Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses and the massage scandals of 1894

Physiotherapy, movement, and action

Movement has always been central to physiotherapy practice and theory. But physiotherapists have largely focused on forms of human bodily movement governed by the neuro-mechanical body system in illness or injury. Many other forms of movement exist though, and we argue here that the exploration of these other movements might give physiotherapists new language, concepts, and tools, to guide its adaptation to forms of healthcare that are becoming increasingly complex, diverse, and inclusive. Drawing on Hannah Arendt's concept of vita activa (or "active life"), we examine how physiotherapists have traditionally captured and defined movement. Critiquing past practices for over-emphasizing what Arendt called labor, and work, we suggest that an approach governed by her concept of action, might offer physiotherapists a way to give movement greater significance. We explore what active life might mean for a revised approach to movement, and highlight examples of vita activa already emerging in physiotherapy. We close the paper by calling for a reevaluation of what movement means for the profession and its clients.

Challenging power and unearned privilege in physiotherapy: lessons from Africa

Power and unearned privilege in the profession of physiotherapy (PT) reside in the white, Western, English-speaking world. Globally, rehabilitation curricula and practices are derived primarily from European epistemologies. African philosophies, thinkers, writers and ways of healing are not practiced widely in healthcare throughout the globe. In this invited perspectives paper, we discuss the philosophies of Ubuntu and Seriti, and describe how these ways of thinking, knowing, and being challenge Western biomedical approaches to healthcare. We believe implementing these philosophies in the West will assist patients in attaining the health outcomes they seek. Further we call for Western professionals and researchers to stand in solidarity with their African counterparts in order to move towards a diversity of practitioners and practices that help to ensure better outcomes for all.

A Rebuttal to Perpetuating Victimization with Efforts to Reduce Human Trafficking: a Call to Action for Massage Therapist Protection

This document is a rebuttal to Perpetuating Victimization with Efforts to Reduce Human Trafficking: a Call to Action for Massage Therapist Protection by Rosenow and Munk that appeared in the March issue. The paper is to be applauded for providing a massage therapist’s viewpoint on the issue of human trafficking guised as massage, and concisely summarizing the main impact on the profession. The solutions involved, however, are problematic, as is the underlying view that licensing practitioners and their businesses is de-signed to protect the massage therapist and trafficking victims. Finally, this commentary suggests a regulatory solution that should be implemented for any re-porting process to be successful.

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

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

A Pan-Canadian Perspective on Education and Training Priorities for Physiotherapists. Part 2: Professional Interactions and Context of Practice

Purpose: Canadian physiotherapists who participated in the Physio Moves Canada (PMC) project of 2017 identified the state of training programmes as a threat facing professional growth of the discipline. One purpose of the project was to identify priority areas for physiotherapist training programmes as identified by academics and clinicians across Canada. Method: The PMC project included a series of interviews and focus groups conducted across clinical sites in every Canadian province and in Yukon Territory. Data were interpreted using descriptive thematic analysis; identified sub-themes were returned to participants for reflection. Results: Overall, 116 physiotherapists and 1 physiotherapy assistant participated in 10 focus groups and 26 semi-structured interviews. Results are presented using the curriculum guidelines of the time for organization. Here we describe two themes: Physiotherapy Professional Interactions, further defined by interpersonal and interprofessional competencies, and Context of Practice further defined by advocacy, leadership, community awareness, and business competencies. Conclusions: Participants appear to express a desire for programmes to train reflexive and adaptable primary health care practitioners with strong foundational knowledge and clinical expertise, complemented by interpersonal and interprofessional skills to empower physiotherapists to effectively care and advocate for patients, to lead health care teams, and to share ideas to inspire change towards a future of physiotherapy practice.

Diversity in the Australian speech-language pathology workforce: Addressing Sustainable Development Goals 3, 4, 8, and 10

PURPOSE

Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia.

RESULT

A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+.

