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Arrigoni A, Rossettini G, Palese A, Thacker M, Esteves JE. Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study. Musculoskelet Sci Pract 2024; 73:103164. [PMID: 39151365 DOI: 10.1016/j.msksp.2024.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs. AIM This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference. METHODS The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions. RESULTS The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation. CONCLUSION Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.
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Affiliation(s)
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Via Bengasi 4, 37134, Verona, Italy; Department of Physiotherapy, Faculty of Sport Sciences, Musculoskeletal Pain and Motor Control Research Group, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain.
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
| | - Mick Thacker
- Department of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Jorge E Esteves
- Malta ICOM Educational, Santa Venera, Malta; UCO School of Osteopathy, Health Sciences University, London, UK; Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.
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Andrade P, Thomson OP. Must The Show Go On? A Qualitative Study Exploring Barriers And Enablers To Manual Therapists' Care Of Dancers. J Dance Med Sci 2024:1089313X241255441. [PMID: 38859673 DOI: 10.1177/1089313x241255441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Dance Medicine is a growing discipline, and healthcare for dancers requires appreciating particularities of their artistic craft. Manual therapists (MTs) are often dancers' first choice when seeking care. Whilst dancers' experiences of injury and healthcare have been extensively researched, little is known of MTs' perspectives of caring for them. AIM This study aimed to gain an understanding of MTs' perspectives of caring for dancers. Communication, treatment strategies and obstacles to a successful therapeutic alliance were examined to broaden knowledge and improve care. METHODS This was a qualitative study using Grounded Theory as a framework for data collection and analysis. A purposive sample of 8 participants was recruited-physiotherapists, chiropractors, and osteopaths with 2+ years' experience of treating dancers. Data collection was conducted via semi-structured interviews, which were transcribed verbatim, anonymized, member checked, and later analyzed. RESULTS Data analysis constructed 3 categories which described the range of participants' experiences. Two categories were identified-(i) A Strangled Industry and (ii) Be-all End-all Patients-and found to culminate in a core category: (iii) Beyond Hands-on, which exemplified MTs' attempts to address clinical challenges. CONCLUSIONS MTs experience several challenges when providing healthcare to dancers. These encompass psychosocial aspects relating to dancers' internal world and the dance industry environment. It suggests that caring for dancers demands comprehensive, collaborative, and psychologically informed approaches. Emphasis should also be given to developing and implementing dance-specific pain science for all stakeholders.
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Affiliation(s)
- Paula Andrade
- Research Centre, University College of Osteopathy, London, UK
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Accardi C, Cerritelli F, Bovo L, Esteves JE. The osteopath-parent-child triad in osteopathic care in the first 2 years of life: a qualitative study. Front Psychol 2023; 14:1253355. [PMID: 37849480 PMCID: PMC10577191 DOI: 10.3389/fpsyg.2023.1253355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
Background Enactivism and active inference are two important concepts in the field of osteopathy. While enactivism emphasizes the role of the body and the environment in shaping our experiences and understanding of the world, active inference emphasizes the role of action and perception in shaping our experiences and understanding of the world. Together, these frameworks provide a unique perspective on the practice of osteopathy, and how it can be used to facilitate positive change in patients. Since the neonatal period is a crucial time for development, osteopaths should aim to create a therapeutic relationship. Arguably, through participatory sense-making, osteopaths can help the baby build a generative model (with positive priors) to deal with stress and needs throughout their life. Aim Since the literature considers that interactions with the environment, which enact the patients' experiences, depending on contextual factors and communication between patient and caregiver, this research explored whether there is a correspondence between the indications in the literature and clinical practice in the management of the mother/parent-child dyad during osteopathic care on children aged 0 to 2 years old. Methods Semi-structured interviews were conducted with a purposive sample of nine osteopaths with experience in the field of pediatrics. Interviews were transcribed verbatim, and constructivist grounded theory was used to conceptualize, collect and analyze data. Codes and categories were actively constructed through an interpretive/constructionist paradigm. Results The core category was the idea of the pediatric osteopath as a support for the family, not only for the child. Four additional categories were identified: (1) Preparing a safe environment for both children and parents, (2) Communication, (3) Attachment and synchrony, and (4) Synchronization. Conclusion Through participatory sense-making, osteopaths manage contextual factors to establish an effective therapeutic alliance through the osteopath-parent-child triad to facilitate the construction of the child's internal generative model to promote healthy development. The therapeutic encounter is considered an encounter between embodied subjects, occurring within a field of affordances (ecological niche) that allows the interlocutors to actively participate in creating new meanings through interpersonal synchronization. Participatory sense-making and the establishment of a therapeutic alliance through the osteopath-parent-child triad are crucial to promote healthy development in the child.
