How can movement quality be promoted in clinical practice? A phenomenological study of physical therapist experts

The reliability of a two-plane qualitative assessment tool for a single leg HOP task amongst multidisciplanary sports medicine practitioners

OBJECTIVE

To determine the reliability of a qualitative assessment of trunk and lower extremity alignment during a single hop for distance in youth athletes.

DESIGN

Repeated measures.

METHODS

Twenty-five healthy female youth athletes were recorded performing a single leg hop (SLH). Videos were viewed and scored using a qualitative assessment tool by a physical therapist (PT), Certified Strength and Conditioning Specialist (CSCS), and Athletic Trainer (AT), on two separate occasions. Interclass correlation coefficients (ICCs) for each item and total score were calculated with a 2-way mixed-effect model with 95% confidence intervals (95% CIs).

RESULTS

The tool demonstrated moderate intra-rater reliability for the total score (PT ICC = 0.74, CSCS ICC = 0.60, AT ICC = 0.71). Individual item intra-rater reliability ranged from poor to good for the PT (-0.06-0.80), poor to moderate for the CSCS (0.35-0.70), and poor to good for the AT (0.43-0.83). Total score inter-rater reliability was moderate in round one and poor in round two (ICC = 0.57 and ICC = 0.49, respectively).

CONCLUSIONS

Moderate intra-rater reliability and poor to moderate inter-rater reliability amongst a PT, CSCS, and an AT was demonstrated. Future studies should explore the tool's reliability amongst a more homogenous group of raters to better determine its utility.

Movement Awareness Therapies in Eating Disorders: A Systematic Review and Meta-Analysis

Given the rising prevalence and complexity of eating disorders, a comprehensive multidisciplinary holistic approach is necessary. This work aimed to assess the effectiveness of body and movement awareness therapies in patients with eating disorders. Search strategy was undertaken using several scientific health databases. Articles were eligible if they were randomized controlled trials analyzing the effects of movement and body awareness therapies in eating disorders. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement for systematic reviews was followed and the risk of bias was assessed using the "Cochrane Collaboration Tool to assess the risk of bias." 11 articles met the inclusion criteria, including 437 patients. No high-quality randomized controlled trials were found. Forest plot analysis of the Eating Disorder Examination scale showed a difference favors to body awareness therapies but not significantly neither homogeneous. The interventions analyzed included yoga, body awareness therapy, dance, and psychomotor therapy. Body awareness therapies provide some additional benefits for eating disorder symptoms, such as emotion regulation, self-criticism, self-confidence, self-compassion, anxiety, body attitude, eating disorder symptoms, and quality of life.

A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice

Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.

Perceptions of learning and teaching human movement in physiotherapy: A systematic review and metasynthesis of qualitative studies

PURPOSE

Human movement is essential for health and well-being. Understanding human movement is pivotal in physiotherapy, but also an important element of physiotherapy education. This review identified, critically appraised, and synthesized the available evidence on learning and teaching human movement in physiotherapy as perceived by students, therapists, and instructors.

METHODS

The databases MEDLINE, CINAHL, ERIC, PsycINFO, MEDIC and FINNA, were searched. The search was conducted in March/April 2020 and updated in March 2022. The systematic review followed the JBI methodology for systematic reviews of qualitative evidence and was conducted in accordance with an a priori protocol.

RESULTS

The overall quality of the 17 included studies was scored low on ConQual but dependability and credibility were rated as moderate. Four synthesized findings aggregated from 17 categories and 147 findings described the perceived significance of 1) being present in movement, 2) movement quality, 3) movement transfer, and 4) contextual factors for the learning or teaching of human movement in physiotherapy.

CONCLUSION

The synthesized findings indicate that the perceived significance of contextual factors, movement quality and transfer, and being present in movement should be considered in all learning and teaching of movement in physiotherapy. However, the evidence of the review findings was evaluated as low-level, which should be considered when applying these results to physiotherapy education or practice.

Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study

BACKGROUND

The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale.

OBJECTIVE

This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability.

METHODS

A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education.

RESULTS

The faculty members' and students' positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability.

CONCLUSIONS

The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption.

Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial

BACKGROUND

Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA.

OBJECTIVE

To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE).

STUDY DESIGN

A prospective, assessor-blinded, and block-randomized controlled trial.

METHODS

Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health.

RESULTS

At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included.

