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Sivertsen M, De Jaegher H, Alstadhaug KB, Arntzen EC, Normann B. The precarity of patient participation - a qualitative interview study of experiences from the acute stroke and rehabilitation journey. Physiother Theory Pract 2024; 40:1265-1280. [PMID: 36345567 DOI: 10.1080/09593985.2022.2140319] [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: 04/28/2021] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Active patient participation is an important factor in optimizing post-stroke recovery, yet it is often low, regardless of stroke severity. The reasons behind this trend are unclear. PURPOSE To explore how people who have suffered a stroke, perceive the transition from independence to dependence and whether their role in post-stroke rehabilitation influences active participation. METHODS In-depth interviews with 17 people who have had a stroke. Data were analyzed using systematic text condensation informed by the concept of autonomy from enactive theory. RESULTS Two categories emerged. The first captures how the stroke and the resultant hospital admission produces a shift from being an autonomous subject to "an object on an assembly line." Protocol-based investigations, inactivity, and a lack of patient involvement predominantly determine the hospital context. The second category illuminates how people who have survived a stroke passively adapt to the hospital system, a behavior that stands in contrast to the participatory enablement facilitated by community. Patients feel more prepared for the transition home after in-patient rehabilitation rather than following direct discharge from hospital. CONCLUSION Bodily changes, the traditional patient role, and the hospital context collectively exacerbate a reduction of individual autonomy. Thus, an interactive partnership between people who survived a stroke and multidisciplinary professionals may strengthen autonomy and promote participation after a stroke.
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Affiliation(s)
- Marianne Sivertsen
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromsoe, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
| | - Hanne De Jaegher
- Department of Philosophy, University of the Basque Country, Avenida de Tolosa, San Sebastián, Spain
- University of Sussex School of Psychology, Brighton, UK
| | - Karl Bjørnar Alstadhaug
- Department of Clinical Medicine, UiT the Arctic University of Norway, Langnes, Tromsoe, Norway
- Department of Neurology, Nordland Hospital Trust, Bodoe, Norway
| | - Ellen Christin Arntzen
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| | - Britt Normann
- Department of Physiotherapy, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
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Dahl SSH, Arntzen EC, Normann B. The meaningfulness of exploring one's own limits through interactions and enjoyment in outdoor high-intensity physiotherapy for people with multiple sclerosis: a qualitative study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1303094. [PMID: 38566621 PMCID: PMC10986173 DOI: 10.3389/fresc.2024.1303094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Background and purpose Physical activity (PA) is often reduced in people with MS (pwMS), even when disability is low. Understanding the perspectives of pwMS on interventions aiming to improve PA is important to inform the development of such services. The aim of this study was to explore the experiences of pwMS participating in an outdoor, high-intensity and balance exercise group intervention. Methods This qualitative study was nested within an RCT exploring a novel intervention integrating sensorimotor exercises with high-intensity intervals of running/walking. Individual, in-depth interviews with the intervention group (n = 15; 12 women, 3 men; age 38-66; EDSS score 0-3.5) were conducted postintervention (mean days = 14), analyzed using a phenomenological-inspired approach with systematic text condensation, and interpreted based on enactive theory. Results Four categories were generated: (1) Exploration of one's own physical abilities: Challenging one's own limits was perceived by all participants to improve movement performance and/or intensity level. Such bodily changes engendered strong positive feelings. Some negative consequences of high-intensity training were described, increasing a feeling of loss. (2) New insights and beliefs: Participants experienced enhanced beliefs in their own capabilities, which they integrated in activities outside the intervention. (3) An engaging environment: The group setting was perceived as supportive, and the outdoor environment was perceived as stimulating activity. (4) Professional leadership, tailoring and co-creation of enjoyment: Physiotherapist-led, individualized interactions were regarded as necessary to safely revisit prior activities, such as running. Co-creating enjoyment facilitated high-intensity training and intervention adherence. Discussion High-intensity training combined with detailed exercises in a physiotherapy outdoor group was perceived to create meaningful bodily changes and enhance PA and prospects for both PA and life. Importantly, however, some negative experiences were also reported from the high-intensity training. Enactive theory allowed for the illumination of new perspectives: the importance of embodiment for self-efficacy and of tailored physiotherapy and an outdoor-group environment for exploring one's own limits to physical capabilities. These aspects should inform future exercise interventions in pwMS with low disability.
