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Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap 2024; 32:17. [PMID: 38773515 PMCID: PMC11110311 DOI: 10.1186/s12998-024-00537-0] [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: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. PURPOSE The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. METHODS A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. CONCLUSIONS Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.
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Affiliation(s)
- Roger Kerry
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Edward Lee
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- Nottingham CityCare Partnership, Bennerley Rd, Nottingham, NG6 8WR, UK
| | - Vasileios Georgopoulos
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA, UK
| | - Adam Meakins
- Department of Orthopaedics, West Herts Hospitals Trust, Watford, WD18 0HB, UK
| | - Chris McCarthy
- School of Physiotherapy, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Chad Cook
- Department of Orthopaedics, Duke University, 200 Morris Street, Durham, NC, 27701, USA
| | - Colette Ridehalgh
- School of Sport and Health Sciences, University of Brighton, Darley Rd, Eastbourne, BN20 7UR, UK
- Clinical Neuroscience, Trafford Building, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Amanda Banton
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | | | - Firas Mourad
- Department of health, LUNEX, Differdange, 4671, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands
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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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Lange E, Danielsson L. Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy. Physiother Theory Pract 2023:1-12. [PMID: 38145499 DOI: 10.1080/09593985.2023.2296574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy. METHODS A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach. RESULTS The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm. CONCLUSIONS The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.
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Affiliation(s)
- Elvira Lange
- Department of General Practice, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, FoUUI-centrum Göteborg och Södra Bohuslän, Göteborg, Sweden
| | - Louise Danielsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Christensen N, Black L, Gilliland S, Huhn K, Wainwright S. The Role of Movement in Physical Therapist Clinical Reasoning. Phys Ther 2023; 103:pzad085. [PMID: 37418230 DOI: 10.1093/ptj/pzad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/27/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The purpose of this study was to explore how physical therapists use movement as a component of their clinical reasoning. Additionally, this research explored whether movement as a component of clinical reasoning aligns with the proposed signature pedagogy for physical therapist education, human body as teacher. METHODS The study utilized qualitative, descriptive methods in a multiple case studies design (each practice setting represented a different case for analysis purposes) with cross-case comparisons. Researchers conducted 8 focus groups across practice settings including acute care, inpatient neurological, outpatient orthopedics, and pediatrics. Each focus group had 4 to 6 participants. Through an iterative, interactive process of coding and discussion among all researchers, a final coding scheme was developed. RESULTS Through exploration of the research aims, 3 themes emerged from the data. These primary themes are: (1) movement drives clinical reasoning to optimize function; (2) reasoning about movement is multisensory and embodied; and (3) reasoning about movement relies on communication. CONCLUSIONS This research supports a description of movement as the lens used by physical therapists in clinical reasoning and the integral role of movement in clinical reasoning and in learning from and through movement of the human body while learning from clinical reasoning experiences in practice. IMPACT As the understanding of the ways physical therapists use and learn from movement in clinical reasoning and practice continues to emerge, it is important to continue exploring ways to best make this expanded, embodied conception of clinical reasoning explicit in the education of future generations of physical therapists.
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Affiliation(s)
- Nicole Christensen
- Department of Physical Therapy, Samuel Merritt University, Oakland, California, USA
| | - Lisa Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska, USA
| | - Sarah Gilliland
- Department of Physical Therapy, Tufts University, Seattle, Washington, USA
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine, USA
| | - Susan Wainwright
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Cormack B, Stilwell P, Coninx S, Gibson J. The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiother Theory Pract 2023; 39:2273-2288. [PMID: 35645164 DOI: 10.1080/09593985.2022.2080130] [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: 12/03/2020] [Revised: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel's original BPSM. These deviations have led to confusion and suboptimal patient care. OBJECTIVES 1) To review Engel's original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an "enactive" modernization of the BPSM. METHODS Critical narrative review in the context of musculoskeletal pain. RESULTS The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a "humanistic" interpretation based on person- and relationship-centredness. The second version is a "causation" interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations. CONCLUSION The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an "enactive-BPS approach" to musculoskeletal care aligns with Engel's vision yet addresses theoretical limitations and may mitigate misapplications.