CONCLUSIONS

BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.

Exploring clinical reasoning in Austrian mental health physiotherapy: the physiotherapist´s perspective

INTRODUCTION

In mental health physiotherapy, there is a lack of research investigating the assumptions and clinical reasoning strategies of the professionals. A critical view on what is taken for granted within physiotherapy promotes professional development.

PURPOSE

The purpose of this study was to explore and describe the essence of clinical reasoning of Austrian mental health physiotherapists, and to illuminate the meaning of their experiences.

METHOD

Ten semi-structured individual interviews were conducted with Austrian mental health physiotherapists. The transcripts were analyzed using a phenomenological hermeneutical method.

RESULTS

The informants' clinical reasoning emerged as a process of three perspectives: 1) a relational and interactional perspective; 2) a perspective of wholeness; and 3) a perspective of symptoms. The results were then further interpreted using the theories of intercorporeality and bodily resonance.

CONCLUSION

To bring the different clinical reasoning perspectives together to one clinical reasoning process, a discourse of reconciliation is suggested as a favorable strategy, which may be useful both in clinical practice and education.

Experiences with basic body awareness therapy as an add-on to cognitive behavioural therapy among Danish military veterans with PTSD: An interview study

BACKGROUND

The Danish Veterans Centre offers a body-orientated therapy, Basic Body Awareness Therapy (BBAT), in addition to the psychological trauma-focused therapy to military veterans suffering from symptoms of post-traumatic stress disorder (PTSD). This study explored how the veterans a) experienced BBAT as a physiotherapeutic approach and as an add-on treatment to their usual Cognitive Behavioural Therapy (CBT) and b) whether it makes sense for the individual veteran to incorporate BBAT into their treatment.

MATERIALS AND METHODS

Individual semi-structured interviews with four veterans who had completed 12 BBAT sessions concurrently with their usual CBT treatment. Interviews were transcribed and analysed using Malterud's version of Giorgi's 4-step systematic text condensation.

RESULTS

Three main categories emerged: "Effects of treatment", "The setting of the treatment" and "Complementary nature of BBAT and CBT". Within each category were 2-5 underlying subgroups. Participants found it made sense to combine BBAT with their CBT since it benefitted them differently and addressed their bodily symptoms and improved body perception/awareness.

CONCLUSION

BBAT showed potential as a supplement to CBT and seemed to benefit the veterans through focusing on bodily symptoms and how to calm them. Future studies are needed because of the limited research on the topic.

Developing self-care in an interdependent therapeutic relationship: patients' experiences from Norwegian psychomotor physiotherapy

Factors causing and sustaining long-lasting musculoskeletal pain differ between patients, but must be identified in order to target treatment. During physiotherapy, there are multiple factors influencing the treatment outcome. The focus in the present study was to grasp patients' experiences of how social burdens influence the development and persistence of symptoms of muscle pain, and how the relationship with the physiotherapist influences the process of change during Norwegian Psychomotor Physiotherapy. A phenomenological, descriptive, and retrospective design was chosen. Data were collected through focus-group interviews. Eleven patients participated. They ranged in age from 34 to 67 years. The analysis was inspired by Giorgi's phenomenological method. The results identified a general, overarching structure; "Caring for others and developing self-care" and the two interwoven themes "Emerging awareness of overload" and "Receiving care from the physiotherapist." These themes describe the essence of the experiences from the treatment process. To be recognized by the physiotherapist, both through the hands-on treatment and verbal communication, appears to be crucial for patients to develop an awareness of the factors causing and sustaining their pain problems. This awareness seemed necessary for the process of change to take place and for the patients to take more responsibility for their own care.

Treating gynecological pain: key factors in promoting body awareness and movement in somatocognitive therapy (SCT). A case study of a physiotherapy student´s treatment approaches