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Affiliation(s)
| | | | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Knutsen K, Solbakken R, Normann B. The diverse invitations to participate in early rehabilitation - A qualitative study of nurse-patient interactions in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103556. [PMID: 37793317 DOI: 10.1016/j.iccn.2023.103556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES To gain insight into the interaction between nurses and patients in early rehabilitation and the role of patient participation in this context. RESEARCH DESIGN AND SETTING A qualitative study with a phenomenological-hermeneutic approach was conducted in two units/hospitals from January 2022 to January 2023, utilizing observations and video recordings of eight nurse/patient dyads combined with post observation interviews with the nurses. The study was analysed by systematic text condensation and video analysis, informed by interaction theory. FINDINGS Two contrasting categories emerged: 1) Absent invitations: the nurse performed procedures without involving the patient; in other situations, the nurse informed the patient without requesting participation. Simultaneously, spontaneous patient movements were not acknowledged by the nurse. The nurses explained that this practice occurred due to time pressure, oversights, a lack of belief regarding patients' capacities, the unit's culture and little training. 2) Invitations that strengthened participation: the nurse verbally requested activity that often resulted in an inadequate response, or bodily extended invitations that sometimes led to joint active movement. Patients were the most active participants when nurses combined verbal prompts, eye contact, physical handling, and dialogue. In the interviews, the nurses emphasized giving patients enough time to participate and repeatedly encouraged participation because the patient's condition and capacity constantly fluctuated. CONCLUSION Interactions that combine verbal and bodily invitations appear crucial for patient participation in early rehabilitation in the intensive care unit, emphasizing the importance of integrated tailored bodily communication. The nurses' lack of insight into and attention to the patient's bodily potential for active movement combined with a paternalistic approach to the patient's situation may hinder patients' active participation. IMPLICATIONS FOR CLINICAL PRACTICE Integrated forms of interaction that explore patients' capacity and potential for participation should be employed in line with verbal communication. Developing competence in early rehabilitation should be emphasized in critical care nurses' education and training.
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Affiliation(s)
- Karina Knutsen
- Faculty of Nursing and Health Science, Nord University, Mailbox 1490, 8049 Bodoe, Norway. https://twitter.com/@karinaknutsen1
| | - Rita Solbakken
- Faculty of Nursing and Health Science, Nord University, Mailbox 1490, 8049 Bodoe, Norway.
| | - Britt Normann
- Faculty of Nursing and Health Science, Nord University, Mailbox 1490, 8049 Bodoe, Norway.
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Halák J, Kříž P. Phenomenological physiotherapy: extending the concept of bodily intentionality. MEDICAL HUMANITIES 2022; 48:e14. [PMID: 35217571 DOI: 10.1136/medhum-2021-012300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
This study clarifies the need for a renewed account of the body in physiotherapy to fill sizable gaps between physiotherapeutical theory and practice. Physiotherapists are trained to approach bodily functioning from an objectivist perspective; however, their therapeutic interactions with patients are not limited to the provision of natural-scientific explanations. Physiotherapists' practice corresponds well to theorisation of the body as the bearer of original bodily intentionality, as outlined by Merleau-Ponty and elaborated upon by enactivists. We clarify how physiotherapeutical practice corroborates Merleau-Ponty's critical arguments against objectivist interpretations of the body; particularly, his analyses demonstrate that norms of optimal corporeal functioning are highly individual and variable in time and thus do not directly depend on generic physiological structures. In practice, objectively measurable physical deviations rarely correspond to specific subjective difficulties and, similarly, patients' reflective insights into their own motor deficiencies do not necessarily produce meaningful motor improvements. Physiotherapeutical procedures can be understood neither as mechanical manipulations of patients' machine-like bodies by experts nor as a process of such manipulation by way of instructing patients' explicit conscious awareness. Rather, physiotherapeutical practice and theory can benefit from the philosophical interpretation of motor disorders as modifications of bodily intentionality. Consequently, motor performances addressed in physiotherapy are interpreted as relational features of a living organism coupled with its environment, and motor disorders are approached as failures to optimally manage the motor requirements of a given situation owing to a relative loss of the capacity to structure one's relation with their environment through motor action. Building on this, we argue that the process of physiotherapy is most effective when understood as a bodily interaction to guide patients towards discovering better ways of grasping a situation as meaningful through bodily postures and movements.