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Affiliation(s)
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sabrina Coninx
- Institute for Philosophy II, Ruhr University Bochum, Bochum, Germany
| | - Jo Gibson
- Physiotherapy Department, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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Sørvoll M, Øberg GK, Girolami GL. Motor control and skill acquisition in pediatric physical therapy: an enactive proposal. Front Psychol 2023; 14:1226593. [PMID: 37901085 PMCID: PMC10611475 DOI: 10.3389/fpsyg.2023.1226593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
Theories of motor control and skill acquisition strongly influence and guide various fields of clinical practice. In last decades, changes in theoretical frameworks related to the conceptualization of brain plasticity, functional structures within the child, and environment have led to a revision of therapy approaches progressing from therapist-driven to child-initiated approaches. Even though theoretical frameworks and clinical practice are closely linked to the child's body, the profession has paid less attention to theories concerning the body's role and status in interpersonal relationships when fostering motor control and skill acquisition in children. In this theoretical paper we discuss the theoretical frameworks of motor control and skill acquisition that currently guide clinical practice. Through highlighting valuable contributions of these theories, we explore theoretical and practical benefits pediatric physical therapy can acquire by taking an enactive approach as a means to bring the child as a subject into focus. We rely on enactive concepts of embodiment, autonomy, and participatory sense-making in our exploration to provide an extended understanding of motor control and skill acquisition shaping our beliefs about what counts in therapeutic encounters in pediatric physical therapy.
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Affiliation(s)
- Marit Sørvoll
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Therapeutic Services, University Hospital North Norway, Tromsø, Norway
| | - 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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Nicholls DA, Ahlsen B, Bjorbækmo W, Dahl-Michelsen T, Höppner H, Rajala AI, Richter R, Hansen LS, Sudmann T, Sviland R, Maric F. Critical physiotherapy: a ten-year retrospective. Physiother Theory Pract 2023:1-13. [PMID: 37688439 DOI: 10.1080/09593985.2023.2252524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy's historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the "posts". In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.
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Affiliation(s)
- David A Nicholls
- School of Clinical Sciences, A-12, Auckland University of Technology, Auckland, New Zealand
| | - Birgitte Ahlsen
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Wenche Bjorbækmo
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Tone Dahl-Michelsen
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Heidi Höppner
- Interprofessional Health Care, University of Applied Sciences, Berlin, Germany
| | - Anna Ilona Rajala
- Faculty of Social Sciences, Unit of Social Research, Tampere University, Tampere, Finland
| | - Robert Richter
- Hochschule Furtwangen, Studienzentrum Freiburg, Freiburg, Germany
| | - Louise Søgaard Hansen
- Department for People and Technology, Centre for Health Promotion Research, Roskilde University, Roskilde, Denmark
| | - Tobba Sudmann
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Randi Sviland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Filip Maric
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Schwab SM, Andrade V, Santos Moreira T, Cavanaugh JT, Vaz DV, Silva PL. Narrowing the physiotherapy knowledge-practice gap: faculty training beyond the health sciences. Physiother Theory Pract 2023; 39:675-689. [PMID: 35068343 DOI: 10.1080/09593985.2022.2027585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Physiotherapists seek to improve client movement and promote function within an individual's unique environmental and social realities. Despite this intention, there is a well-noted knowledge-practice gap, that is, therapists generally lack sufficient foundational preparation to effectively navigate societal challenges impacting contemporary healthcare. As one step toward addressing the issue, we propose an educational solution targeting current and future physiotherapy faculty, whose responsibilities for entry-level course development and curriculum design substantially impact student readiness for clinical practice. We propose that physiotherapy faculty trained via postprofessional education in a non-biomedical field (e.g. psychology, education, and philosophy) will be uniquely prepared to provide students with tools for dealing with complex social issues facing their clients; critical analysis skills; statistical and technological training; and a deeper theoretical and philosophical understanding of practice. Taken together, such interdisciplinary tools could help address the knowledge-practice gap for physiotherapists and promote the ongoing evolution of the profession in concert with contemporary healthcare. Physiotherapists who pursue interdisciplinary studies may more deeply understand the challenges faced by clinicians and may be well-positioned to leverage knowledge and methods in another scientific discipline to expand and transform the scope of solutions to these challenges.