Background: Longstanding gynecological pain affects large numbers of women in the Western world. Somatocognitive therapy (SCT), a hybrid of cognitive psychotherapy and physiotherapy, is an evidence-based approach that has been successfully applied in the treatment of women suffering from such disorders, for example chronic pelvic pain (CPP) and provoked vestibulodynia (PVD), both demanding pain conditions. The curriculum of Oslo Metropolitan University's Mensendieck physiotherapy bachelor's program includes SCT training for the management of PVD.Purpose: The purpose of this study is to describe and explore the content of a SCT session based on a body and mind approach as performed by a physiotherapy student at a student outpatient clinic.Methods: A video-based case study of the student-patient encounter was undertaken midway through an SCT treatment course and subjected to content analysis.Findings: Three categories illustrating the learning process of body awareness, associated with the three-phase SCT were identified: 1) demystifying genital and chronic pain; 2) concentration, and body and mind experiences; and 3) patience, persistence, and willingness to change.Conclusion: The observation of the somatocognitive therapy session illustrates the value of an empathic relationship with the patient, in order to encourage her to explore body sensations and become familiar with the vulvar area. The therapy engages the patient in understanding pain mechanisms, thus educating her to overcome the fear of pain.

Physiotherapists' conceptions of movement awareness- A phenomenographic study

The phenomenon of movement awareness requires more attention to make it explicit in physiotherapy. The aim of this study was to explore the variation in physiotherapists' conceptions of movement quality, focusing on movement awareness. The informants were 15 physiotherapists from a variety of physiotherapy fields. We collected data through two group interviews and used the phenomenographic method to analyze them. Four themes emerged from the data: 1) Being in contact with one's own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness. These themes varied by four descriptive categories of the movement awareness phenomenon: (I) Hesitation regarding own movement experiences; (II) Momentary contact with own movement experiences; (III) Presence in movement awareness and (IV) Better understanding of others' movement awareness. The physiotherapists' understanding of the movement awareness phenomenon widened through three critical aspects in the descriptive categories: Recognizing one's own movement awareness, Distinguishing one's own and others' movement awareness and New insights into implementing actions related to movement awareness in physiotherapy. These results can expand the understanding of the phenomenon of movement awareness among physiotherapists, although further research is needed.

Automated classification of movement quality using the Microsoft Kinect V2 sensor

Practitioners commonly perform movement quality assessment through qualitative assessment protocols, which can be time-intensive and prone to inter-rater measurement bias. The advent of portable and inexpensive marker-less motion capture systems can improve assessment through objective joint kinematic analysis. The current study aimed to evaluate various machine learning models that used kinematic features from Kinect position data to classify a performer's Movement Competency Screen (MCS) score. A Kinect V2 sensor collected position data from 31 physically active males as they performed bilateral squat, forward lunge, and single-leg squat; and the movement quality was rated according to the MCS criteria. Features were extracted and selected from domain knowledge-based kinematic variables as model input. Multiclass logistic regression (MLR) was then performed to translate joint kinematics into MCS score. Performance indicators were calculated after a 10-fold cross validation of each model developed from Kinect-based kinematic variables. The analyses revealed that the models' sensitivity, specificity, and accuracy ranged from 0.66 to 0.89, 0.58 to 0.86, and 0.74 to 0.85, respectively. In conclusion, the Kinect-based automated movement quality assessment is a suitable, novel, and practical approach to movement quality assessment.

Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis

OBJECTIVE

Hip osteoarthritis may cause compensational movement strategies that require extra physical and mental effort. Such aberrant functioning can be captured in movement quality evaluation. The objective of this study was to explore whether movement quality, evaluated as a multiperspective phenomenon, is reflected in commonly used and recommended functional measures in this group of patients.

METHODS

A cross-sectional study design was used. Baseline included 80 female and 21 male participants with hip osteoarthritis. Movement quality was evaluated by the Body Awareness Rating Scale-Movement Quality and Experience (BARS-MQE), part one, including 12 movement items. Correlation analyses (Pearson and Spearman) were performed to explore associations between BARS-MQE (sum score and single item scores), and scores on measures of physical capacity (Chair test, Stairs test, 6 minutes walking test; 6MWT), self-reported activity level (UCLA), function (HOOS subscales), pain during walking (NRS), self-efficacy (ASES) and health (EQ-5D-5L). Based on previous evidence, we hypothesized moderate associations between BARS-MQE and these measures.

RESULTS

BARS-MQE's sum score showed moderate associations with Stairs test, 6MWT and UCLA (r = -0.425 to 0.304) and weak associations (r = 0.29 to 0.12) with ASES Pain and Symptoms, HOOS ADL, Chair test, NRS, HOOS Pain and Sports, and EQ-5D-5L. No association was found between BARS-MQE and HOOS Symptoms and Quality of life. Movement quality in item 12, walking, demonstrated moderate or weak association with all included measures.