CONCLUSION

This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10.

The emergence of physiotherapy in Germany from the mid-19th to the mid-20th centuries: A "female profession" concerned with movement in the health care arena

Background: The history of physiotherapy in Germany dates back to the mid-nineteenth century, when German physicians discovered Swedish medical gymnastics as a therapeutic treatment modality. From the early 20th century onwards, physiotherapy slowly began to establish itself as a field of activity specifically for women of the middle classes who provided assistive services to medical doctors.Method: Extensive overview of published and unpublished research on the history of German physiotherapy as well as select primary sources from the 19th and 20th centuries. Additionally reference is made to historical research regarding the emergence of the physical culture and life reform movements, as well as on gender research regarding upper and middle class female employment opportunities in the social and health care sector. Findings: This study outlines the two leitmotifs of physiotherapy's incorporation into the medical sector (i.e. medicalisation) and its (self-)image as a "female profession" (i.e. feminisation) as two intertwined historical phenomena shaping the critical period when physiotherapy assumed its role as a health profession in Germany. These developments from the mid-19th to the mid-20th centuries resulted in the emergence of a "female profession" with a distinct focus on the role of movement as a treatment modality.Discussion: Critical engagement with a handed down professional self-image is needed. On the basis of my historiographical overview, I suggest a future research agenda which would result in a more appropriate understanding of early physiotherapists in Germany as historical agents.

The role of neurasthenia in the formation of the physiotherapy profession

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19^th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the massage and electricity so vital to the success of the Rest Cure, used the opportunity to develop approaches to treatment that would form the backbone of the physiotherapy profession in England after 1894. Methods: Extensive primary and secondary texts were drawn from a wide range of sources and critically reviewed. Findings: This study argues that the management of neurasthenic cases in the 1880s and 90s created the conditions necessary for the development of the profession's relationship with medicine and the establishment of new practice roles for women, and that these would play an important role in shaping the physiotherapy profession in Britain after 1894. Read through the critical sociological writings of Magali Sarfatti Larson and Anne Witz, I argue that the work of the nurse-masseuses can be seen as a complex gendered negotiation between the need to be deferential to the dominant male medical profession; distinct from emerging notions of the angelic, motherly nurse; obedient, technically competent and safe. The creation of a space in the clinic room for a third practitioner who could deliver a different form of care to the doctor or the nurse, established an approach to practice that physiotherapists would later adopt almost without amendment. Discussion: I argue that this approach owes much to the work done by nurse-massueses who established and tested its principles in treating cases of neurasthenia.

Learning professional touch: an exploration of pre-registration Physiotherapy students' experiences

Physical touch is considered a core competency in Physiotherapy, central to clinical reasoning and communication. Nevertheless, there is a dearth of research into how the skill is learned and the experiences of students in that process. The aim of this paper is to explore that learning experience among pre-registration physiotherapy students. An approach underpinned by phenomenology and ethnographic methods was undertaken over an 8-month period in one Higher Education Institution in the UK. Data came from a series of observations and focus groups, complemented by personal reflective learning diaries with first- and second-year undergraduate students. Focus group data were analyzed thematically and triangulated with other data sources. Three themes were developed: 1) 'Uncertainty, self-awareness and anxiety' explores the discomfort experienced in the early stages; 2) 'Emerging familiarity and awareness of inter-action' demonstrates developing confidence in bodily capability and communicative capacity; and 3) 'Realities of touch in a clinical environment' focuses on the shift from the pre-clinical to clinical context and highlights the cyclical processes of embodied learning. This study highlights the complexity and immediacy of the embodied learning of touch and its interactions with the development of professional identity. Negotiation of boundaries, both seen and unseen, creates jeopardy in that process through the first two years of the course.

People who identify as LGBTIQ+ can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey

QUESTIONS

What are the experiences of people who identify as lesbian, gay, bisexual, transgender, intersex, queer or related identities (LGBTIQ+) and attend physiotherapy? How could those experiences of physiotherapy be improved?

