Role of executive autonomy in the effectiveness of physiotherapeutic care.

In order to initiate a physiotherapeutic care, the free and informed consent of the patient / client about the evaluations and interventions essential for the management of his clinical condition is required. It is an ethical principle to respect the patient’s decision-making autonomy, that is, to acknowledge his or her authority over what will or will not be done in relation to his medical care (Beauchamp and Childress, 2001), or any other health care. However, we should not only focus on the patient’s decision-making autonomy, but also on his executive autonomy, described as the patient’s ability to plan, sequence, and perform tasks associated with managing his medical conditions (Naik AD et al.,2009). Especially when dealing with chronic health conditions such as diabetes, hypertension and others. What I understand, with the little practical experience so far, is that we strive to follow the principle of beneficence, formulating physiotherapeutic interventions with predictions of the best results, based on the confidence of our knowledge and abilities, and the patient’s conscious acceptance of our intervention , But sometimes without considering the biopsychosocial conditions of the patient that interfere in the effectiveness of the results that we wish to achieve, that is, in their autonomy of execution in front of the therapy. For example, in Diabetes mellitus, as we work with the patient to control their blood glucose levels in order to prevent the complications of the disease, we encourage and almost require them to do physical activity, such as walking during the week. At first, the patient, aware of the importance of physical activity to control his blood glucose, agrees to perform the walk. However, it may be that the neighborhood or street where he lives is not suitable for walking, or that he does not feel secure in doing the activity alone or that he is responsible throughout the day for the care of a child, such as a grandchild , And can not put your treatment into practice. This means that, even with decision-making autonomy, the patient is not successful in treatment because there are barriers to executive autonomy that should have been investigated by the physiotherapist and resolved so that the therapeutic goal could be achieved. One way to achieve the expected result is to follow the International Classification of Functionality (ICF) to identify and correlate the patient’s deficiencies, limitations, constraints, environmental and personal factors in order to provide comprehensive and effective physiotherapeutic care. As students, we have learned that by using the ICF to perform the functional diagnosis we are able to see the whole context around the patient and minimize the chances of our treatment failing.

Naik AD, Dyer CB, Kunik ME, McCullough LB. Patient autonomy for the management of chronic conditions: a two component re-conceptualization. Am J Bioethics. 2009;9(2):23–30.

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4 Replies to “Role of executive autonomy in the effectiveness of physiotherapeutic care.”

  1. Hello
    The title of your post is what first attracted my attention. I know what autonomy is but have never come across executive autonomy. Thankfully, your well explained description of the two and the differences between them helped me gain a good understanding. Using referencing to further explain your understanding is a great way of getting your message across, well done!

    Where I live in Cape Town, South Africa, there are many people who suffer from chronic conditions like the ones you have mentioned among others. It is only when we work in certain communities and health care settings that we realize how essential an ICF table is for these patients and every other patient for that matter. An ICF table allows for us as physiotherapists (or soon to be) to treat our patients holistically, that is looking at a patient in terms of their health conditions, their mental state as well as the environment they live in and their social circumstances. Perhaps doing some research on an holistic approach to physiotherapy treatment will help. This will further assist in reiterating the importance of an ICF table. I am not 100% certain on what your ICF table consists of, but having a look at the patients personal and environmental barriers and facilitators is a great way of helping us to plan a treatment program that suits the patients needs, holistically.

    I enjoyed reading your post! Best of luck
    Jenita
    UWC

    Liked by 1 person

  2. Hi Blogger

    I really enjoyed reading this and it was great to see how you take all aspects of care into account with your patients and see them holistically. I agree that the ICF is a necessary tool for determining whether treatment (now and future) will be successful and if there are any barriers that need to be overcome. Taking into account the patient’s social circumstances will help modify home-based treatment.

    Too many a time will people see the irrelevance of taking social history, but here you make its importance clear.

    Keep posting
    Chene
    UWC

    Liked by 1 person

  3. Hi there,

    Thank you for your post. I found it to be very interesting and something all of us can relate to.

    Here in South Africa we also have trouble with the matters you discussed in your post. We have so many people suffering from chronic illnesses that seek our help and, like you mentioned, we are sometimes so focussed (especially as students) to give patients treatment and advice that we know, theoretically, would result in the best outcomes for the patient. We so often forget about the patient’s social circumstances that would prevent him from adhering to treatment advice and optimal recovery. I agree that the ICF is an amazing tool we have to use when treating our patients. It allows us to correctly determine what environmental or personal barriers our patients could possibly have. Do you have any advice as to ways of altering treatment and home programmes to still ensure that patients recover optimally, even though they might have a lack of resources or live in circumstances that prevent them from adhering to home programmes?

    Your topic definitely relates to the module content and your use of additional evidence is good; it enhances the quality of your piece. I liked your title and agree that it is very intriguing – It immediately grabbed my attention. When it comes to your structure of the writing, I however feel that in your future posts you should rather try to use more paragraphs as this would make your posts easier to read.

    Well done!

    Lania
    UWC
    Cape Town

    Liked by 1 person

    1. Hello Lania. I believe that knowing the home and the community of the patient would be the ideal to propose some adaptations in the environment and in the treatment that facilitated adherence to it. In some conditions this is very difficult and therefore we must obtain from the patient as much information as possible to formulate an individualized therapy that addresses goals that are attainable and consistent with their social reality.

      Liked by 1 person

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