CONCLUSION

In this study of participants diagnosed with hip osteoarthritis, movement quality evaluated by BARS-MQE was moderately reflected in measures of physical capacity and activity, but weakly reflected in self-reported measures of health problems. With its particular dynamic procedure and inclusion of the whole moving person, movement quality evaluation by the BARS-MQE was shown to provide supplementary information on functioning, scarcely captured by the commonly used and recommended measures.

Physiotherapists' experiences of the meaning of movement quality in autism: a descriptive phenomenological study

Introduction: Movement quality, represented in unrestricted movements, flow and pleasure, is often lacking in people with autism. One aspect is the non-verbal expression of the present emotional and psychological state of an individual.Purpose: To describe the meaning of movement quality in autism, as experienced by specialized physiotherapists.Method: Ten physiotherapists were interviewed. The data were recorded, transcribed verbatim, and analyzed using Giorgi᾽s descriptive phenomenological method.Findings: The general structure of movement quality in people with autism included eight key constituents: 1) reduced postural control; 2) deviant muscle tone and tension; 3) deviant sensory processing; 4) a lack of conscious awareness; 5) difficulties with body boundaries; 6) coordinating movements (including breathing); 7) lack of anticipatory preparations of movements; and 8) need of cognitive thoughts to control movements.Conclusions: This study provide an understanding of how movement quality in people with autism is expressed. Their lived bodies constantly need to protect themselves from sensory impressions from within or the surroundings, causing emotional distress and obscuring the meaning of their movements. Their bodily expression becomes restrained, fragmented, and hesitant. Understanding movement patterns and emotional reactions following their struggle with movements may facilitate constructive interaction and communication, which give important implications when designing physiotherapy interventions.

Is Prick of Conscience Associated With the Sensation of Physical Prick?

"Prick of conscience" is a phrase to express feelings of guilt in both English and Korean. Particularly in South Korea, guilt is metaphorically associated with a sense of touch by pricking. Koreans commonly express feelings of guilt by using the metaphor, "It pricks my conscience." Across three studies, we examined whether prick of conscience (i.e., feelings of guilt) is grounded in bodily experiences of physical prick (e.g., a needle prick), using a sample of Koreans. Participants who recalled past unethical acts were less likely to choose a needle prick rather than medication as a treatment for indigestion, whereas those who recalled ethical acts presented no significant difference in their willingness to receive either treatment (Study 1). Participants who decided to lie sensed the finger prick deeper and felt more pain as compared to those in the truth group or the control group (Study 2). Lastly, participants who had the finger prick rendered harsher moral judgments than participants in the control condition (Study 3). In line with an embodied cognition framework, these findings suggest that prick of conscience is not just a linguistic metaphor but can be embodied as physical sensations in forms of pricking.

Construct Validity of the Observable Movement Quality Scale in Pediatrics: Hypothesis Testing of a Formative Measurement Model

BACKGROUND

The Observable Movement Quality (OMQ) Scale measures generic movement quality. Each item of the OMQ Scale focuses on a different element; together, the 15 items assess the whole construct of movement quality.

OBJECTIVE

The aim of this study was to determine the construct validity of the OMQ Scale using 7 hypotheses defined to conform to the Consensus-Based Standards for the Selection of Health Measurement Instruments.

DESIGN

This was an exploratory validation study.

METHODS

A pediatric physical therapist assessed motor performance in 101 children using an age-specific motor test and the OMQ Scale. The direction, magnitude, and rationale for 7 hypotheses, which concerned relationships (n = 2), probability of low scores (n = 4), and difference between diagnosis subgroups (n = 1), were defined.

RESULTS

The results confirmed 6 of the 7 hypotheses, indicating sufficient construct validity. Significant positive relationships were found between OMQ Scale total scores and the severity of motor disabilities (r = 0.72) and z scores on motor tests (r = 0.60). Probabilities for low scores on OMQ Scale items-exceeding the chi-square critical value-were confirmed for children diagnosed with spasticity, psychomotor retardation, mitochondrial diseases, and ataxia; however, probabilities for low OMQ Scale item scores on strength regulation in children with ataxia were not confirmed. OMQ Scale total scores for children who were not ambulatory because of neurological conditions were significantly different from those for children who were not ambulatory because of fatigue (r = 0.66).

