"If I don't trust them, I shut down": understanding patient and practitioner perspectives of multidisciplinary treatment for people with persistent physical symptoms. A focused ethnography.

Abstract

Despite the high prevalence of persistent physical symptoms (PPS), guidance for rehabilitation services treating people with these symptoms is limited. This study aimed to understand multidisciplinary interventions designed to improve activity and participation within specialist PPS services. A focused ethnography was conducted, including observations, informal conversations and interviews with healthcare professionals and patients, alongside documentary analysis of healthcare records. This was carried out at three specialist PPS services across the UK. Participants included 17 people with PPS and 25 healthcare professionals. Three themes were developed focused on key rationales and experiences of therapy: Reconceptualising activity as a safe possibility; Healthcare professionals showing up with authenticity and curiosity; and Empowering people in their rehabilitation. Collectively, they highlight the multiple ways in which both engaging with healthcare professionals and increasing activity may feel unsafe to people with PPS, the importance of building trusting relationships to overcome these challenges, and the need to attend to dynamics of control within rehabilitation. Building and maintaining trusting therapeutic relationships, that foster shared understandings, and feelings of safety and control when increasing activity, is central in specialist rehabilitation for people with persistent physical symptoms.