DESIGN

Primarily qualitative design using a purpose-built online survey.

PARTICIPANTS

People aged 18 years or older, who self-identified as LGBTIQ+, and had attended physiotherapy in Australia.

METHODS

Open responses were analysed with thematic analysis and quantitative responses with descriptive statistics.

RESULTS

One hundred and fourteen participants responded to the survey, with 108 meeting all eligibility criteria. Four main themes were identified in the analysis, with almost all participants reporting experiences during physiotherapy interactions relating to at least one of the following themes: 'assumptions' about participants' sexuality or gender identity; 'proximity/exposure of bodies', including discomfort about various aspects of physical proximity and/or touch and undressing and/or observing the body; 'discrimination', including reports of overt and implicit discrimination as well as a fear of discrimination; and 'lack of knowledge about transgender-specific health issues'. Positive experiences were also evident across the first, third and fourth themes. Participants suggested or supported a number of ways to improve LGBTIQ+ experiences with physiotherapy, including: LGBTIQ+ diversity training for physiotherapists, education specific to the LGBTIQ+ population (particularly transgender health), and open options for gender provided on forms.

CONCLUSION

People who identify as LGBTIQ+ can experience challenges when attending physiotherapy, including: erroneous assumptions by physiotherapists, discomfort, explicit and implicit discrimination, and a lack of knowledge specific to their health needs. Positive findings and participant-suggested changes offer ways to improve physiotherapy for LGBTIQ+ people across educational and clinical settings.

Objecting: Multiplicity and the practice of physiotherapy

Drawing from Annemarie Mol’s conceptulisation of multiplicity, we explore how health care practices enact their object(s), using physiotherapy as our example. Our concern is particularly to mobilise ways of practicing or doing physiotherapy that are largely under-theorised, unexamined or marginalised. This approach explores those actions that reside in the interstitial spaces around, beneath and beyond the limits of established practices. Using Mol’s understanding of multiplicity as a theoretical and methodological driver, we argue that physiotherapy in practice often subverts the ubiquitous reductive discourses of biomedicine. Physiotherapy thus enacts multiple objects that it then works to suppress. We argue that highlighting multiplicities opens up physiotherapy as a space which can broaden the objects of practice and resist the kinds of closure that have become emblematic of contemporary physiotherapy practice. Using an exemplar from a rehabilitation setting, we explore how physiotherapists construct their object(s) and consider how multiplicity informs an otherwise physiotherapy that has broader implications for health care and rehabilitation.

Half a Man: The Symbolism and Science of Paraplegic Impotence in World War II America

At the conclusion of the Second World War, more than 600,000 men returned to the United States with long-term disabilities, profoundly destabilizing the definitions, representations, and experiences of male sexuality in America. By examining an oft-neglected 1950 film, The Men, along with medical, personal, and popular accounts of impotence in paralyzed World War II veterans, this essay excavates the contours of that change and its attendant anxieties. While previous scholarship on film and sexuality in the postwar period has focused on women's experiences, we broaden the analytical lens to provide a fuller picture of the various meanings of male sexuality, especially disabled heterosexuality. In postwar America, the paralyzed veteran created a temporary fissure in conventional discussions of the gendered body, a moment when the "normality" and performative features of the male body could not be assumed but rather had to be actively defined. To many veterans, and to the medical men who treated them, sexual reproduction--not function-became the ultimate signifier of remasculinization.

