New perspectives on person-centered care: an affordance-based account

Motor Strategies: The Role of Active Behavior in Spatial Hearing Research

When completing a task, the ability to implement behavioral strategies to solve it in an effective and cognitively less-demanding way is extremely adaptive for humans. This behavior makes it possible to accumulate evidence and test one's own predictions about the external world. In this work, starting from examples in the field of spatial hearing research, I analyze the importance of considering motor strategies in perceptual tasks, and I stress the urgent need to create ecological experimental settings, which are essential in allowing the implementation of such behaviors and in measuring them. In particular, I will consider head movements as an example of strategic behavior implemented to solve acoustic space-perception tasks.

"Tremendous burdens often unveil enormous gifts": The experiences of South African caregivers implementing speech and language teletherapy for children with cerebral palsy during COVID-19

PURPOSE

In accordance with South Africa's restrictions to mitigate the spread of COVID-19, some speech-language pathologists (SLPs) attempted to engage in novice teletherapy regimes to ensure continuity of care for children with cerebral palsy (CP). This study aimed to explore the experiences of caregivers of children with CP implementing SLP teletherapy during COVID-19 in South Africa. The goal was to shed light on how these families can be better supported and how teletherapy practices can be adjusted for this population.

METHODS

This study employed a qualitative phenomenological research design using in-person and virtual semi-structured interviews with 18 purposively sampled participants with children with CP who received speech and language teletherapy during COVID-19. The data was evaluated using an inductive thematic analysis approach whereby themes elicited from the caregivers' narratives were analyzed.

RESULTS

Interviews (n = 18) unveiled the significant understanding caregivers gained by becoming integral and active stakeholders in the provision of teletherapy. Caregivers were able to meaningfully communicate and bond with their children with CP. However, caregivers also assumed the burden that teletherapy placed on them, as they had to renegotiate their role during the pandemic in order to provide routine teletherapy.

CONCLUSION

Findings indicated the need for person-centered SLP teletherapy interventions that utilize contextually and culturally responsive techniques and resources.

How physiotherapists attend to the human aspects of care when working with people with low back pain: a thematic analysis

Pain is a multidimensional experience. Physiotherapy has attempted to enhance earlier biomedical approaches to patient care through approaches like the 'biopsychosocial' model. Nevertheless, physiotherapy continues to focus on biomedical and/or behavioural aspects of care. We critically investigated how physiotherapists attend to human (psychosocial, emotional, existential, and moral) aspects of low back pain care. We co-analysed ethnographic data with researchers, patients, and physiotherapists using concepts of conforming, tinkering and abandoning 'scripts'. Data included observations of 28 physiotherapy interactions between 26 patients and 10 physiotherapists and 7 researcher-clinician dialogues. Analysis suggests when conforming to scripts, clinicians have difficulty recognising and responding to emotions; time pressure limited clinicians focus, and a biological focus often distracted from psychosocial aspects of people's back pain experiences. In contrast, tinkering with or abandoning scripts allowed space to broaden the focus. Drawing from theorists such as Butler (1999) and Gibson et al. (2020) our analysis contributes to health sociology, arguing that 'tinkering' with or 'abandoning' scripts can foster more humanistic, flexible and reflexive approaches to care. Although health sociologists have explored tinkering, abandoning is new; within physiotherapy, it encapsulates being able to respond with agility to non-physical elements of care without constraint from traditional ways of thinking and doing.

Intellectual Humility: How Recognizing the Fallibility of Our Beliefs and Owning Our Limits May Create a Better Relationship Between the Physical Therapy Profession and Disability

Despite the many advancements over the history of the profession, physical therapy remains in a somewhat paradoxical relationship with disability. The physical therapist profession values disability as diversity but continues to focus on the normalization of body functions as the primary means to promote functionality in people with disability. This focus, consistent with a medicalized view of disability, may prevent physical therapists from empowering individuals with disability to explore alternative, yet effective, perceptual-motor strategies to achieve their functional goals. Additionally, recent research documents implicit, negative biases of physical therapists and physical therapist assistants toward people with disability, again consistent with the medicalized view that disability is the product of an imperfectly functioning body. Dominant underlying beliefs in any profession are often difficult to counter because they are so pervasive, and those beliefs can be reinforced and made stronger when challenged. The purpose of this Perspective article is to introduce physical therapists to a rising construct in psychology-intellectual humility-that may help to facilitate the profession's relationship with disability. Intellectual humility is predicated on recognizing the fallibility of one's beliefs and related practices. Intellectual humility is a promising construct for physical therapy to address the disability paradox and confront implicit attitudes that have served as the basis for many dominant ideas about disability. This Perspective synthesizes views and evidence from the behavioral and social sciences, philosophy, and critical disability studies to contribute to the ongoing evolution of the profession with respect to disability.