LIMITATIONS

The sample of children was based on theoretical assumptions about relevant variations in clinical representations; on the basis of the results, it appears that children with low strength regulation were underrepresented.

CONCLUSION

The confirmation of nearly all hypotheses supported the validity of the OMQ Scale for measuring movement quality in clinical practice in addition to standardized age-adequate motor performance tests.

Relationship between depression and movement quality in normal young adults

[Purpose] Somatic symptoms, such as hyposomnia and anorexia, can affect depression and result in decreased movement quality; however, the relationship between movement quality and somatic symptoms is unclear. The present study investigated the characteristics of this relationship using observable posture and movements. [Participants and Methods] Twenty healthy young adults (mean age 20.9 ± 0.4 years) participated in the study. First, we administered the Self-rating Depression Scale questionnaire to the participants. Second, a qualified physical therapist assessed the movement quality of the volunteers using the Body Awareness Rating Scale-Movement Quality and Experience. We classified the participants into high- and low-score groups based on their Self-rating Depression Scale scores and then analyzed the Body Awareness Rating Scale-Movement Quality and Experience scores in both groups. [Results] There was a significant difference in the movement quality between the Self-rating Depression Scale high- and low-score groups. The Self-rating Depression Scale total score ranged from 20 to 80, with higher scores indicating a greater severity of depression. The low-score group had higher scores for the Body Awareness Rating Scale-Movement Quality and Experience than the high-score group in all items. [Conclusion] The present study showed that movement quality was related to symptoms of depression, thereby suggesting that early detection and treatment interventions for depression are possible by an assessment of movement quality.

Descriptions of movement experiences in the Body Awareness Rating Scale - Movement Quality and Experience evaluation. A qualitative study of patients diagnosed with hip osteoarthritis

Background: Patients' access to movement experiences is implemented in the evaluation tool Body Awareness Rating Scale - Movement Quality and Experience, with its two intertwined parts: 1) the physiotherapist's observations of movement quality; and 2) the patient's descriptions of immediate movement experiences.Objective: To study movement experiences and reflections described by patients diagnosed with hip osteoarthritis when guided to explore simple daily-life movements in this particular evaluation context.Design: An explorative qualitative study with open-ended questions following each of the 12 movements integrated into the evaluation.Methods: 35 participants diagnosed with hip osteoarthritis were included; 28 women and 7 men, aged 23-78 years. Their descriptions were audiotaped, transcribed verbatim and analyzed in accordance with qualitative content analysis.Results: The patients described experiences of a dynamic adaptation of movement strategies based on sensations from the moving body. Two interrelated categories of movement awareness were identified: 1) Experienced movement challenges, including three sub-categories; a) Lack of contact, b) Movement changed by symptoms, and c) Compensational movement habits, and 2) Movement components promoting well-being, including three sub-categories; a) Integrating balance, breathing and awareness into movement, b) Small, simple, soft and safe movements, and c) A taste of own movement resources for daily life.Conclusions: The Body Awareness Rating Scale - Movement Quality and Experience provides a platform for patients to become aware of and describe their movement habits and resources in own words, intertwined with the physiotherapist movement observations. Derived descriptions reflect a patient perspective to be implemented in therapy.

Differences in body positional bilateral symmetry between stance and supine positions, and the impact of attention and awareness on postural symmetry

BACKGROUND AND PURPOSE

Postural asymmetries may cause structural pathological conditions and impaired movement pattern. The influence of body position and awareness towards symmetry has not yet been elucidated. The aim of this study was twofold: First, to compare the body positional bilateral symmetry between standing and supine positions, and second, to examine whether the awareness to symmetry can modify posture perception and body positional bilateral symmetry.

METHODS

We analyzed the degree of anterior postural alignment symmetry of 34 healthy subjects by photogrammetric method (three photographs in a standing position and three in a supine position). Each photo captured different state of awareness: Subjective Comfortable Posture (SCP), Subjective Perceived Symmetrical Posture (SPSP), and Guided Posture Protocol (GPP).

RESULTS

The standing position increased the symmetrical alignment of the neck (p < 0.013) and the upper limbs (p < 0.011). However, the supine position demonstrated increased symmetrical alignment of the upper trunk (p < 0.019) and the feet (p < 0.002). In the standing position, GPP showed greater symmetry of the neck (p < 0.022), the shoulders (p < 0.014), the thorax midline (p < 0.009), the upper trunk (p < 0.000) and the upper limbs (p < 0.029). No significant changes were observed in the supine position between the three states of awareness.

