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Zegarra-Parodi R, D’Alessandro G, Baroni F, Swidrovich J, Mehl-Madrona L, Gordon T, Ciullo L, Castel E, Lunghi C. Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy. Healthcare (Basel) 2024; 12:1149. [PMID: 38891224 PMCID: PMC11171789 DOI: 10.3390/healthcare12111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient-practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. METHODS our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. RESULTS A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. CONCLUSION Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective.
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Affiliation(s)
| | - Giandomenico D’Alessandro
- Clinical-Based Human Research Department, Foundation Centre for Osteopathic Medicine (COME) Collaboration, 65121 Pescara, Italy;
- Research Department, A.T. Still Academy Italia (ATSAI), 70124 Bari, Italy
| | | | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
| | | | - Travis Gordon
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA;
| | - Luigi Ciullo
- Istituto Europeo per la Medicina Osteopatica (IEMO), 16122 Genova, Italy;
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Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap 2024; 32:17. [PMID: 38773515 PMCID: PMC11110311 DOI: 10.1186/s12998-024-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. PURPOSE The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. METHODS A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. CONCLUSIONS Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.
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Affiliation(s)
- Roger Kerry
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Edward Lee
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- Nottingham CityCare Partnership, Bennerley Rd, Nottingham, NG6 8WR, UK
| | - Vasileios Georgopoulos
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA, UK
| | - Adam Meakins
- Department of Orthopaedics, West Herts Hospitals Trust, Watford, WD18 0HB, UK
| | - Chris McCarthy
- School of Physiotherapy, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Chad Cook
- Department of Orthopaedics, Duke University, 200 Morris Street, Durham, NC, 27701, USA
| | - Colette Ridehalgh
- School of Sport and Health Sciences, University of Brighton, Darley Rd, Eastbourne, BN20 7UR, UK
- Clinical Neuroscience, Trafford Building, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Amanda Banton
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | | | - Firas Mourad
- Department of health, LUNEX, Differdange, 4671, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Fritz JM, Ford I, George SZ, Vinci de Vanegas L, Cope T, Burke CA, Goode AP. Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials. FRONTIERS IN PAIN RESEARCH 2024; 5:1324096. [PMID: 38706872 PMCID: PMC11066221 DOI: 10.3389/fpain.2024.1324096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.
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Affiliation(s)
- Julie M. Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Laura Vinci de Vanegas
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Tyler Cope
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Colleen A. Burke
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
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Seebacher B, Geimer C, Neu J, Schwarz M, Diermayr G. Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study. PLoS One 2024; 19:e0299909. [PMID: 38457374 PMCID: PMC10923432 DOI: 10.1371/journal.pone.0299909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. PURPOSE To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. METHODS In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. RESULTS The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. CONCLUSIONS In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Rehabilitation Science, Clinic for Rehabilitation Münster, Münster, Austria
| | - Carole Geimer
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Julia Neu
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Maria Schwarz
- Department of Psychosocial Rehabilitation, Clinic for Rehabilitation Münster, Münster, Österreich
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
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Takeuchi N. A dual-brain therapeutic approach using noninvasive brain stimulation based on two-person neuroscience: A perspective review. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:5118-5137. [PMID: 38872529 DOI: 10.3934/mbe.2024226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Our actions and decisions in everyday life are heavily influenced by social interactions, which are dynamic feedback loops involving actions, reactions, and internal cognitive processes between individual agents. Social interactions induce interpersonal synchrony, which occurs at different biobehavioral levels and comprises behavioral, physiological, and neurological activities. Hyperscanning-a neuroimaging technique that simultaneously measures the activity of multiple brain regions-has provided a powerful second-person neuroscience tool for investigating the phase alignment of neural processes during interactive social behavior. Neural synchronization, revealed by hyperscanning, is a phenomenon called inter-brain synchrony- a process that purportedly facilitates social interactions by prompting appropriate anticipation of and responses to each other's social behaviors during ongoing shared interactions. In this review, I explored the therapeutic dual-brain approach using noninvasive brain stimulation to target inter-brain synchrony based on second-person neuroscience to modulate social interaction. Artificially inducing synchrony between the brains is a potential adjunct technique to physiotherapy, psychotherapy, and pain treatment- which are strongly influenced by the social interaction between the therapist and patient. Dual-brain approaches to personalize stimulation parameters must consider temporal, spatial, and oscillatory factors. Multiple data fusion analysis, the assessment of inter-brain plasticity, a closed-loop system, and a brain-to-brain interface can support personalized stimulation.