IMPACT

The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.

Narrowing the physiotherapy knowledge-practice gap: faculty training beyond the health sciences

Physiotherapists seek to improve client movement and promote function within an individual's unique environmental and social realities. Despite this intention, there is a well-noted knowledge-practice gap, that is, therapists generally lack sufficient foundational preparation to effectively navigate societal challenges impacting contemporary healthcare. As one step toward addressing the issue, we propose an educational solution targeting current and future physiotherapy faculty, whose responsibilities for entry-level course development and curriculum design substantially impact student readiness for clinical practice. We propose that physiotherapy faculty trained via postprofessional education in a non-biomedical field (e.g. psychology, education, and philosophy) will be uniquely prepared to provide students with tools for dealing with complex social issues facing their clients; critical analysis skills; statistical and technological training; and a deeper theoretical and philosophical understanding of practice. Taken together, such interdisciplinary tools could help address the knowledge-practice gap for physiotherapists and promote the ongoing evolution of the profession in concert with contemporary healthcare. Physiotherapists who pursue interdisciplinary studies may more deeply understand the challenges faced by clinicians and may be well-positioned to leverage knowledge and methods in another scientific discipline to expand and transform the scope of solutions to these challenges.

Reciprocity in Low Back Pain Care and Its Role in Power Dynamics: A Give-and-Take Approach

OBJECTIVE

The shift toward patient-centered care in physical therapy fostered a deeper consideration of power-sharing in clinical interactions. Elements of reciprocity may enhance such power considerations between physical therapist and patients, but there has been little investigation into how reciprocity is enacted in physical therapy, its value, and how to improve it if required. This study investigates forms of reciprocity during physical therapist-patient interactions in low back pain (LBP) care with the aim of enhancing patient-centered approaches.

METHODS

The qualitative design involved (1) ethnographic observations at a fee-for-service practice in Australia, and (2) reflexive discussions between researchers and participating clinicians. To understand reciprocity, the analysis drew from the concepts of "accepting'"(or "blocking") "offers" that have been previously applied to physical therapy interactions. The analysis is a sub-study using a larger dataset and analyses in which we partnered with physical therapists and people living with LBP.

RESULTS

Forty-nine observations and 13 reflexive discussions were undertaken with 42 people with LBP and 10 physical therapists. Analysis developed 3 themes suggesting that forms of reciprocity depended on physical therapists accepting or blocking patients' offers, inviting patients to make an offer, and offering personal stories. These elements of reciprocity are relevant to power-sharing during interactions and may impact patient-centered care.

CONCLUSION

Our results suggest that attending to forms of reciprocity can help physical therapists shift power in clinical interactions. By inviting and accepting "offers," physical therapists may build collaborative interactions, support individuals to guide the treatment narrative, and shift away from biomedically centered management approaches. Such recommendations create reciprocal environments that might enhance patient-centered care.

IMPACT

This is one of the few studies to explore how reciprocity is enacted in interactions between physical therapists and s with LBP. Our findings highlight how engaging with the concept of reciprocity could assist with sharing power, improving physical therapist-patient relationships, and enhancing patient-centered care.

Person-centred care in individuals with stroke: a qualitative study using in-depth interviews

BACKGROUND

Person-centred care (PCC) has considerable effects on the clinical practice of health professionals. The purpose of this study was to describe the perspectives and perceived barriers and enablers of individuals with stroke regarding the PCC model in stroke rehabilitation.

METHODS

A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited using non-probabilistic purposeful sampling and a snowball-technique strategy. The inclusion criteria consisted of: (a) individuals > 18 years, (b) diagnosed with moderate or severe stroke according to the National Institutes of Health Stroke Scale and (c) in the post-acute or chronic stage of the disease. In total, 31 individuals with stroke were included. In-depth interviews and researchers' field notes were used to collect the data. A thematic analysis was performed. Also, credibility, transferability, dependability and confirmability techniques were followed to establish trustworthiness of the data.