CONCLUSIONS

Study results indicate that the supine position shows greater degree of upper trunk's symmetrical alignment than the standing position. It also indicates that while standing, focusing attention into symmetry improves body positional bilateral symmetry. These results might have clinical implications when working with patients who suffer from asymmetric posture.

Dilation and Constriction of Subjective Time Based on Observed Walking Speed

The physical properties of events are known to modulate perceived time. This study tested the effect of different quantitative (walking speed) and qualitative (walking-forward vs. walking-backward) features of observed motion on time perception in three complementary experiments. Participants were tested in the temporal discrimination (bisection) task, in which they were asked to categorize durations of walking animations as "short" or "long." We predicted the faster observed walking to speed up temporal integration and thereby to shift the point of subjective equality leftward, and this effect to increase monotonically with increasing walking speed. To this end, we tested participants with two different ranges of walking speeds in Experiment 1 and 2 and observed a parametric effect of walking speed on perceived time irrespective of the direction of walking (forward vs. rewound forward walking). Experiment 3 contained a more plausible backward walking animation compared to the rewound walking animation used in Experiments 1 and 2 (as validated based on independent subjective ratings). The effect of walking-speed and the lack of the effect of walking direction on perceived time were replicated in Experiment 3. Our results suggest a strong link between the speed but not the direction of perceived biological motion and subjective time.

Experiences from group basic body awareness therapy by patients suffering from fibromyalgia: A qualitative study

The aim of this study was to obtain a deeper understanding of how patients with fibromyalgia experienced movement awareness through a basic body awareness therapy group treatment program. A total of 19 participants with fibromyalgia diagnosis were interviewed individually and in groups. Data collection was done from three sources: (1) interviews from the Basic Body Awareness Rating Scale (BARS) part 2 at baseline, at end of treatment, as well as at 12 and 24 weeks follow up; (2) focus group discussions that took place at the end of each session, and at the end of treatment; and (3) an in-depth focus group. Giorgi's method was followed for data construction and analysis. The researchers conducted 57 individual interviews, 10 focus groups, and one in-depth focus group. The findings revealed the following categories: "creating a new relation to self"; "change the pattern of body awareness"; "being in a group"; and "experiencing physical capacity", showing influences among them. Body awareness seems to have an impact in the therapeutic process in patients suffering from fibromyalgia.

The effect of psychomotor physical therapy on health-related quality of life, pain, coping, self-esteem, and social support

BACKGROUND

Norwegian psychomotor physiotherapy (NPMP) is commonly applied for patients with long-lasting pain and psychological symptoms. The approach is based on a bio-psychosocial model of health and might have benefits to physical, psychological, and physical domains of health-related quality of life (HRQOL). No previous randomized controlled clinical trials have been performed to examine the effectiveness of NPMP as individual treatment. The aim was therefore to assess the effect of a 6-month intervention of NPMP on HRQOL and on pain, coping, social support, and self-esteem.

METHODS

The study was a pragmatic randomized controlled trial comparing an intervention group with a control group. Participants were recruited from 36 physiotherapists specialized in NPMP, working in private practice. The intervention group received NPMP once weekly for 6 months, whereas the control group received no intervention. Measurements were performed at baseline and after 6 months. A total of 105 participants were included. HRQOL was measured by the 36-item Short Form Health Survey, SF-36. To examine the effect of the intervention, independent sample t tests were performed with the "difference in mean values," delta (=∆, posttest result - baseline result).

RESULTS

Significant differences between the two groups were observed in six of the eight SF-36 domains: Physical Functioning, Bodily Pain, General Health, Mental Health, Social Functioning, and Vitality. Effect size ranged from 0.9 for Vitality to 0.3 for Role Physical and Role Emotional. Furthermore, there was a significant difference between groups regarding pain and self-esteem in favour of the intervention group. The Cohen's d effect sizes of the different dimensions of HRQOL ranged from 0.3 to 0.9 with a median of 0.6.

CONCLUSION

The results of this study demonstrate that 6-month intervention of NPMP increased HRQOL and self-esteem as well as reduced pain.