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Affiliation(s)
- Naoyuki Takeuchi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan
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Heywood S, Bunzli S, Dillon M, Bicchi N, Black S, Hemus P, Bogatek E, Setchell J. Trauma-informed physiotherapy and the principles of safety, trustworthiness, choice, collaboration, and empowerment: a qualitative study. Physiother Theory Pract 2024:1-16. [PMID: 38374583 DOI: 10.1080/09593985.2024.2315521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Trauma is common and may lead to lasting adverse effects on health. Trauma-informed practice does not treat trauma but uses a strengths-based approach to encourage engagement in services. OBJECTIVE To understand how physiotherapy attends to trauma-informed principles. METHODS This qualitative ethnographic study was set in an Australian hospital. Three data collection methods were used, including observations of clinical practice, interactive reflexive group discussions with physiotherapists, and interviews with patients. Data analysis included an initial inductive phase followed by thematic mapping to trauma-informed principles. Critical reflexivity was used throughout to examine how the authors' perspectives and assumptions affected the analysis. RESULTS Twelve observations of consultations, ten interviews with people receiving physiotherapy, and five group discussions with physiotherapists were conducted. Themes produced within each of five principles of trauma-informed care included: Safety: not just a number, uncertainty beyond managing physical risks, upbeat approach as default needs balance, pragmatic environments inadequate; Trustworthiness: touch needs further consideration, assumed consent; Choice: limited options; Collaboration: let's do it together, variable consideration of the patient as expert, task focus, pushing the "right" treatment, missing insight into power imbalance; Empowerment: extending function and independence, building nonphysical skills but lack of clarity. CONCLUSION Physiotherapy incorporates crucial aspects of trauma-informed care, but opportunities exist to enhance physiotherapists' skills and knowledge, particularly in relation to non-physical safety considerations.
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Affiliation(s)
- Sophie Heywood
- Physiotherapy Department, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Samantha Bunzli
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
- Medicine, Dentistry and Health, Griffith University, Nathan, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Miriam Dillon
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Nadia Bicchi
- Physiotherapy Department, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Susan Black
- Physiotherapy Department, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Physiotherapy Department, Caulfield Hospital Alfred Health, Caulfield, Australia
| | - Philippa Hemus
- Transformation team, St Vincent's Mental Health, Fitzroy, Australia
| | - Eva Bogatek
- Physiotherapy Department, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- The Institute for Urban Indigenous Health, Cox Rd, Windsor, Australia
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Wood L, Foster NE, Dean SG, Booth V, Hayden JA, Booth A. Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review. Br J Sports Med 2024; 58:222-230. [PMID: 38176852 DOI: 10.1136/bjsports-2023-107598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Therapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP. METHODS This was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations. RESULTS Of 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient-clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP. CONCLUSIONS Engagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.
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Affiliation(s)
- Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
| | | | - Vicky Booth
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Booth
- Information Resources Group, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Kealy E, Hebron C. Holding space and sitting with emotions: the lived experiences of physiotherapists using psychological strategies in pain care. Physiother Theory Pract 2024:1-14. [PMID: 38299915 DOI: 10.1080/09593985.2023.2300400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Persistent pain is the biggest global cause of years lived with disability. Physiotherapists working in pain care aim to take a holistic perspective helping persons to gain a multidimensional understanding of their condition and achieve meaningful goals despite their symptoms. In recent years there has been a paradigm shift in physiotherapeutic pain care toward a psychologically informed physiotherapy approach. Physiotherapists have incorporated principles of strategies such as: cognitive behavioral therapy (CBT); acceptance and commitment therapy (ACT); psychological flexibility; or mindfulness-based therapies in helping persons move forwards despite their pain. OBJECTIVES The purpose of this study was to explore the lived experience of physiotherapists using psychological strategies in pain care. METHODS Seven participants were purposefully recruited for this study and data was collected through semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Master themes were developed to help express the qualitative meanings of the lived experiences. FINDINGS Seven master themes were identified: 1) Trust; 2) Active listening; 3) Developing understanding; 4) Exploring the journey; 5) Making it meaningful; 6) Being held; and 7) Holding space and sitting with emotions. All themes are interwoven and profoundly connected in the essence of a safe "space." CONCLUSION Participants described a journey toward holding space and sitting with emotions. All themes were interwoven and profoundly connected in the essence of a safe "space," where persons can voice their emotions in a non-judgmental environment. The themes may represent a pathway for the physiotherapist to facilitate a person on their journey of healing.
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Affiliation(s)
- Eoin Kealy
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
| | - Clair Hebron
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
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Lange E, Danielsson L. Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy. Physiother Theory Pract 2023:1-12. [PMID: 38145499 DOI: 10.1080/09593985.2023.2296574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy. METHODS A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach. RESULTS The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm. CONCLUSIONS The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.