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Affiliation(s)
- Jan Halák
- Department of Philosophy, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Kříž
- Department of Philosophy, Palacky University Olomouc, Olomouc, Czech Republic
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Sørvoll M, Øberg GK, Girolami GL. The Significance of Touch in Pediatric Physiotherapy. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:893551. [PMID: 36189075 PMCID: PMC9397783 DOI: 10.3389/fresc.2022.893551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022]
Abstract
Change in theoretical framework over the last decades and recent research in pediatric physiotherapy, has created a debate surrounding therapeutic touch. What is the role of or is there a need for handling and hands-on facilitated guidance (facilitation)? Does it limit and/or interfere with children's learning and development? It is frequently argued that therapeutic touch represents a passive and/or static approach that restricts disabled children's participation during interaction and activity in clinical encounters leading to decreased home, school and community participation. Touch may even appear as coercive and controlling. In this context, therapeutic touch is largely associated with physical hands-on activities. However, therapeutic touch can also be understood as an intersubjective phenomenon that arises from a deep connection between movement, perception, and action. We believe the significance of therapeutic touch and its impact on physiotherapy for children has not been considered from this broader, holistic perspective. In this theoretical paper, we will apply enactive concepts of embodiment, sensory-motor agency, coordination, and emergence to explore the concept and importance of touch in physiotherapists‘ clinical face-to face encounters with children. We will frame the discussion within the context of the typical sensorimotor development of children from the fetal stage to birth on and into adulthood. Moreover, we will rely on biological, physiological, and phenomenological insights to provide an extended understanding of the importance of touch and the significance of touch in clinical practice.
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Affiliation(s)
- Marit Sørvoll
- Section for Innovation in Education, Norwegian Directorate for Higher Education and Skills, 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
- *Correspondence: Gunn Kristin Øberg
| | - Gay L. Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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Sivertsen M, De Jaegher H, Arntzen EC, Alstadhaug KB, Normann B. Embodiment, tailoring, and trust are important for co-construction of meaning in physiotherapy after stroke: A qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1948. [PMID: 35306716 PMCID: PMC9539856 DOI: 10.1002/pri.1948] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/20/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
Background and Purpose Physiotherapy, with an emphasis on high intensity, individually tailored, and person‐centered treatment, is an effective route for recovery after a stroke. No single approach, however, has been deemed paramount, and there is limited knowledge about the patient experience of assessment, goal‐setting, and treatment in physiotherapy. In this study, we seek to report patient experiences of I‐CoreDIST—a new physiotherapy intervention that targets recovery—and those of usual care. The purpose is to investigate how individuals with stroke experience the bodily and interactive course of physiotherapy during their recovery process. Methods A qualitative study, nested within a randomized controlled trial, consisting of in‐depth interviews with 19 stroke survivors who received either I‐CoreDIST or usual care. Data were analyzed using systematic text condensation, and this analysis was informed by enactive theory. Results Interaction with the physiotherapist, which was guided by perceived bodily changes, fluctuated between being, on the one hand, formal/explicit and, on the other, tacit/implicit. The experiences of participants in the intervention group and the usual care group differed predominantly with regards to the content of therapy sessions and the means of measuring progress; divergences in levels of satisfaction with the treatment were less pronounced. The perception of positive bodily changes, as well as the tailoring of difficulty and intensity, were common and essential features in generating meaning and motivation. An embodied approach seemed to facilitate sense‐making in therapy situations. In the interaction between the participants and their physiotherapists, trust and engagement were important but also multifaceted, involving both interpersonal skills and professional expertise. Conclusion The embodied nature of physiotherapy practice is a source for sense‐making and meaning‐construction for patients after a stroke. Trust in the physiotherapist, along with emotional support, is considered essential. Experiencing progress and individualizing approaches are decisive motivators.