Demanding treatment processes in Norwegian psychomotor physiotherapy: From the physiotherapists' perspectives

Long-lasting musculoskeletal pain may be understood as the embodiment of bio-psycho-social strain. A combined theoretical perspective of biomedicine, physiotherapy and phenomenology may make these painproblems more comprehensible for the therapist. Norwegian psychomotor physiotherapy is one treatment approach applied on patients with long-lasting musculoskeletal pain. The approach is process-oriented, and can be long-term, complex and demanding. To explore this issue, we employed a multi-stage focus-group phenomenological methodology including five experienced physiotherapists. We found that during these demanding situations, the physiotherapists described their experiences including the feeling of being stuck, and further, how the experience of being in touch with their own body opened possibilities to bear, and act in the demanding situations. The physiotherapists had to find a balance between being in touch with themselves and concurrently listen to and be in contact with their patients.

The effects of exercise on perception of verticality in adolescent idiopathic scoliosis

PURPOSE

Visual and proprioceptive cues are important for body orientation to maintain correct posture. This study investigated the effects of exercise training on subjective visual, postural, and haptic perception of verticality in patients with scoliosis.

SUBJECTS AND METHODS

Thirty-two female adolescents with moderate idiopathic scoliosis were randomly allocated to "Core Stabilization Exercise (CSE)," "Body Awareness," or "Traditional Exercise (TE)" groups. Each group completed a 1-hour supervised program, two days per week for 10 weeks while continuing to wear spinal braces. Perceptual visual, postural, and haptic estimates were assessed before and after treatment.

RESULTS

Subjective visual vertical perception only improved in the awareness group. Subjective visual horizontal perception, postural vertical perception, total postural perception scores, total haptic perception scores, and haptic perception 45° to the right were significantly improved in the stabilization and awareness groups. For the 60° right and 60° left postural perception parameters, as well as the 45° left haptic perception parameters, perception improved only in the stabilization group. No improvement was observed in the traditional group.

CONCLUSION

Improvements in visual, postural, and haptic verticality perception within the stabilization exercise training and Basic Body Awareness group treatment suggest the addition of these exercise methods for the treatment of idiopathic scoliosis to improve internal body orientation.

Therapeutically efficient components of Basic Body Awareness Therapy as perceived by experienced therapists - A qualitative study

BACKGROUND

Basic Body Awareness Therapy (BBAT) is a physiotherapeutic method used in rehabilitation to increase physical and emotional balance. The aim was to identify and describe perceived therapeutically efficient components of BBAT.

METHODS

Twenty-four experienced BBAT therapists participated in focus group interviews. The data were analysed with content analysis.

RESULTS

One central theme, the therapeutic space consisted of two categories; the therapeutic encounter and the therapeutic tools, which emerged as the core of the perceived therapeutically efficient components. The therapeutic encounter entailed the therapeutic approach, affect attunement, continuous interaction during treatment, affect mirroring and communicating by use of a person-centred approach. The therapeutic tools included adjustment and adaptation, the use of manual, verbal and non-verbal guiding, and creating an atmosphere of safety and sanctuary.

CONCLUSION

The significance of interaction by use of a person-centred approach combined with the ability to continuously adjust the treatment constituted useful guidelines when designing rehabilitation using BBAT treatment.

Situational Analysis of Physical Therapist Clinical Instructors' Facilitation of Students' Emerging Embodiment of Movement in Practice

BACKGROUND

Physical therapists improve the functional ability of patients after injury and disease. A unique component of their practice is the ability to use the movement of their own bodies to effect change in their patients. This ability has been recognized as a distinctive attribute of expert physical therapists.

OBJECTIVE

The purpose of this qualitative situational analysis study was to examine how physical therapist clinical instructors perceive and facilitate their students' emerging integration of movement in practice.

DESIGN

Data collection and analysis were guided by a theoretical framework for understanding "professional ways of being." Data were analyzed using coding and mapping strategies consistent with situational analysis techniques.

METHODS

The study included 5 physical therapist clinical instructors and their respective 5 physical therapist students. Data were collected during beginning, midterm, and final weeks of the students' clinical internships using participant interviews, observation, and document analysis.

RESULTS

Coded data were summarized using situational analysis mapping strategies, resulting in 11 maps. These maps were further analyzed and reduced to 5 thematic behaviors enacted by a clinical instructor as he or she helps facilitate students' use of movement in practice. These behaviors are adapt, prepare, enhance, connect , and develop .