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Affiliation(s)
- Elvira Lange
- Department of General Practice, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, FoUUI-centrum Göteborg och Södra Bohuslän, Göteborg, Sweden
| | - Louise Danielsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Boge-Olsnes CM, Risør MB, Øberg GK. Exploring the potential of a standardized test in physiotherapy: making emotion, embodiment, and therapeutic alliance count for women with chronic pelvic pain. Front Psychol 2023; 14:1166496. [PMID: 37599746 PMCID: PMC10437049 DOI: 10.3389/fpsyg.2023.1166496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There has been an increased use of standardized measurements in health care meant to provide objective information to enhance the quality and effectivity of care. Patient performance tests are based on standardized predefined criteria with a limited focus. When facing multifaceted health conditions, information expanding the predefined criteria in a standardized test may be required to understand the patient's complex symptoms. Relying on test information based on measurements according to functional biology, one risks missing information communicated by the sensitive and expressive body of the individual patient. The aim of this article is to investigate how body, self and illness perception is constituted as a co-construction between a physiotherapist and a patient with complex symptoms, expanding the use of a standard physiotherapy test. Methods This qualitative study is based on video-recordings and in-depth interviews of seven women with the complex health condition chronic pelvic pain. The video recordings consist of the patients performing the Standard Mensendieck test pre- and post-treatment with Norwegian psychomotor physiotherapy. The interviews are based on the patients` and the physiotherapists` conversations while watching and elaborating on these video recordings. Empirical data is analyzed within the theoretical perspectives of phenomenology and enactive theory, especially focusing on the concepts of embodiment and intersubjectivity. Results Taking an embodied approach, considering the body as expressive, communicative, and vulnerable to the environment and context, the results show that through bodily expressions the patients experienced the test situation as demanding, thus providing information beyond what the test was intended to measure. Additionally, when administering a standardized test, the interaction between the therapist and the patient had an impact on the results. Sensitive attention towards the patients bodily expressive emotions as a vital part of the interaction, reinforced therapeutic alliance by ensuring the integrity and autonomy of the patient. Discussion Mutual communication, gave new insights regarding the patients' complex symptoms and reinforced their belief in themselves and their recovery processes. Applying the patient's expertise on herself and her life together with the professional expertise may make health care an interdependent practice where sensemaking is a co-construction of meaning between the patient and the health personnel.
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Affiliation(s)
- Cathrine Maria Boge-Olsnes
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mette Bech Risør
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway
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Eilertsen SEH, Eilertsen TH. Why is it so hard to identify (consistent) predictors of treatment outcome in psychotherapy? - clinical and research perspectives. BMC Psychol 2023; 11:198. [PMID: 37408027 DOI: 10.1186/s40359-023-01238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Anxiety and depression are two of the most debilitating psychological disorders worldwide today. Fortunately, effective treatments exist. However, a large proportion of patients do not recover from treatment, and many still have symptoms after completing treatment. Numerous studies have tried to identify predictors of treatment outcome. So far, researchers have found few or no consistent predictors applicable to allocate patients to relevant treatment. METHODS We set out to investigate why it is so hard to identify (consistent) predictors of treatment outcome for psychotherapy in anxiety and depression by reviewing relevant literature. RESULTS Four challenges stand out; a) the complexity of human lives, b) sample size and statistical power, c) the complexity of therapist-patient relationships, and d) the lack of consistency in study designs. Together these challenges imply there are a countless number of possible predictors. We also consider ethical implications of predictor research in psychotherapy. Finally, we consider possible solutions, including the use of machine learning, larger samples and more realistic complex predictor models. CONCLUSIONS Our paper sheds light on why it is so hard to identify consistent predictors of treatment outcome in psychotherapy and suggest ethical implications as well as possible solutions to this problem.
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Affiliation(s)
- Silje Elisabeth Hasmo Eilertsen
- Haugaland DPS/Department of Research and Innovation, Helse Fonna HF, Haugaland DPS v/ Silje Eilertsen, Postboks 2052, Haugesund, Norway.
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Grimus J, Horler C, Hebron C. Building bespoke exercise: The clinical reasoning processes of physiotherapists when prescribing exercise for persons with musculoskeletal disorders. Musculoskeletal Care 2023; 21:372-379. [PMID: 36281648 DOI: 10.1002/msc.1704] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
AIMS This qualitative study aimed to explore physiotherapists' clinical reasoning when prescribing exercise for persons with musculoskeletal disorders. METHODS A constructivist grounded theory inspired methodological approach was used. Six physiotherapists working in the United Kingdom were recruited via purposive sampling. Data collection and analysis included semi-structured interviews, memo writing, coding, and a constant comparative method. FINDINGS A concept of 'building bespoke exercise' has been generated to conceptualise the participants' clinical reasoning when prescribing exercise. CONCLUSION The findings of this study highlight processes of co-designing and co-constructing exercise programmes in collaboration with persons receiving care. Physiotherapists can use this study to reflect on their own clinical reasoning to inform their own practice.
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Kayes NM, Papadimitriou C. Reflecting on challenges and opportunities for the practice of person-centred rehabilitation. Clin Rehabil 2023:2692155231152970. [PMID: 36726297 DOI: 10.1177/02692155231152970] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation. CHALLENGES Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation. OPPORTUNITIES Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation. CONCLUSION Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.