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Affiliation(s)
- Marianne Sivertsen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsoe, Norway.,Nordland Hospital Trust, Bodoe, Norway
| | - Hanne De Jaegher
- Department of Philosophy, University of the Basque Country, San Sebastián, Spain.,School of Psychology, University of Sussex, Brighton, UK
| | - Ellen Christin Arntzen
- Nordland Hospital Trust, Bodoe, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| | - Karl Bjørnar Alstadhaug
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsoe, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
| | - Britt Normann
- Nordland Hospital Trust, Bodoe, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
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Norris M, Wainwright E. Learning professional touch: an exploration of pre-registration Physiotherapy students' experiences. Physiother Theory Pract 2020; 38:90-100. [PMID: 32053416 DOI: 10.1080/09593985.2020.1725944] [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] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Meriel Norris
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Emma Wainwright
- College of Education, Brunel University London, Uxbridge, UK
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What is physiotherapy and where are we heading? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1805. [DOI: 10.1002/pri.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 11/07/2022]
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Lahelle AF, Øberg GK, Normann B. Group dynamics in a group-based, individualized physiotherapy intervention for people with multiple sclerosis: A qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1829. [PMID: 31883187 DOI: 10.1002/pri.1829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/22/2019] [Accepted: 12/13/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Group-based physiotherapy is a common and beneficial intervention for people with multiple sclerosis (MS). Most group interventions are not individually adapted to each participant's needs. Evidence on how individualization and group elements can be combined in a clinical setting is lacking. The objective of this study is to expand the knowledge base in neurological physiotherapy by investigating the nature of group dynamics in a group-based, individualized intervention for people with MS. METHODS This qualitative study included 13 nonparticipatory video observations (14 hr 38 min) of GroupCoreDIST exercise sessions complemented by 13 interviews (12 hr 37 min) with physiotherapists (PTs). The purposively sampled participants included 40 patients with MS (expanded disability scale of 1.0-6.5) and six PTs with expertise in neurological physiotherapy. Data were analysed using systematic text condensation in an enactive theoretical framework. RESULTS Two main categories emerged from the material. (a) Individual systems affect group dynamics: Individual perceptions of success through adapted and embodied approaches positively affected the dynamics of the group. (b) Disease and exercise peer support: Social support was a substantial product of dynamic group processes and was enhanced through the PTs' strategic focus on experience sharing. CONCLUSION The results revealed that group dynamics benefit from individualization and the PTs' focus on experience sharing. These findings are contrary to the prevailing view that individualization and group-based interventions are mutually exclusive and thus should be considered in group-based interventions for people with MS.
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Affiliation(s)
- Andreas Falck Lahelle
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Britt Normann
- The Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Arntzen EC, Straume B, Odeh F, Feys P, Normann B. Group‐based, individualized, comprehensive core stability and balance intervention provides immediate and long‐term improvements in walking in individuals with multiple sclerosis: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1798. [DOI: 10.1002/pri.1798] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/12/2019] [Accepted: 05/17/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Bjørn Straume
- Department of Community Medicine, Faculty of Health SciencesUiT, The Arctic University of Norway Tromsø Norway
| | - Francis Odeh
- Institute for Clinical Medicine, Faculty of Health ScienceUiT, The Arctic University of Norway Tromsø Norway
- Department of NeurologyNordland Hospital Trust Bodø Norway
| | - Peter Feys
- BIOMED/REVALUniversity of Hasselt Diepenbeek Belgium
| | - Britt Normann
- Department of PhysiotherapyNordland Hospital Trust Bodø Norway
- Department of Health and Care SciencesUiT, The Arctic University of Norway Tromsø Norway
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