LIMITATIONS

The limited number of participants and the relative homogeneity of the student sample may have limited the diversity of data collected.

CONCLUSIONS

The 5 behaviors are useful when considered as a trajectory of development. To our knowledge, this study marks the first description of how physical therapist clinical instructors develop students' use of movement in practice and how to enact behaviors important in students' continued professional development. The findings are important for clinical instructors and academic programs considering how best to prepare students to use movement and develop their skills early in practice.

"Crawling Out of the Cocoon": Patients' Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression

BACKGROUND

Although the effectiveness of physical exercise for depression has been studied for many years, few studies have described patients' experiences of what exercise means to them, beyond the biological focus. Moreover, exercise as a treatment for depression is rarely explored in a physical therapy context.

OBJECTIVES

The purpose of this study was to explore a physical therapy exercise intervention, as experienced by people with major depression.

DESIGN

This study had an inductive approach and used qualitative content analysis.

METHODS

Semistructured interviews were conducted with 13 people who participated in physical therapist-guided aerobic exercise in a randomized controlled trial. All participants were diagnosed with major depression according to the Diagnostic and Statistical Manual of Mental Disorders. Data were collected and analyzed in an inductive manner using qualitative content analysis according to Graneheim and Lundman.

RESULTS

Four categories emerged: (1) struggling toward a healthy self, (2) challenging the resistance, (3) feeling alive but not euphoric, and (4) needing someone to be there for you. The participants experienced that although the exercise intervention was hard work, it enhanced the feeling of being alive and made them feel that they were doing something good for themselves. These feelings were a welcome contrast to the numbness and stagnation they experienced during depression.

LIMITATIONS

The study was conducted in Swedish primary care. Transferability of results must be viewed in relation to context.

CONCLUSIONS

Exercise in a physical therapy context can improve the patients' perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient's vulnerability and ambiguity in an empathic and perceptive way.

The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives

OBJECTIVE

The study's purpose was to describe the range of knowledge pertaining to the Bobath (NDT) concept in adult neurological rehabilitation, synthesizes the findings, identify knowledge gaps and develop empirically based recommendations for future research.

METHODS

A scoping review of research and non-research articles published from 2007 to 2012. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria for studies were electronically accessible English language literature with Bobath and/or Neurodevelopmental Therapy as the subject heading in the title/keyword/abstract/intervention comparison with respect to adult neurological conditions. Data were abstracted and summarized with respect to study design, theoretical framework, clinical application including population representation, study fidelity, intervention comparison, duration of care, measurement and findings.

RESULTS

Of the 33 publications identified 17 were intervention studies (11 RCT's/1 prospective parallel group design/5 N-of-1). One other paper was a systematic review.

CONCLUSIONS

The intervention studies, primarily RCT designs, have serious methodological concerns particularly related to study/treatment fidelity and measurement resulting in no clear clinical direction. Aspects such as theoretical framework, therapist skill, quality of movement measurement and individualized interventions require careful consideration in the design of Bobath studies. Implications for Rehabilitation Future intervention studies should be based on the current Bobath theoretical framework and key aspects of clinical practice. Study and treatment fidelity issues need to be carefully considered when interpreting the results of existing RCT's evaluating the Bobath concept. N-of-1 randomized, observational, factorial and mixed method study designs should be considered as alternative study options.

Opening toward life: experiences of basic body awareness therapy in persons with major depression

Although there is a vast amount of research on different strategies to alleviate depression, knowledge of movement-based treatments focusing on body awareness is sparse. This study explores the experiences of basic body awareness therapy (BBAT) in 15 persons diagnosed with major depression who participated in the treatment in a randomized clinical trial. Hermeneutic phenomenological methodology inspired the approach to interviews and data analysis. The participants’ experiences were essentially grasped as a process of enhanced existential openness, opening toward life, exceeding the tangible corporeal dimension to also involve emotional, temporal, and relational aspects of life. Five constituents of this meaning were described: vitality springing forth, grounding oneself, recognizing patterns in one's body, being acknowledged and allowed to be oneself, and grasping the vagueness. The process of enhanced perceptual openness challenges the numbness experienced in depression, which can provide hope for change, but it is connected to hard work and can be emotionally difficult to bear. Inspired by a phenomenological framework, the results of this study illuminate novel clinical and theoretical insight into the meaning of BBAT as an adjunctive approach in the treatment of depression.