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Affiliation(s)
- Nicola M Kayes
- Faculty of Health and Environmental Sciences, Centre for Person Centred Research, School of Clinical Sciences, 1410Auckland University of Technology, Auckland, New Zealand
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14
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Hartley SE, Ryad H, Yeowell G. Future-proofing the Profession: Physiotherapists' perceptions of their current and emerging role. Physiotherapy 2022; 119:72-79. [PMID: 36940489 DOI: 10.1016/j.physio.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES As healthcare systems continue to modernise, physiotherapists are required to transform their practice to remain contemporary and meet future population needs. The study aims to gain an insight into physiotherapists' perceptions of their current and emerging future role. The intention is to develop an understanding of the physiotherapist's role and how it can continue to evolve to support populations' needs in more sustainable and innovative ways. DESIGN A qualitative design using semi-structured interviews was undertaken informed by Gadamerian hermeneutic philosophy. PARTICIPANTS Participants were gained from a postgraduate physiotherapy programme in Northwest England that recruits physiotherapists from across the UK; via the research teams' professional networks and using snowball sampling. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken. Ethical approval and informed consent was obtained. RESULTS 23 participants (15 female). 4 themes were identified: 'An underpinning philosophy of practice' that promotes holistic care and supports patient wellbeing. An 'evolving role broadening the scope of practice' with many 'agents of change shaping the profession'. When 'preparing the future workforce and their transition into practice', graduates were seen as more adaptable and resilient. However, more affiliation between the university and placement providers to enhance learning environments is needed. CONCLUSIONS Physiotherapists need to re-evaluate their role so a clear vision for the future can be co-created to ensure they remain contemporary and continue to optimise their potential. An emerging role that re-envisages a holistic approach that incorporates health promotion as fundamental to this role could support physiotherapists' transformation in practice. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Sandra Elaine Hartley
- Department of Health Professions, Brooks Building, Birley Campus, Manchester Metropolitan University, 53 Bonsall Street, Manchester M15 6GX, England, UK.
| | - Hanane Ryad
- Department of Health Professions, Brooks Building, Birley Campus, Manchester Metropolitan University, 53 Bonsall Street, Manchester M15 6GX, England, UK.
| | - Gillian Yeowell
- Department of Health Professions, Brooks Building, Birley Campus, Manchester Metropolitan University, 53 Bonsall Street, Manchester M15 6GX, England, UK.
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Ivanova D, Bishop FL, Newell D, Field J, Walsh M. Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession. Chiropr Man Therap 2022; 30:35. [PMID: 36056368 PMCID: PMC9438171 DOI: 10.1186/s12998-022-00442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background The construct of working alliance has been used to operationalise the patient–clinician relationship. Research evidence from the rehabilitation literature has established an association between the construct and several patient outcomes. The aim of this systematic literature review was to study working alliance in the chiropractic discipline. Method This review followed a mixed method systematic review methodology: EBSCO (The Allied and Complementary Medicine Database), EBSCO (MEDLINE), EBSCO PsycINFO, Web of Science Core Collection, Chiro index, and grey literature were searched for quantitative, qualitative, and mixed methods studies on 17th March 2021. Qualitative appraisal was conducted using the Mixed Methods Appraisal Tool, version 2018. The qualitative component was synthesised via thematic synthesis and explored patients’ and chiropractors’ perceptions of the nature and role of working alliance. The quantitative component was synthesised via narrative synthesis to examine how the construct has been measured in research and what its effect on clinical outcomes and patient satisfaction is. The findings were integrated in the discussion section. Results Thirty studies were included. The qualitative component found that both patients and chiropractors consider working alliance as a key factor in the treatment journey. The findings illustrated that the construct includes the bond between a patient and a chiropractor which is underpinned by trust and attentiveness to patients’ needs, values and preferences. Qualitative data also suggested that strong working alliance has the potential to improve patients’ adherence to treatment and that it is characterised by ongoing negotiation of expectations about the goals of care and the tasks involved in the treatment plan. The quantitative component highlighted that even though working alliance is relevant to the chiropractic discipline, very few studies have quantitatively measured the construct and its effect. Conclusion The findings of this review emphasise the subjective importance of working alliance in the chiropractic clinical encounter. However, there were not enough homogenous studies measuring the effect of working alliance on clinical outcomes and patient satisfaction to conduct a meta-analysis. Future research should focus on evaluating potential direct and mediated effects on patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00442-4.
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Affiliation(s)
- Dima Ivanova
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK.
| | - Felicity L Bishop
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK
| | - Dave Newell
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK.,Anglo European College of Chiropractic University College, Parkwood Campus, Parkwood Road, Bournemouth, BH5 2DF, Dorset, UK
| | - Jonathan Field
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK
| | - Madeleine Walsh
- University of Southampton, University Road, Southampton, SO17 1BJ, Hampshire, UK
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16
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McParlin Z, Cerritelli F, Rossettini G, Friston KJ, Esteves JE. Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care. Front Behav Neurosci 2022; 16:897247. [PMID: 35846789 PMCID: PMC9280207 DOI: 10.3389/fnbeh.2022.897247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/24/2022] [Indexed: 12/05/2022] Open
Abstract
Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops "priors" necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding - and explaining - the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically - to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others - through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments.
