are more satisfied with services when therapists communicate adequately. The objective of this study was to explore how French-speaking physiotherapists and patients with low back pain explore and assess the patient's pain experience during initial encounters.


METHODS
The initial consultation of six consenting patients with low back pain and two physiotherapists was videotaped. Conversation analysis was used to describe and analyse the communication practices related to pain assessment.


RESULTS
When physiotherapists explored patients' pain experience, they specifically focused on the impact of pain on function. The observed physiotherapists used the following communication strategies: 1) using yes/no questions and 'okay' as a resource to shift to a new topic; 2) following documentation quite stringently without allowing digression; 3) building the next question on the basis of the patient's discourse; 4) inviting the patient to talk using formulations such as 'tell me about your troubles?'; and 5) using gaze and nodding as continuers. The physiotherapists used two different approaches to close the encounter. While one therapist chose to summarize the consultation, including a prognostic assessment, the other one ended the consultation by organizing the follow-up consultation.


CONCLUSIONS
This exploratory study examines the interaction between patients and physiotherapists during initial encounters and identifies assumptions underlying pain assessment that shape the therapists' exploration of patients' pain experience. It also shows evidence of the physiotherapists' difficulties to inquire about the patient's perspective.
University of Applied Sciences and Arts Western Switzerland (HES-SO), University of Health Sciences (HESAV), Avenue Beaumont, Lausanne, Switzerland.
Emmanuelle
E
Opsommer
Veronika
V
Schoeb
D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D010361:Patients; D059825:Physical Therapists; D026741:Physical Therapy Modalities; D011379:Prognosis; D012017:Referral and Consultation; D014743:Videotape Recording
conversation analysis; low back pain; observational study; physiotherapy