RESULTS

Thirty-one individuals with stroke (11 women) were included. Three main themes were identified: (a) The person behind the "patient" label, recognizing the person beyond their illness and valuing their identity and individual characteristics, (b) The person at the centre of care, considering themselves as an active agent in their own care and respecting their preferences and expectations for their care process and (c) Training for PCC, providing health professionals with tools to achieve professional skills for the implementation and development of the PCC model.

CONCLUSIONS AND SIGNIFICANCE

This paper describes relevant aspects that health professionals should consider when providing PCC in the context of the rehabilitation of individuals with stroke. Key messagesThe individuals' perspective regarding person-centred care (PCC) has considerable effects on the clinical practice of health professionals.Individuals with stroke describe how there is a person behind the "patient" label, with identity, needs and desire to participate in decision making.Training in the PCC model helps healthcare professionals identify the needs of individuals with stroke during rehabilitation.

Disclosing the person in renal care coordination: why unpredictability, uncertainty, and irreversibility are inherent in person-centred care

This article explores an example of person-centred care: the work of so-called renal care coordinators. The empirical basis of the article consists of qualitative interviews with renal care coordinators, alongside participant observations of their patient interactions. During the analyses of the empirical material, I found that that one of the coordinators’ most fundamental ambitions is to get to know who the patient is. This is also a central tenet of person-centred care. The aim of the article is not only to argue for the plausibility of this tenet, but also, and more importantly, to highlight and explore its implications in the context of healthcare, through the example of renal care coordination. By drawing on the philosophy of Hannah Arendt, the article shows that the disclosure of who the patient is that takes place in person-centred care requires speech and action, which are modes of human activity that initiate processes characterized by unpredictability, uncertainty, and irreversibility. This unpredictability, uncertainty, and irreversibility, found to be inherent in person-centred care, is then discussed in relation to the pursuit of certainty characterizing contemporary evidence-based medicine. At the end of the article the conclusion is drawn that, if healthcare is to be person-centred, it must find ways of accommodating the contradictory pursuits of certainty and uncertainty found in evidence-based medicine and person-centred care respectively.

Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research

The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.

A posthuman decentring of person-centred care

In this paper, we examine person-centred care through a Deleuzian posthuman lens with the aim of exploring what becomes possible when the concepts of both person and care are de-centred. We do so through a consideration of the sets of relations that produce 'the client' in health care contexts. Our analysis maps particular entangled material-semiotic forces producing 'M/michael', a young man with a diagnosis of Duchenne muscular dystrophy, within a rehabilitation clinic. Drawing on Deleuzian notions of assemblage, affect, and becoming we explore 'person-care' as an active production that dynamically enacts persons-as-clients through clinical arrangements. Persons are thus reconceptualised in terms of locally produced subject positions and their care relations, rather than pre-existing beings who can be 'centred' within health services. Paradoxically, by de-centring persons and care, we work to conjure ways to strengthen the aspirations of person centredness to humanise health practices. In doing so, we consider different possibilities for re-imagining clinical work and contribute to debates regarding how healthcare conceptualises and addresses disability, health, and wellbeing. We suggest that such posthuman analyses can open up new ways of understanding and re/forming healthcare.

Framing a Phenomenological Mixed Method: From Inspiration to Guidance

Despite a long history of researchers who combine phenomenology with qualitative or quantitative methods, there are only few examples of working with a phenomenological mixed method—a method where phenomenology informs both qualitative and quantitative data generation, analysis, and interpretation. Researchers have argued that in working with a phenomenological mixed method, there should be mutual constraint and enlightenment between the qualitative (first-person, subjective) and quantitative (third-person, objective) methods for studying consciousness. In this article, we discuss what a framework for phenomenological mixed methods could look like and we aim to provide guidance of how to work within such framework. We are inspired by resources coming from research in mixed methods and existing examples of phenomenological mixed-method research. We also present three cases of phenomenological mixed methods where we study complex social phenomena and discuss the process of how we conducted the studies. From both the research inspiration and our own studies, we depict the landscape of possibilities available for those interested in mixing phenomenology with qualitative and quantitative methods, as well as the challenges and common pitfalls that researchers face. To navigate in this landscape, we develop a three-fold structure, focusing on (1) the phenomenological frame, (2) the phenomenologically informed generation of qualitative and quantitative data (tier one), and (3) the phenomenologically informed analysis and interpretation of data (tier two).