Characteristics and experiences of physical therapist-parent goal-setting interactions in out-patient pediatric physical therapy in Saudi Arabia: a mixed methods study

Reema Abdullah Shubaily

doi:10.17918/00011061

Background and Purpose. Collaborative goal-setting (CGS) with families is endorsed as best practice in pediatric rehabilitation as it aligns with family-centered services and benefits both therapists and families. However, CGS implementation is considered challenging and the extent of its application in out-patient pediatric physical therapy settings is limited to self-reported data. The purpose of this research was to establish knowledge on the characteristics of the CGS process in out-patient pediatric physical therapy settings in Saudi Arabia and on the experiences of parents and physical therapists (PTs) with this process. Methods. I used an explanatory sequential mixed methods design with a quantitative phase followed by a qualitative phase. Quantitively, I recruited 20 PT-child-parent triads from Riyadh in which I observed and audio-recorded the initial and second out-patient pediatric physical therapy sessions for each child. I measured PT-parent's quality of interactions using the Pediatric Evaluation Measure of Engagement-Observation version and their interaction behaviors around goal-setting using the Collaborative Goal-setting Assessment Tool (CGSAT). I assessed the associations of PTs' quality of interactions with parents and their behaviors with PTs' family-centered service beliefs, communication skills, and expertise indicators. I assessed the associations of PT-parent interaction behaviors with parents' socioeconomic status and their familiarity with pediatric rehabilitation services. Qualitatively, I interviewed a subsample of eight PT-parent dyads from the quantitative phase to describe their goal-setting experiences and identify the barriers and facilitators to CGS from their perspectives. Results. PTs and parents demonstrated moderate foundational engagement in their quality of interactions, with PTs performing an average of 50% of CGSAT behaviors and parents performing 71%. Both groups showed higher performance in the initial therapy interactions (73%) and concerns clarification (60%) subsections of the CGSAT, compared to lower performance in the goal-setting process (33%) subsection. No significant associations were found between PTs' quality of interactions with parents and their behaviors with PTs' selected characteristics. No significant associations were found between PT-parent interactions and selected parents' characteristics. We identified three themes that describe PTs' and parents' goal-setting experiences and their perceptions of CGS barriers and facilitators: 1) What we bring to the initial therapy encounter matters, 2) CGS is an indistinct and multidetermined phenomenon, and 3) Intervention, rather than goal-setting, is the central focus of PTs and families. Conclusion. This study describes and characterizes PT-parent interactions with a focus on CGS during the start of physical therapy services for young children in out-patient settings in Riyadh, Saudi Arabia. The findings of the quantitative and qualitative phases of the study demonstrate that PTs share and gather information related to the child with parents during the sessions with less emphasis on CGS with parents. PTs and parents identified multilayered factors that influence CGS at the family, PT, and organizational levels.

Characteristics and experiences of physical therapist-parent goal-setting interactions in out-patient pediatric physical therapy in Saudi Arabia: a mixed methods study

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Characteristics and experiences of physical therapist-parent goal-setting interactions in out-patient pediatric physical therapy in Saudi Arabia: a mixed methods study

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