The role of Philosophical Hermeneutics in contributing to an understanding of physiotherapy practice: a reflexive illustration

Exploring the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business: a hermeneutic phenomenological study

AIM

To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business.

DESIGN

A hermeneutic phenomenological approach.

PARTICIPANTS

Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling.

METHODS

In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed.

RESULTS

Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff.

CONCLUSIONS

Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER.

Musculoskeletal physiotherapists' experiences of using remote consultations during the COVID-19 pandemic: A qualitative study

BACKGROUND

The coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic.

OBJECTIVES

To explore musculoskeletal physiotherapists' experiences of using remote consultations in one area of England during the COVID-19 pandemic.

DESIGN

Qualitative study using hermeneutic phenomenology based on the approach of Gadamer.

METHODS

Semi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics.

FINDINGS

Musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists.

CONCLUSION

The findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services.

"Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain"

INTRODUCTION

Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies.

PURPOSE

However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP.

METHOD

The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal.

FINDINGS AND CONCLUSION

Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.

The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care

AIM

The aim of this research was to explore the experiences of uncertainty amongst Musculoskeletal First Contact Practitioners working in primary care.

BACKGROUND

The Musculoskeletal First Contact Practitioner role involves advanced physiotherapists providing an alternative to the GP by acting as first point of contact for people presenting to primary care with musculoskeletal conditions. Limited research into the role exists but the first-contact aspect, clinical complexity and time pressures are deemed to contribute to uncertainty within the role.

METHOD

A qualitative research design was undertaken using a hermeneutic interpretative phenomenological approach. Data was collected using semi-structured interviews with subsequent thematic analysis of the data.

FINDINGS

Eight participants working as Musculoskeletal First Contact Practitioners across England were recruited using purposive sampling. Five themes were identified: (1) Role clarity within primary care, (2) Burden of responsibility, (3) Preparedness for the primary care environment, (4) 'I'm not really sure how long I am going to stay in this role', (5) Mitigating uncertainty.

CONCLUSION

This study demonstrates the multifaceted phenomenon of uncertainty amongst Musculoskeletal First Contact Practitioners. Uncertainty appeared to be influenced by the primary care environment, preparedness for the role and perceived burden of responsibility. Diagnostic uncertainty was prevalent with concerns of missing serious pathology evident. The impact of uncertainty on wellbeing was linked to possible burnout and retention issues. Consultation approaches, access to support networks and a cultural shift in tolerating uncertainty were reported to mitigate uncertainty. Further research into possible differences in experiences related to employment models appears warranted.

Exploring the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business: A hermeneutic phenomenological study

AIM

To explore the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business.

DESIGN

A hermeneutic phenomenological approach.

PARTICIPANTS

Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling.

METHODS

In-depth, semi-structured video interviews (n = 12) were audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, and small sections of data and all emerging codes were independently reviewed.

RESULTS

Knowledge acquisition: participants acquired business knowledge from training, external help, and trial-and-error approaches. Improved physiotherapy-related business training was requested. Business skills: Business plans were generally organic or lapsed with time. Success and timing of marketing strategies varied widely. The altruistic nature of many physiotherapists creates difficulties in requesting payments for services. Clinical policies: Lone working risks appeared more weighted towards protecting staff from physical abuse rather than allegations.

CONCLUSIONS

Improved physiotherapy-related business support and guidance may be beneficial. Focusing on word-of-mouth, website marketing, and establishing support networks may benefit practice owners. Greater consideration of the potentially negative implications of lone working, particularly accusations of inappropriate sexual behaviour, is recommended.

The Impact of Hypermobile “Ehlers-Danlos Syndrome” and Hypermobile Spectrum Disorder on Interpersonal Interactions and Relationships

Background

People with Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders are hampered in their social participation, especially in the social relationships they have.

Objective

The aim of this study is to research the impact of hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobile Spectrum Disorders (HSD) on interpersonal interactions and relationships.

Methods

A phenomenological hermeneutic study was performed. Semi-structured interviews were used to explore the experiences of 11 participants.

Results

Four themes emerged from the data analysis. (1) people with hEDS or HSD can no longer do what they want to do and that affects their identity, (2) people with hEDS or HSD have to find a balance in the amount of activities they participate in, (3) having hEDS or HSD influences how to ask for, accept and give help, and (4) Relationships are affected in persons with hEDS or HSD. As well as changes in the social network, different types of relationships are influenced by the disease, including relationship with their partner, their children, their friends, strangers, fellow-sufferers and health care professionals.

Frozen shoulder: living with uncertainty and being in "no-man's land"

BACKGROUND

Frozen Shoulder (FS) is a painful debilitating condition that is a significant burden to those experiencing it and healthcare systems. Despite research investigating the pathogenesis and effective treatment for the condition, there is a paucity of research exploring how having frozen shoulder is lived through and meaningful to persons experiencing it.

OBJECTIVE

To explore how living with Frozen Shoulder is experienced and meaningful.

METHODS

A qualitative research study design using hermeneutic phenomenology methodology was used. In-depth unstructured interviews were conducted with six purposively recruited participants. Interpretive Phenomenological methods were used to analyze the data forming emergent, superordinate and master themes to qualitatively expose the meaningful aspects of living through FS.