Professional relations in sport healthcare: workplace responses to organisational change

This article examines the impact of organisational changes in UK elite sport on the professional relations among and between different healthcare providers. The article describes the processes by which demand for elite sport healthcare has increased in the UK. It further charts the subsequent response within medicine and physiotherapy and, in particular, the institutionalisation of sport-specific sub-disciplines through the introduction of specialist qualifications. Drawing on semi-structured interviews with 14 doctors and 14 physiotherapists, the article argues that organisational changes have led to intra-professional tensions within both professional groups but in qualitatively different forms reflecting the organisational traditions and professional identities of the respective disciplines. Organisational changes promoting multi-disciplinary healthcare teams have also fostered an environment conducive to high levels of inter-professional cooperation though significant elements of inter-professional conflict remain. This study illustrates how intra-professional relations are affected by specialisation, how legitimation discourses are used by different professions, and how intra- and inter-professional conflict and cooperation should be seen as highly interdependent processes.

A History of Massage in Nurse Training School Curricula (1860-1945)

Introduction: Guided by Florence Nightingale, massage nurse training instruction methods were duplicated in the U.S. nurse training curricula. In the 1880s to 1900s massage training and instruction was delivered by physicians, nurses, or masseurs for many disease conditions. In the 1930s to 1940s, influential nurse authors and educators began to recommend specialization in physiotherapy for nurses. Scientific and pharmacological solutions for symptoms of disease became popular, thus practicing basic nursing comfort measures using massage declined. Purposes: To trace roots of massage in the medical literature, the inclusion of massage in U.S. nurse training school curricula, and examine the historical shift from massage as a basic nursing comfort measure to a specialization of physiotherapy. Method: Primary text books by physicians, nurses, massage instructors; medical/nursing journals; nursing curriculum guidelines—archival collections of the Center for Historical Nursing Inquiry; Historical Collections at the University of Virginia Claude Moore Health Sciences Library; private historical collections; and secondary published books/ articles were used. Findings: Prior to increase in scientific care, use of analgesics, and specialization of physiotherapy departments, the nurse provided basic comfort measures that included massage. Historical research in the use of massage in nursing may help refocus attention on the healing of the mind/body and reinforce the value of compassionate touch and balance in nursing practice today.

Making breathing your business: enterprising practices at the margins of orthodoxy

Over the last 30 years there has been a gradual but nonetheless significant shift in the political economy of healthcare in developed countries. The health reforms that have accompanied this shift have had a significant impact upon medicine, nursing and a number of other orthodox health professions, but to date, little work has been done to explore the changing nature of physiotherapy practice. This study draws on Foucault's notion of governmentality to explore the enterprising practices of a new physiotherapy clinic established in Auckland, New Zealand. Drawing on a critical history of respiratory physiotherapy, which had previously been firmly anchored within the public health sector, we show that the actions and practices of the clinic's staff are testing the margins of orthodox physiotherapy practice and exploring the new market possibilities offered by consumer demand for optimal health. The study explores how the physiotherapists at the clinic are problematizing the practices, clinical spaces and clientele associated with orthodox practice, and, most notably, commodifying breathing, to create a space within which it is possible to think about physiotherapy otherwise. This study builds on the instability now surrounding the orthodox health professions and asks if exemplars like that offered in this article provide some meaningful insights into the future for healthcare practice.

Physiotherapists' accounts of their clients in geriatric inpatient rehabilitation

This article aims to describe how physiotherapists working with frail older people talk about their clients. Semi-structured qualitative interviews with physiotherapists (n = 11) were audio recorded, transcribed and analysed using discourse analysis. Two accounts were identified: (i) older adults as recipients of a treatment intervention at the rehabilitation centre, with the dimensions 'a focus on physical impairments' and 'a focus on social needs' and (ii) older adults as partners in an exercise intervention to support their everyday living at home. Older adults' everyday living context was not considered in the approach where, in an isolated and objectified manner, the physiotherapists focused on physical impairments. Placing great emphasis on the clients' social needs in turn implied passive treatments. In both instances the physiotherapists' activities were focused on the present, that is, the time of the clients' stay at the rehabilitation facility, rather than on their everyday challenges at home. These aspects were taken into accounts to a greater extent when older adults were positioned as partners and functional limitations were contemplated in relation to domestic daily living.