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Affiliation(s)
- Zoe McParlin
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | | | - Karl J. Friston
- Institute of Neurology, Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gzira, Malta
- University College of Osteopathy, London, United Kingdom
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Rodríguez-Nogueira Ó, Leirós-Rodríguez R, Pinto-Carral A, Álvarez-Álvarez MJ, Morera-Balaguer J, Moreno-Poyato AR. The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study. Musculoskelet Sci Pract 2022; 59:102557. [PMID: 35338901 DOI: 10.1016/j.msksp.2022.102557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance. OBJECTIVE The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them. DESIGN Cross-sectional research. METHODS An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out. RESULTS Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01). CONCLUSIONS The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Arrate Pinto-Carral
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - María José Álvarez-Álvarez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Jaume Morera-Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Carrer Carmelitas 3, 03203, Elche, Alicante, Spain.
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
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Phillips AR. Professional identity in osteopathy: A scoping review of peer-reviewed primary osteopathic research. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Esteves JE, Cerritelli F, Kim J, Friston KJ. Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy. Front Psychol 2022; 13:812926. [PMID: 35250743 PMCID: PMC8894811 DOI: 10.3389/fpsyg.2022.812926] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under (En)active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the lived world and, crucially, the consequences of their behaviour. We argue that (En)active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic (e.g., in paediatric care) exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed.
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Affiliation(s)
- Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gżira, Malta
- Research Department, University College of Osteopathy, London, United Kingdom
- *Correspondence: Jorge E. Esteves,
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Joohan Kim
- Department of Communication, Yonsei University, Seoul, South Korea
| | - Karl J. Friston
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, London, United Kingdom
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20
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Galea Holmes MN, Wileman V, Hassan S, Denning J, Critchley D, Norton S, McCracken LM, Godfrey E. Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: A mixed-methods treatment fidelity evaluation. Br J Health Psychol 2022; 27:935-955. [PMID: 35118763 PMCID: PMC9540449 DOI: 10.1111/bjhp.12583] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/10/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. DESIGN A mixed-methods study nested within a randomized controlled trial was conducted. METHODS A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment. RESULTS PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% (n = 17) and 47% (n = 9) of participants reported treatment receipt and enactment of at least one component, respectively. CONCLUSIONS This mixed-methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain. Low ACT competence could be addressed through additional support and adaptations to therapeutic processes for delivery by physiotherapists.
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Affiliation(s)
- Melissa N Galea Holmes
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Vari Wileman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Shaira Hassan
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Julie Denning
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Duncan Critchley
- Department of Physiotherapy, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Sam Norton
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Lance M McCracken
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.,Department of Physiotherapy, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
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21
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Barber P, Lack SD, Bartholomew C, Curran AJ, Lowe CM, Morrissey D, Neal BS. Patient experience of the diagnosis and management of patellofemoral pain: A qualitative exploration. Musculoskelet Sci Pract 2022; 57:102473. [PMID: 34740149 DOI: 10.1016/j.msksp.2021.102473] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patellofemoral pain (PFP) is common and long-term treatment outcomes are unsatisfactory. Qualitative exploration of diagnosis and management from the perspective of people with PFP is lacking. OBJECTIVES To inform care and improve intervention delivery by exploring the experience of people with PFP regarding diagnosis and management. DESIGN Qualitative study with semi-structured interviews. METHOD Online recruiting yielded a convenience sample of participants with PFP for semi-structured interview. Interviews were recorded, transcribed verbatim, and analysed using thematic analysis until theoretical saturation by multiple investigators to determine themes and sub-themes. RESULTS 12 participants were interviewed, with three themes identified; the value of diagnosis, the need for tailored (individualised) care, and the role of education. Participants viewed receiving a diagnosis as essential to guide management, yet one was rarely provided, causing uncertainty about pain mechanisms; "it's nice to be told what it is that's wrong". Interventions needed to be tailored to the individual as not all participants responded in the same way to treatment(s) or had the same needs; "everyone copes and reacts differently". Finally, participants viewed education as essential to empower them to understand and manage the condition; "if I'd have been given more information, I think I'd know how to deal with it more". CONCLUSIONS The overarching narrative from three themes was a desire for clearly communicated personalised care that meets individual needs. People with PFP desire a diagnosis to explain their pain, tailored interventions, and appropriate education to optimise their experience and outcomes.
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Affiliation(s)
- Philip Barber
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK; Connect Health, The Light Box, Quorum Park, Benton Lane, Newcastle Upon Tyne, Tyne and Wear, NE12 8EU, UK
| | - Simon David Lack
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; Pure Sports Medicine, Point West Building, 116 Cromwell Road, London, SW7 4XR, UK
| | - Clare Bartholomew
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Amy Jessica Curran
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Catherine Minns Lowe
- Department of Allied Health Professions, Midwifery and Social Work, School of Health and Social Work, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; Physiotherapy Department, Barts Health NHS Trust, Mile End Hospital, Bancroft Road, London, E1 4DG, UK
| | - Bradley Stephen Neal
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University London, Mile End Hospital, Bancroft Road, London, E1 4DG, UK; School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3WA, UK.