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Affiliation(s)
- Caterina Accardi
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
- Malta ICOM Educational Ltd., Gzira, Malta
| | - Francesco Cerritelli
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
| | - Lorenza Bovo
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
- Malta ICOM Educational Ltd., Gzira, Malta
| | - Jorge E. Esteves
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
- Malta ICOM Educational Ltd., Gzira, Malta
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Arcuri L, Consorti G, Tramontano M, Petracca M, Esteves JE, Lunghi C. “What you feel under your hands”: exploring professionals’ perspective of somatic dysfunction in osteopathic clinical practice—a qualitative study. Chiropr Man Therap 2022; 30:32. [PMID: 36045398 PMCID: PMC9429724 DOI: 10.1186/s12998-022-00444-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite controversy regarding its validity and clinical usefulness, manual examination findings still have an important role for manipulative therapies. As an example, somatic dysfunction (SD) remains central to osteopathic practice.This study aims to explore the experienced osteopaths' attitudes concerning SD and its role in osteopathic practice. This qualitative research could contribute to building a consistent paradigm for manual intervention in all musculoskeletal manipulations. Methods A thematic analysis with grounded theory elements was used. Data were collected through semi-structured interviews carried out between February and April 2021. A purposive sample of twenty professional osteopaths with past experience in osteopathic care was chosen to reflect the phenomenon's variety. The data analysis was done inductively and in tandem with the recruiting to keep track of data saturation. Results Eleven osteopaths participated in the study. Three main themes emerged from the data analysis: (1) SD as a safe tissue-touch-based communication tool between operator and person complex adaptive health system; (2) The treatment of SD is shareable between osteopaths, other health professionals, and the patients involved in the therapeutic pathway improving body awareness and health; (3) The development of the SD concept in research and practice to better clarify osteopathic profession identity and definition. Conclusions A panel of expert osteopaths consider the concept of SD as a valuable tool integrated into the osteopathic evaluation and treatment process. The shared concept and clinical application of SD is informed by person-centered care concepts and from the fields of neuroscience, cognitive and complexity science. Our study reports a common need among osteopaths to develop an evidence-based framework of SD to allow the best development of the osteopathic profession. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00444-2.
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A Content Analysis of Osteopaths’ Attitudes for a More Inclusive Clinical Practice towards Transgender People. Healthcare (Basel) 2022; 10:healthcare10030562. [PMID: 35327040 PMCID: PMC8953530 DOI: 10.3390/healthcare10030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/21/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives. The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. Methods. This study was a content analysis based on the Standards for Reporting Qualitative Research guidelines. Purposive sampling of 10 Italian osteopaths was applied. Data were collected through semi-structured interviews, from March to April 2021, and subsequently transcribed verbatim with the content analysis carried out as an iterative process. Results. One participant was excluded during the first interview due to them being unsuitable for this study. Data saturation was reached after two interviews with the remaining nine participants. Data analysis revealed four main themes: microaggressions, acceptance and non-judgement, person-centered treatment, and education implementation. Conclusions. This study presents cisgender Italian osteopaths’ attitudes in the care of transgender people, revealing the desire to embrace and apply osteopathic tenets regardless of the patient’s gender identity.
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Sampath KK, Darlow B, Tumilty S, Shillito W, Hanses M, Devan H, Thomson OP. Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain - a mixed methods systematic review. BMC Health Serv Res 2021; 21:695. [PMID: 34266436 PMCID: PMC8281672 DOI: 10.1186/s12913-021-06720-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain. METHODS The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies. RESULTS A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data. DISCUSSION Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.
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Affiliation(s)
- Kesava Kovanur Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology, 51, Akoranga Road, Hamilton, New Zealand.
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand.
- School of Public Health, University of Technology Sydney, Sydney, Australia.