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Affiliation(s)
- Sarah M Schwab
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
| | - Valéria Andrade
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
| | - Tarcísio Santos Moreira
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
| | - James T Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Daniela V Vaz
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula L Silva
- Center for Cognition, Action, and Perception, Department of Psychology, Edwards Center 1, University of Cincinnati, Cincinnati, OH, USA
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Tuttle N, Hillier S. Developing fluency in a language of tactile communication. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1027344. [PMID: 36712783 PMCID: PMC9874285 DOI: 10.3389/fresc.2022.1027344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
Touch has been an integral part of physiotherapeutic approaches since the inception of the profession. More recently, advances in the evidence-base for exercise prescription and "active" management have brought "touch" into question. This, in part, assumes that the patient or recipient simply passively receives the input rather than being an active partner in the interaction. In this article, we propose that touch can be used as a two-way conversation between therapist and client where each is engaged in tactile communication that has the potential to raise patient awareness and improve movement-based behaviour.
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Affiliation(s)
- Neil Tuttle
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia,Correspondence: Neil Tuttle
| | - Susan Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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O'Brien SR, Barry M, Davidson E, Porzi L, Spink M, Weatherbee D. Physical therapist clinical reasoning in home care for walking assistive device prescription: A description of practice. Physiother Theory Pract 2023; 39:80-88. [PMID: 34706615 DOI: 10.1080/09593985.2021.1996495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Home care in the United States (US) provides rehabilitative care to people who are homebound after acute hospitalization. Patients with stroke and brain injury (BI) are commonly seen by physical therapists (PTs/PTAs), who often address the loss of walking independence. Clinical reasoning (CR) is required for walking assistive device (WAD) prescription within the home. There has never been a description of the home care PT CR process, which could inform entry-level training and health policy. PURPOSE To describe the homecare CR process by identifying factors used for prescription of WADs in patients with stroke and BI. Secondly, to describe any practice issues associated with WADs. METHODS Directors of 7 agencies affiliated with Nazareth College DPT program were recruited to identify PTs/PTAs to complete an online survey between March - July 2017. Quantitative and qualitative data were collected, and analyzed for frequencies or for common themes. RESULTS A total of 334 PTs/PTAs were enrolled from all agencies and 72 responses were analyzed. The CR process did not differ between stroke and BI. Safety was the primary factor, which was assessed by patient query, observation skills, and objective measures. PTs/PTAs also measured balance, strength, function, cognition, and patient preferences within the context of the home. WADs obtained prior to initiation of home care often weren't used. CONCLUSION A complex CR process has been described for WAD prescription in home care for patients with stroke and BI. Entry-level training and health policy implications are described.
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Affiliation(s)
- Suzanne R O'Brien
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Meghan Barry
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Emily Davidson
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Lauren Porzi
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Makenzi Spink
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Danae Weatherbee
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
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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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Joplin-Gonzales P, Rounds L. The Essential Elements of the Clinical Reasoning Process. Nurse Educ 2022; 47:E145-E149. [PMID: 35503469 DOI: 10.1097/nne.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical reasoning is an important skill that enables health care professionals to identify and evaluate patients' real or potential problems, implement appropriate interventions, solve clinical problems, and improve the quality of health care and patient outcomes. PURPOSE The goal of this study was to go beyond individual professions and seek consensus across health care professions on the essential elements of the clinical reasoning process. METHODS This study used a traditional Delphi methodology to seek consensus from clinical reasoning experts from the fields of nursing, medicine, and physical and occupational health. RESULTS The experts reached a consensus on 56 essential elements identified from the clinical reasoning literature. This is the first time health care professions have reached a consensus on the essential elements of the clinical reasoning process using a Delphi study. CONCLUSIONS Achieving consensus on the essential elements of the clinical reasoning process is essential to better understanding, improved teaching, and evaluation of clinical reasoning skills.
