An evaluation of a new domiciliary physiotherapy service
The aim of this research was to undertake an evaluation of domiciliary physiotherapy, by assessing the cost effectiveness of a new Domiciliary Physiotherapy Service (DPS) and by analysing the process of domiciliary physiotherapy practice. The main element of the work was a randomised controlled trial of the DPS, in which an experimental group receiving domiciliary physiotherapy assessment and intervention was compared with a control group receiving conventional care. Hypotheses that domiciliary physiotherapy would improve clients' independence in activities of daily living (ADL) and health status, and reduce clients' use of other services, were tested. The null hypotheses related to ADL and health status could not be rejected, possibly because of a smaller than intended sample size, and/or the masking of real effects by sample attrition, or lack of sensitivity of the outcome measures. There was evidence to suggest that the DPS may have significantly increased, rather than decreased, the proportion of clients with at least one contact with another health or social service. The analysis of the process of domiciliary physiotherapy developed as the RCT progressed. An interpretive account of domiciliary physiotherapy practice, framed within the author's own experiential knowledge, was constructed using quantitative and qualitative data from DPS treatment records, GP referral forms, and interviews with clients, carers and experienced community-based therapists. The interpretive analysis has underpinned a new `reciprocal learning' model of domiciliary physiotherapy, which may assist practitioners working in the field. The way forward for domiciliary physiotherapy practice may be to acknowledge that measurable clinical outcomes cannot easily be determined, and that criteria for assessing the value of domiciliary physiotherapy should be based on client and carer perspectives.