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22
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Takeuchi N. Perspectives on Rehabilitation Using Non-invasive Brain Stimulation Based on Second-Person Neuroscience of Teaching-Learning Interactions. Front Psychol 2022; 12:789637. [PMID: 35069374 PMCID: PMC8769209 DOI: 10.3389/fpsyg.2021.789637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Recent advances in second-person neuroscience have allowed the underlying neural mechanisms involved in teaching-learning interactions to be better understood. Teaching is not merely a one-way transfer of information from teacher to student; it is a complex interaction that requires metacognitive and mentalizing skills to understand others’ intentions and integrate information regarding oneself and others. Physiotherapy involving therapists instructing patients on how to improve their motor skills is a clinical field in which teaching-learning interactions play a central role. Accumulating evidence suggests that non-invasive brain stimulation (NIBS) modulates cognitive functions; however, NIBS approaches to teaching-learning interactions are yet to be utilized in rehabilitation. In this review, I evaluate the present research into NIBS and its role in enhancing metacognitive and mentalizing abilities; I then review hyperscanning studies of teaching-learning interactions and explore the potential clinical applications of NIBS in rehabilitation. Dual-brain stimulation using NIBS has been developed based on findings of brain-to-brain synchrony in hyperscanning studies, and it is delivered simultaneously to two individuals to increase inter-brain synchronized oscillations at the stimulated frequency. Artificial induction of brain-to-brain synchrony has the potential to promote instruction-based learning. The brain-to-brain interface, which induces inter-brain synchronization by adjusting the patient’s brain activity, using NIBS, to the therapist’s brain activity, could have a positive effect on both therapist-patient interactions and rehabilitation outcomes. NIBS based on second-person neuroscience has the potential to serve as a useful addition to the current neuroscientific methods used in complementary interventions for rehabilitation.
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Affiliation(s)
- Naoyuki Takeuchi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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23
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McCabe E, Roduta Roberts M, Miciak M, Sun H(L, Gross DP. An investigation of the measurement properties of the physiotherapy therapeutic relationship measure in patients with musculoskeletal conditions. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.2005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Douglas P. Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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24
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Unsgaard-Tøndel M, Søderstrøm S. Building therapeutic alliances with patients in treatment for low back pain: A focus group study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 27:e1932. [PMID: 34739185 DOI: 10.1002/pri.1932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE Low back pain is a multidimensional disorder and a biopsychosocial management approach is recommended. However, recent data indicates that physiotherapists mainly focus on biomechanical aspects in treatment and struggle with addressing psychosocial barriers for recovery. We wanted to explore how physiotherapists express their experiences of building therapeutic alliances within a biopsychosocial perspective of low back pain. METHODS Qualitative focus-group interviews were performed with five physiotherapists on two occasions with 6 months in between. Data were analyzed within a hermeneutical perspective with decontextualization and recontextualization, and identification of themes. RESULTS Four main themes were identified from the analyses: (1) An ideal standard: Presence, empathy and applying the biopsychosocial perspective is central for building therapeutic alliance. (2) Time-consuming: Active listening and personally adapted treatment is important and time-consuming. (3) Challenging area: Advanced clinical reasoning is needed to understand and modify complex barriers for recovery. Clinical experience is sometimes necessary to integrate the psychological and social domains into physiotherapy management. (4) The art of balancing: Important to apply sensitive communication to help patients gain new insight. Some heavy psychosocial demands on patients may be outside physiotherapists' professional competence. DISCUSSION The physiotherapists in this focus group study expressed a shared view that therapeutic alliance should build upon person-centering, motivational communication, and facilitation of lifestyle adjustments within a biopsychosocial perspective of low back pain. Complex clinical reasoning necessary as the optimal cause-corrective treatment strategies were often not obvious. Time and tools to uncover and modify relevant psychological obstacles for recovery were perceived challenging and partly dependent on clinical experience. Addressment of psychosocial obstacles for recovery should be included in basic as well as postgraduate curriculums for physiotherapists. Collaborative practice support strategies like peer guidance and better platforms for interprofessional collaboration and decision support could contribute to improve practice in the psychosocial domain.