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Affiliation(s)
- Pamela Joplin-Gonzales
- Assistant Professor (Dr Joplin-Gonzales), College of Nursing, Texas Woman's University, Dallas; and Professor and Associate Dean for Professional Development, DNP Program Director (Dr Rounds), University of Texas Medical Branch, Galveston
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Abbey H. Communication strategies in psychologically informed osteopathic practice: A case report. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Håkstad RB, Øberg GK, Girolami GL, Dusing SC. Enactive explorations of children's sensory-motor play and therapeutic handling in physical therapy. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:994804. [PMID: 36304785 PMCID: PMC9592846 DOI: 10.3389/fresc.2022.994804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022]
Abstract
Introduction In pediatric physical therapy, there is an ongoing debate about the use of therapeutic handling and its potential effects on motor learning. In this study, we build on enactive theoretical perspectives to explore the role of therapeutic handling in connection to children's sensory-motor play, engagement, and performance during a single physical therapy session. Material and methods This is a qualitative study based on video observations of therapy sessions and interviews with 15 physical therapists (PTs) each treating two different children aged 0–3. The authors utilized a framework of co-reviewing, discussing, and reflecting on the sessions. Themes were identified and used to describe the ways by which PTs’ therapeutic handling unfolds, with connections to theories on sensory-motor play and learning, along with enactive perspectives on embodiment, experience, mutual incorporation, and sense-of-agency. Results The characteristics and purposes of therapeutic handling are presented in two main themes: (1) position and support, and (2) directing movement. We found that position and support promoted sensory-motor improvement when the PTs’ handling aligned with the child's play interests and engagements. As part of play, the children used new and additional support surfaces to self-initiate better posture and movement solutions and reach play goals. The PTs’ ways of directing movements varied. To awaken curiosity and induce a child's self-driven motor exploration the PT needs to be subtle, flexible, and precise in the directing of movement. This entails responsiveness to the child's signals and bodily know-how in the placing of hands and direction of pressure to enable the child to actively participate in and eventually self-drive movement. Discussion Therapeutic handling that is mutually incorporated between PT and child can enrich the child's playing-to-learn-to-move process by providing novelty and facilitating the child's sense-of-agency in the self-initiated exploration and refinement of movement possibilities. In the PTs’ effort to merge therapeutic handling with children's play, the momentum of interaction can open new therapeutic windows of movement experience and learning opportunities.
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Affiliation(s)
- Ragnhild B. Håkstad
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Correspondence: Ragnhild B. Håkstad
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gay L. Girolami
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Stacey C. Dusing
- Motor Development Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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15
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Schwab SM, Spencer C, Carver NS, Andrade V, Dugan S, Greve K, Silva PL. Personal factors understood through the Ecological-Enactive Model of Disability and implications for rehabilitation research. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:954061. [DOI: 10.3389/fresc.2022.954061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
The International Classification of Functioning, Disability and Health (ICF) recognizes that disability arises from the interaction between an individual with a medical condition and the context in which they are embedded. Context in the ICF is comprised of environmental and personal factors. Personal factors, the background life and lifestyle of an individual, are poorly understood in rehabilitation. There is limited knowledge about how personal and environmental factors interact to shape the contextual conditions critical for explaining functioning and disability. In this paper, we explore how a newly proposed model of disability, the Ecological-Enactive Model of Disability, can enhance understanding of personal factors across multiple rehabilitation disciplines. We draw from a review of evidence and phenomenological interviews of individuals with Friedreich's Ataxia. We consider the practical impact of this understanding on disability and rehabilitation research and pathways for the future focusing on representative design.
