Physiotherapy for vegetative and minimally conscious state patients: family perceptions and experiences

Purpose: To examine family perceptions of physiotherapy provided to relatives in vegetative or minimally conscious states. Method: Secondary thematic analysis of 65 in-depth narrative interviews with family members of people in vegetative or minimally conscious states. Results: Families place great significance on physiotherapy in relation to six dimensions: "Caring for the person'', "Maximising comfort'', "Helping maintain health/life'', "Facilitating progress'', "Identifying or stimulating consciousness'' and "Indicating potential for meaningful recovery''. They can have high expectations of what physiotherapy may deliver but also, at times, express concerns about physiotherapy's potential to cause pain or distress, or even constitute a form of torture if they believe there is no hope for "meaningful'' recovery. Conclusion: Physiotherapists can make an important contribution to supporting this patient group and their families but it is vital to recognise that family understandings of physiotherapy may differ significantly from those of physiotherapists. Both the delivery and the withdrawal of physiotherapy is highly symbolic and can convey (inadvertent) messages to people about their relative's current and future state. A genuine two-way dialogue between practitioners and families about the aims of physiotherapeutic interventions, potential outcomes and patients' best interests is critical to providing a good service and establishing positive relationships and appropriate treatment.