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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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Boland K, Pigott T, Forbes R. ‘I am the educator and the learner at the same time’: a qualitative survey of the knowledge and use of adult learning theory in UK musculoskeletal physiotherapists' patient education. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patient education is a core component of musculoskeletal care, yet broad definitions exist and effective delivery methods are unclear. Musculoskeletal physiotherapists' use of patient education has been described as individualised and collaborative, reflecting a person-centred model of care. However, discrepancies between perceived and actual practice, and therapist-centred approaches to education, have been observed. Little is known about the theoretical basis of musculoskeletal physiotherapists' patient education practice, yet the adult learning theory frames how adults interact with education and echoes the principles of person-centred care. The aim of this study was to analyse the use of adult learning theory to inform patient education practice among UK musculoskeletal physiotherapists. Methods This study used a novel, online questionnaire to collect quantitative and qualitative data from a self-selecting sample of UK musculoskeletal physiotherapists, using a multimodal recruitment strategy. Complete responses were provided by 66 participants. Categorical and narrative data were collected and descriptive and thematic analyses undertaken. Results Participants generally self-rated their educational competencies highly, with the exception of evaluating patient education. Participants were more familiar with reflective and self-directed learning than with other adult learning theories. Two main themes were described: implicit adult learning theory knowledge and challenges in applying adult learning theory. Conclusions The results suggest that musculoskeletal physiotherapists may have implicit knowledge of adult learning theory, yet challenges exist in applying them. This finding supports the establishment of ongoing training in educational skills for physiotherapists and could be used as a catalyst for musculoskeletal physiotherapists to reflect on their knowledge and use of adult learning theory.
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Affiliation(s)
- Katy Boland
- School of Health & Society, University of Salford, Manchester, UK
| | - Tim Pigott
- School of Health & Society, University of Salford, Manchester, UK
| | - Roma Forbes
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Widerström B, Elvén M, Rasmussen-Barr E, Boström C. "How does physical examination findings influence physiotherapists' decision-making when matching treatment to patients with low back pain?". Musculoskelet Sci Pract 2021; 53:102374. [PMID: 33798815 DOI: 10.1016/j.msksp.2021.102374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Further clinical data how low-back pain (LBP) symptoms and signs manifests in physiotherapy clinical reasoning and treatment decision-making is needed. OBJECTIVE The aim was to explore and describe how symptoms and signs portrayed in three case descriptions of LBP influences physiotherapy treatment decision-making. DESIGN This was an exploratory interview study using inductive content analysis. METHOD Fifteen semi-structured individual interviews were used to collect data of physiotherapists' treatment decision-making regrading three diverse LBP case descriptions. The participants were men, women, experienced and novice, working in primary healthcare settings in one sparsely populated region and in one larger city in Sweden. FINDINGS Two overarching themes were identified influencing decision-making for the treatment of LBP:1) Explicit assessment features distinguish treatment approaches; with categories describing how symptoms and signs were used to target treatment (nature of pain induce reflections on plausible cause; narrative details trigger attention and establishes knowledge-enhancing foci; pain-movement-relationship is essential; diverse emphasis of pain modulation and targeted treatment approaches): and 2) Preconceived notion of treatment, with categories describing personal treatment rationales, unrelated to the presented symptoms and signs (passive treatment avoidance and motor control exercise ambiguity). CONCLUSION This study identifies how assessment details lead to decisions on diverse treatment approaches for LBP, but also that treatment decisions can be based on preconceived beliefs unrelated to the clinical presentation. The results underpin the mix of knowledge sources that clinicians need to balance and the necessity of self-awareness of preconceptions for informed and meaningful clinical decision-making.
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Affiliation(s)
| | - Maria Elvén
- Mälardalen University, School of Health, Care and Social Welfare, Division of Physiotherapy, Västerås, Sweden
| | | | - Carina Boström
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden
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Murtagh S, Bryant E, Hebron C, Ridehalgh C, Horler C, Trosh C, Olivier G. Management of low back pain: Treatment provision within private practice in the UK in the context of clinical guidelines. Musculoskeletal Care 2021; 19:540-549. [PMID: 33713545 DOI: 10.1002/msc.1553] [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] [Received: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To summarise the combination of treatments private UK-based physiotherapists use with patients who have low back pain (LBP) and the extent to which the treatments used are consistent with clinical guideline recommendations. DESIGN Cross-sectional observational survey. METHODS Data were collected from physiotherapists within private UK-based clinics using an online standardised data collection system to record the treatment they provided for patients who had LBP with/without leg pain. Treatment data were classified into those that are 'recommended', 'not recommended' and had 'no recommendation'. RESULTS/FINDINGS Treatment provided to 8003 patients were included in the analyses. Most patients (95.0%) were provided with a 'recommended' treatment. Approximately half of the patients who received 'recommended' treatment were also provided with other treatments that were either 'not recommended' (16.7%), had 'no recommendation' (16.6%) or a combination of both (13.0%). Few patients were provided with only treatments that were 'not recommended' and/or treatment with 'no recommendation' (4.6%). CONCLUSION This study provides insight into the self-reported practice of participating physiotherapists and highlights how they generally adopted a multimodal treatment model for patients with LBP. Consistent with the National Institute for Health and Care Excellence guidelines, most patients received information and advice often in conjunction with exercise and manual therapy. Only a small proportion of patients were provided with treatments that are 'not recommended' and/or treatment that had 'no recommendation'. These findings are useful in documenting the implementation of clinical guidelines given the need for practitioners to balance the best available evidence with patient expectation and preference and to facilitate the therapeutic alliance.