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Warwick Shillito
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Melissa Hanses
- Department of Health Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
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“Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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“Understanding patients' narratives” A qualitative study of osteopathic educators’ opinions about using Medical Humanities poetry in undergraduate education. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lunghi C, Iacopini A, Baroni F, Consorti G, Cerritelli F. Thematic Analysis of Attitudes Held by a Group of Italian Osteopaths Toward Osteopathic Evaluation, Treatment, and Management in the Neonatal and Pediatric Field: A Qualitative Study. J Manipulative Physiol Ther 2021; 44:164-175. [PMID: 33431275 DOI: 10.1016/j.jmpt.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the attitudes held by a group of Italian osteopaths toward osteopathic evaluation, treatment, and management in the neonatal and pediatric field. METHODS A thematic analysis with elements of grounded-theory approaches was used. Purposive sampling was used to recruit expert osteopaths in the neonatal and pediatric field. Data were gathered from July 2017 to January 2018 by individual semistructured interviews and transcribed verbatim. A thematic analysis of the data was then performed. The Consolidated Criteria for Reporting Qualitative Research checklist was used to structure the design of this qualitative study. RESULTS Eight osteopaths participated. Data analysis generated 3 main themes: the role of the osteopath in the collaborative process of care, osteopathic diagnostic-clinical reasoning in the neonatal and pediatric field, and osteopathic treatment in the neonatal and pediatric field. CONCLUSION The present study highlights that Italian osteopaths may prefer interprofessional and integrative activities aimed at supporting adaptive capacity and resilience for pediatric patients.
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Affiliation(s)
- Christian Lunghi
- Qualitative Research Division, COME Collaboration ONLUS, Pescara, Italy; Malta ICOM Educational, San Gilijan, Malta.
| | - Alessio Iacopini
- Qualitative Research Division, COME Collaboration ONLUS, Pescara, Italy
| | - Francesca Baroni
- Qualitative Research Division, COME Collaboration ONLUS, Pescara, Italy; Malta ICOM Educational, San Gilijan, Malta
| | - Giacomo Consorti
- Qualitative Research Division, COME Collaboration ONLUS, Pescara, Italy; Research Department of the Centre pour l'Etude, la Recherche et la Diffusion Osteopathiques, Rome, Italy
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, COME Collaboration ONLUS, Pescara, Italy
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Bettelli L, Pisa V, Formica A. “I do it my way” - Italian osteopaths’ beliefs and attitudes about five osteopathic models: A qualitative study. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abrosimoff M, Rajendran D. ‘Tell me your story’ - How osteopaths apply the BPS model when managing low back pain - A qualitative study. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2019.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Macfarlane C, Cornall D. Expanding options: Supporting skills transfer from a post-graduate osteopathy program to clinical practice. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Complementing or conflicting? A qualitative study of osteopaths’ perceptions of NICE low back pain and sciatica guidelines in the UK. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Delion TPE, Draper-Rodi J. University College of Osteopathy students' attitudes towards psychosocial risk factors and non-specific low back pain: A qualitative study. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Formica A, Thomson OP, Esteves JE. ‘I just don't have the tools’ - Italian osteopaths' attitudes and beliefs about the management of patients with chronic pain: A qualitative study. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2017.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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‘Sometimes I don't feel like an osteopath at all’- a qualitative study of final year osteopathy students' professional identities. INT J OSTEOPATH MED 2017. [DOI: 10.1016/j.ijosm.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Professional ballet dancers' experience of injury and osteopathic treatment in the UK: A qualitative study. J Bodyw Mov Ther 2017; 21:148-156. [PMID: 28167171 DOI: 10.1016/j.jbmt.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/04/2016] [Accepted: 06/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Professional dancers suffer significant musculoskeletal injuries during the course of their careers. Treatment-seeking behaviour is important in all patient populations, yet is rarely investigated amongst professional dancers. This qualitative study aimed to form a better understanding of how dancers decide to seek treatment, and in particular to explore their experiences of receiving osteopathic care for their injuries. METHODS A qualitative study design using grounded theory was used as a methodological framework for data collection and analysis. Semi-structured interviews were used to explore professional dancers' experience of injury and decision-making to seek professional healthcare. RESULTS Five themes were constructed that explain and describe dancers' experience of injuries and their views and perspectives of treatment, these were; the growing dancer, the fear factor, learning to cope, effective treatment, and returning autonomy. CONCLUSION The personal development of each dancer consisted of an amalgam of internal and external pressures. These pressures combine with experiences of pain and injury to influence a dancer's decision-making behaviour when injured and deciding to seek treatment. The study also provide factors relevant in the effective treatment of dancers, and outlined participants' preference for a global physical approach to assessment and treatment of their musculoskeletal pain.
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Hohenschurz-Schmidt DJ, Esteves JE, Thomson OP. Tensegrity and manual therapy practice: a qualitative study. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Thomson OP, Evans DW. Masterclasses – integrating research evidence with expertise into clinical practice. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thomson OP, Petty NJ, Moore AP. Osteopaths' professional views, identities and conceptions – A qualitative grounded theory study. INT J OSTEOPATH MED 2014. [DOI: 10.1016/j.ijosm.2013.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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