FINDINGS

Five Master themes were identified: 1) "Dropping me to my knees," an incredible pain experience; 2) The struggle for normality; 3) An emotional change of self; 4) The challenges of the healthcare journey; and 5) Coping and adapting. The overarching 'binding theme' was Frozen Shoulder: Living with uncertainty and being in "no-man's land."

CONCLUSIONS

This study illuminated the struggle to maintain a normal life while living with the significant pain, physical restriction, sleep loss and disability experienced by persons with Frozen Shoulder. Attempts to cope and adapt were impeded by the challenges of the healthcare journey. The uncertainty of these experiences was conveyed as being in "no man's land" an expression that reflected the existential crisis and impact on persons' sense of self.

Physical Therapists' Opinion of E-Health Treatment of Chronic Low Back Pain

(1) Background: Using new technologies to manage home exercise programmes is an approach that allows more patients to benefit from therapy. The objective of this study is to explore physical therapists’ opinions of the efficacy and disadvantages of implementing a web-based telerehabilitation programme for treating chronic low back pain (CLBP). (2) Methods: Nineteen physical therapists from academic and healthcare fields in both the public and private sector participated in the qualitative study. Texts extracted from a transcript of semi-structured, individual, in-depth interviews with each consenting participant were analysed to obtain the participants’ prevailing opinions. The interviews lasted approximately 40 min each. The participants’ responses were recorded. (3) Results: The results suggest that telerehabilitation can only be successful if patients become actively involved in their own treatment. However, exercise programmes for LBP are not always adapted to patient preferences. New technologies allow physical therapists to provide their patients with the follow-up and remote contact they demand, but long-term adherence to treatment stems from knowledge of the exercises and the correct techniques employed by the patients themselves. (4) Conclusions: Physical therapists treating patients with chronic non-specific low back pain believe that new technologies can provide highly effective means of reaching a greater number of patients and achieving significant savings in healthcare costs, despite the limitations of a telerehabilitation approach in developing an appropriate and effective patient-based physiotherapy programme.

What matters most: a qualitative study of person-centered physiotherapy practice in community rehabilitation

BACKGROUND

Person-centered approaches to care require physiotherapists to engage in trying to understand the full range of biomedical, psychological, and social factors that people bring to the consultation, along with the client's individual responses to those factors. If, however, the main issues of importance to people are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving interventions that clinicians think they need, rather than care based on their expressed needs and preferences.

OBJECTIVE

To understand people's abilities to express the issues of importance to them within a consultation and clinicians' abilities to acknowledge and address those issues.

DESIGN

A qualitative study using an interpretive phenomenological approach.

METHODS

Eight clients were interviewed before they met their physiotherapist, the initial consultation with their physiotherapist was recorded, and both were interviewed separately afterward.

ANALYSIS

The clients frequently do not raise their emotions or feelings as issues of importance, and physiotherapists generally struggle to elicit, or identify as important, such matters. How these were presented to the clinician and subsequently addressed varied. We formulated three themes: 1) managing complex situations; 2) establishing a person-centered agenda; and 3) addressing emotional issues.

CONCLUSIONS

Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.

The acute stroke unit as a meaningful space: The lived experience of healthcare practitioners

This hermeneutic phenomenological study was undertaken in response to the recent re-organization of stroke unit provision in the United Kingdom. Through the analysis of four acute stroke unit practitioners' subjective accounts, the acute stroke unit emerged as a dynamic, meaningful space, where they experienced authenticity and belonging. The findings showed how these practitioners navigated their way through the space, thriving, and/or surviving its' associated vulnerabilities. They offer a different gaze on which to attend to the complexity and challenge that is interwoven with health professionals' flourishing, the spatiality of healthcare practice, and perhaps other demanding places of work.

What matters most to people in musculoskeletal physiotherapy consultations? A qualitative study

BACKGROUND

Person-centred approaches to care require clinicians to engage in trying to understand the full range of problems and concerns, treatment and investigation requests, and emotional and social issues that people bring to the consultation. If, however, the main issues of importance are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving the care that clinicians think they need, rather than care based on individual needs and preferences.

OBJECTIVE

To understand people's abilities to express the issues of importance to them within a consultation and clinicians' abilities to acknowledge and address those issues.

DESIGN

A qualitative study using an interpretive phenomenological approach.

METHODS

Fifteen people and their physiotherapists were interviewed and their consultations recorded. The resulting data sets were analysed to identify and report themes within the data.

FINDINGS

The findings revealed that people present with what are often simple issues, but which are sometimes expressed in an unstructured way in clinical encounters and are often difficult for clinicians to establish. Three linked themes emerged: (1) clear versus unstructured agendas; (2) people need information and understanding; and (3) developing a sense of collaboration.

CONCLUSIONS

The issues of importance that people bring to a consultation are varied and often vague. This research highlights the importance of communication to elicit, identify and address the issues of importance to people in clinical encounters to ensure a positive experience and outcome for both the individual person and clinician.

TWEETABLE ABSTRACT

Achieving desirable health outcomes is more likely when people are supported to think about their priorities and 'what matters to them'.