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Affiliation(s)
- Monica Unsgaard-Tøndel
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physical Therapy, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sylvia Søderstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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25
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Wallace LM, Falla D, Rushton A, Heneghan NR. Group and individual telehealth for chronic musculoskeletal pain: A scoping review. Musculoskeletal Care 2021; 20:245-258. [PMID: 34668312 DOI: 10.1002/msc.1594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND CONTEXT Musculoskeletal (MSK) pain presents a global challenge. Individual and group pain management programmes (PMPs) are recommended approaches for patients with chronic MSK disorders. With advances in remote healthcare capability, telehealth, and the recent COVID-19 pandemic, the importance of telehealth PMPs has become even more evident. Nevertheless, it is not known how patients perceive PMPs for their MSK complaint when delivered via telehealth. OBJECTIVE To synthesise the evidence of patients' experiences of group and individual telehealth PMPs for chronic MSK pain. DESIGN A scoping review informed by the PRISMA extension for scoping reviews. DATA SOURCES Based on a planned search strategy, modified following initial searches, an electronic search was conducted of key databases: Cochrane Library, Medline, CINAHL, EMBASE, AMED, SportDiscus and APA PsychInfo from 2010 until 11 May 2021. STUDY SELECTION Any qualitative or mixed methods study reporting patient experiences of telehealth PMPs for patients with MSK disorders. DATA EXTRACTION AND DATA SYNTHESIS Data were extracted and synthesised using thematic analysis. RESULTS From 446 identified studies, 10 were included. Just two studies investigated group telehealth PMPs for patients with MSK disorders, with eight delivered individually. Four main themes emerged: (1) Usability of the technology, (2) Tailored care, (3) Therapeutic alliance and (4) Managing behaviour. The findings highlight patient acceptability of telehealth to support self-management for chronic MSK disorders, with appropriate clinical and technical support. Group telehealth has the potential to empower patients with peer support. Remote delivery of PMPs also impacts on how patients and providers interact, communicate and develop a therapeutic relationship. CONCLUSIONS AND IMPLICATIONS Barriers and enablers to engagement in telehealth PMPs for patients with chronic MSK disorders have been identified. Peer support and group cohesiveness can be achieved remotely to enhance the patient experience. There is a critical need for further research in this area.
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Affiliation(s)
- L M Wallace
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - D Falla
- Chair in Rehabilitation Science and Physiotherapy, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A Rushton
- School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - N R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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McCabe E, Miciak M, Roduta Roberts M, Sun HL, Gross DP. Measuring therapeutic relationship in physiotherapy: conceptual foundations. Physiother Theory Pract 2021; 38:2339-2351. [PMID: 34632921 DOI: 10.1080/09593985.2021.1987604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The "therapeutic relationship" in physiotherapy refers to the beneficial or healing relationship between the patient and physiotherapist. Interest in researching therapeutic relationships in physiotherapy is growing and there is a need for a measure of therapeutic relationship with a strong conceptual foundation. Body of paper:We begin with a general discussion of the state of therapeutic relationship measurement in physiotherapy research - notably, how current research is based on measures borrowed and adapted from psychotherapy. Then, we introduce Miciak's physiotherapy therapeutic relationship framework, discuss why it offers a solid foundation for measurement development, and describe the key concepts in the framework. We then discuss various approaches to measuring therapeutic relationship, illustrating how Miciak's framework could be used to inform their development. We end by discussing current challenges in measuring therapeutic relationship and how these could be addressed.
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Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, 3-48 Corbett Hall,University of Alberta, Edmonton, Alberta, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, 3-48 Corbett Hall,University of Alberta, Edmonton, Alberta, Canada
| | - Mary Roduta Roberts
- Department of Occupational Therapy, University of Alberta, 2-64 Corbett Hall, Edmonton,Alberta, Canada
| | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, 4-112 Clinical Sciences Building, University of Alberta, Edmonton, Canada
| | - Douglas P Gross
- Department of Physical Therapy, 2-50 Corbett Hall, University of Alberta, Edmonton, Alberta, Canada
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Chesterton P, Chesterton J, Alexanders J. New graduate physiotherapists’ perceived preparedness for clinical practice. A cross-sectional survey. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1958007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Paul Chesterton
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jennifer Chesterton
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Jenny Alexanders
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Haynes A, Sherrington C, Ramsay E, Kirkham C, Manning S, Wallbank G, Hassett L, Tiedemann A. "Sharing Success with Someone": Building therapeutic alliance in physiotherapist-delivered physical activity coaching for healthy aging. Physiother Theory Pract 2021; 38:2771-2787. [PMID: 34324406 DOI: 10.1080/09593985.2021.1946872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Therapeutic alliance, a goal-orientated partnership between clients and practitioners, can enhance program engagement and adherence, and improve treatment outcomes and satisfaction. OBJECTIVES To develop an empirical model that describes how therapeutic alliances can be operationalized in clinical and research settings and use this in our evaluation of the Coaching for Healthy Ageing (CHAnGE) trial. METHODS Secondary analysis of interviews with participants in the CHAnGE trial (n = 32) and a focus group with the physiotherapists who delivered health coaching in that trial (n = 3). Analysis was inductive (thematic) and deductive (using a therapeutic alliance model derived from a literature review and informed by earlier analyses). RESULTS Data from participants and physiotherapists indicated that health coaching in CHAnGE built effective therapeutic alliances (i.e. it facilitated collaborative decision-making and trusting person-centered relationships) which were underpinned by professional skills and structural supports. Components of the intervention that strengthened therapeutic alliance were health coaching training, home visits, the coaching format, and provision of free activity monitors. CONCLUSION This study identifies key concepts and practical 'building blocks' of therapeutic alliance, showing how these were operationalized within an intervention. This may help those in clinical and research settings to recognize the importance and characteristics of therapeutic alliance and put it into practice.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Elisabeth Ramsay