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Affiliation(s)
- Shemane Murtagh
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Elizabeth Bryant
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | | | - Christopher Horler
- School of Health Sciences, University of Brighton, Eastbourne, UK.,Physiotherapy Department, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Caroline Trosh
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - George Olivier
- School of Pharmacy and Bimolecular Sciences, University of Brighton, Brighton, UK
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Pugliese M, Wolff A. The Value of Communication, Education, and Self-Management in Providing Guideline-Based Care: Lessons Learned from Musculoskeletal Telerehabilitation During the COVID-19 Crisis. HSS J 2020; 16:160-163. [PMID: 32837411 PMCID: PMC7397961 DOI: 10.1007/s11420-020-09784-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Matthew Pugliese
- Physical Therapy Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Aviva Wolff
- Hand Therapy Department, Hospital for Special Therapy, 535 East 70th Street, New York, NY 10021 USA
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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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Rondon-Ramos A, Martinez-Calderon J, Diaz-Cerrillo JL, Rivas-Ruiz F, Ariza-Hurtado GR, Clavero-Cano S, Luque-Suarez A. Pain Neuroscience Education Plus Usual Care Is More Effective Than Usual Care Alone to Improve Self-Efficacy Beliefs in People with Chronic Musculoskeletal Pain: A Non-Randomized Controlled Trial. J Clin Med 2020; 9:jcm9072195. [PMID: 32664552 PMCID: PMC7408875 DOI: 10.3390/jcm9072195] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
Self-efficacy beliefs are associated with less physical impairment and pain intensity in people with chronic pain. Interventions that build self-efficacy beliefs may foster behavioral changes among this population. A non-randomized trial has been carried out to evaluate the effectiveness of pain neuroscience education (PNE) plus usual care in modifying self-efficacy beliefs, pain intensity, pain interference and analgesics consumption in people with chronic musculoskeletal pain. Participants were allocated to an experimental (PNE plus usual care, n = 49) and a control (usual care alone, n = 51) group. The primary outcome was self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), and the secondary outcomes were pain intensity, pain interference (Graded Chronic Pain Scale) and analgesics consumption. The participant's pain knowledge (revised Neurophysiology of Pain Questionnaire) after PNE intervention was also assessed to analyze its influence on every outcome measure. All the outcome measures were assessed at the baseline and at four-week and four-month follow-ups. PNE plus usual care was more effective than usual care alone to increase self-efficacy beliefs and decrease pain intensity and pain interference at all follow-up points. No differences between groups were found in terms of analgesics consumption. Knowledge of pain neurophysiology did not modify the effects of PNE plus usual care in any of the outcome measures. These results should be taken with caution because of the non-randomized nature of this design, the limited follow-ups and the uncertainty of the presence of clinical changes in self-efficacy for participants. Larger, methodological sound trials are needed.
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Affiliation(s)
- Antonio Rondon-Ramos
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. Las Lagunas, 29650 Mijas, Málaga, Spain;
- Universidad de Málaga, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, 29071 Málaga, Spain;
| | - Javier Martinez-Calderon
- Universidad de Málaga, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, 29071 Málaga, Spain;
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Málaga, Spain
| | - Juan Luis Diaz-Cerrillo
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. La Carihuela, 29620 Torremolinos, Málaga, Spain;
| | - Francisco Rivas-Ruiz
- Research Unit, Agencia Sanitaria Costa del Sol, 29603 Marbella, Málaga, Spain;
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 29603 Marbella, Málaga, Spain
| | - Gina Rocio Ariza-Hurtado
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. San Pedro de Alcántara, 29670 Marbella, Málaga, Spain;
| | - Susana Clavero-Cano
- Servicio Andaluz de Salud, Distrito de Atención Primaria Costa del Sol, U.G.C. Las Albarizas, 29600 Marbella, Málaga, Spain;
| | - Alejandro Luque-Suarez
- Universidad de Málaga, Facultad de Ciencias de la Salud, Departamento de Fisioterapia, 29071 Málaga, Spain;
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Málaga, Spain
- Correspondence:
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