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Shona Manning
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,Christian Homes Tasmania Inc, Kingston, TAS, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.,School of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Level 10N King George V Building Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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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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Hand therapists' perspectives and practices related to musculoskeletal pain: A biopsychosocial lens. Musculoskelet Sci Pract 2021; 52:102345. [PMID: 33639527 DOI: 10.1016/j.msksp.2021.102345] [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: 11/11/2020] [Revised: 01/17/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND While the biopsychosocial model is advocated for pain management, biomedical approaches continue to dominate in practice. Understanding musculoskeletal clinicians' perspectives and practices related to pain can inform training needs to optimize care. Little is known regarding the viewpoint of hand therapists who may not have exposure to modern pain models. OBJECTIVE To explore hand therapists' perspectives and practices related to musculoskeletal pain using a biopsychosocial lens. METHODS This interpretive descriptive qualitative study was embedded in an explanatory sequential mixed methods design. Thirteen hand therapists in the United States were purposefully sampled based on low and high scores on the Revised Neurophysiology of Pain Questionnaire. Each therapist participated in one semi-structured virtual interview. Data were analyzed using open and a priori codes, which were synthesized into themes that aligned with each domain of the biopsychosocial model. FINDINGS Participants described "balancing local tissues and the brain," "empowering through education and function," and "looking beyond the individual." Recognition of multidimensional components of pain reinforced participants' awareness that "pain is always real." DISCUSSION Hand therapists appreciated pain as a multidimensional phenomenon, with biological, psychological, and social facets. However, a potential bias toward structural pathology warrants additional training to promote high-value musculoskeletal care.
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Paling C, Hebron C. Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges. Musculoskeletal Care 2020; 19:28-37. [PMID: 33022867 DOI: 10.1002/msc.1504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cauda equina syndrome (CES) is rare, but its symptoms are not and musculoskeletal physiotherapists frequently encounter persons with suspected CES. Given that delayed diagnosis of CES can result in devastating consequences for affected persons and costly litigation for healthcare organisations, it is imperative that persons presenting with suspected CES are well managed. However, this may present a challenge to physiotherapists. Therefore, the aim of this study is to explore physiotherapists' experiences of managing persons with suspected CES. METHODS Semi-structured interviews were conducted with musculoskeletal physiotherapists. Verbatim transcripts were analysed using an interpretive paradigm and thematic analysis. ETHICAL APPROVAL Ethical approval was obtained from a university Ethics committee and NHS Research and Development. FINDINGS Five interlinking themes emerged. The themes of worry in relation to risk management and communication difficulties seemed to represent significant challenges. The remaining themes were described as antidotes to these challenges: Lightening the load with teamwork and shared responsibility, the usefulness of a clear pathway and perception of improved confidence and competence with experience and training. DISCUSSION The findings are discussed in the context of other literature, and practical recommendations are made relating to pathway implementation, team working, communication aids, training on CES and measures to care for staff wellbeing. CONCLUSION Findings suggest that it is important to be aware of and address the challenges faced by physiotherapists in order to care for clinicians' wellbeing and ensure a safe and smooth journey for persons with suspected CES. Summary Video: https://www.youtube.com/watch?v=lIHqCKIQ1jk&t=90s.
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Affiliation(s)
- Claire Paling
- Wiltshire Heath and Care, Outpatient Physiotherapy, Level 3, Sallisbury District Hospital, Sallisbury, UK
| | - Clair Hebron
- School of Health Professions, University of Brighton, Brighton, UK
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Hartholt E, Vuoskoski P, Hebron C. Physiotherapists' lived experiences of decision making in therapeutic encounters with persons suffering from whiplash-associated disorder: A hermeneutic phenomenological study. Musculoskeletal Care 2020; 18:519-526. [PMID: 32677355 DOI: 10.1002/msc.1496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022]
Abstract
Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as exercise prescription, education and communicating diagnosis. There is a paucity of studies exploring decision making in whiplash-associated disorder (WAD); thus, the aim of this study was to explore the physiotherapists' lived experiences of decision making related to treating persons with WAD. A qualitative research design based on hermeneutic phenomenological methodology was used in this study. Five participants (physiotherapists) were purposefully recruited, and data are collected via semistructured interviews, which were recorded and transcribed verbatim. Interpretative phenomenological analysis (IPA) was used as a method for analysing the data. Emergent, superordinate and master themes emerged from the data to illuminate the lived experiences under exploration. Three master themes were identified: (1) sense of collaboration; (2) sense of being out of control; and (3) sense of emotional engagement (subthemes: feeling of satisfaction and feelings of distress and uncertainty). A sense of collaboration revealed varied meaning related to the role of persons receiving care, suggesting a lack of conceptual clarity related to shared-decision making. A perceived loss of a sense of being in control was related to experienced emotions, such as feelings of distress and uncertainty. The findings of this study highlight the importance of providing space for reflection and mentoring in the workplace.
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Affiliation(s)
- Elles Hartholt
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
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