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Condo M, Justice B. Student Perceptions of the Use of Case-Based Cadaver Dissections in Doctorate of Physical Therapy Program. MEDICAL SCIENCE EDUCATOR 2022; 32:679-682. [PMID: 35818608 PMCID: PMC9270514 DOI: 10.1007/s40670-022-01540-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 06/03/2023]
Abstract
Case-based cadaver dissection offers students unique opportunities to blend traditional anatomic knowledge acquisition with clinical reasoning. Twelve physical therapy students completed surveys centered on case-based dissections. Case-based cadaver dissections were defined in this study as multiple clinical vignettes that required students to use the accessible cadavers to solve clinically based problems. The results of the study provide preliminary evidence that students perceive case-based cadaver dissections as beneficial to their anatomy education and beneficial to the development of their clinical reasoning skills. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01540-x.
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Affiliation(s)
- Matthew Condo
- Department of Physical Therapy, Methodist University, Fayetteville, NC USA
| | - Blake Justice
- Department of Physical Therapy, Methodist University, Fayetteville, NC USA
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17
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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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18
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Bayly J, Bradshaw A, Fettes L, Omarjee M, Talbot-Rice H, Walshe C, Sleeman KE, Bajwah S, Dunleavy L, Hocaoglu M, Oluyase A, Garner I, Cripps RL, Preston N, Fraser LK, Murtagh FE, Higginson IJ, Maddocks M. Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data. Palliat Med 2022; 36:319-331. [PMID: 34964384 DOI: 10.1177/02692163211063397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients' symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. AIM To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. DESIGN Cross-sectional national online survey. SETTING/PARTICIPANTS Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. FINDINGS 61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. CONCLUSION This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.
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Affiliation(s)
- Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,St Barnabas Hospices, Worthing, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Muhammed Omarjee
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | | | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Rachel L Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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19
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Perner S, Danielsson L. Exploring clinical reasoning in Austrian mental health physiotherapy: the physiotherapist´s perspective. Physiother Theory Pract 2021; 38:2827-2840. [PMID: 34607511 DOI: 10.1080/09593985.2021.1986872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Stefan Perner
- Department of Health Sciences, Physiotherapy, FH Campus Wien, Vienna, Vienna, Austria.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Louise Danielsson
- Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
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20
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Stott H, Cramp M, McClean S, Turton A. 'Somebody stuck me in a bag of sand': Lived experiences of the altered and uncomfortable body after stroke. Clin Rehabil 2021; 35:1348-1359. [PMID: 33706575 PMCID: PMC8358539 DOI: 10.1177/02692155211000740] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study explored stroke survivors' experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. DESIGN A qualitative phenomenological study. SETTING Participants' homes. PARTICIPANTS A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. INTERVENTIONS Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. RESULTS Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. CONCLUSION Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.
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Affiliation(s)
| | - Mary Cramp
- University of the West of England, Bristol, UK
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21
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Hansen GM, Brunner I, Pallesen H. Patients' and Health Professionals' Experiences of Group Training to Increase Intensity of Training after Acquired Brain Injury: A Focus Group Study. Rehabil Res Pract 2021; 2021:8838038. [PMID: 33505728 PMCID: PMC7808818 DOI: 10.1155/2021/8838038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Increased intensity of training in the subacute phase after acquired brain injury facilitates plasticity and enhances better function. Group training can be a motivating factor and an effective means of increasing intensity. Reports on patients' and health care professionals' experiences on increasing the amount of active practice through group training during in-patient rehabilitation after acquired brain injury have been limited. METHODS Two focus groups, patients and health care professionals, participated each in two interviews, before and after implementation of the Activity block, i.e., 2-hour daily intensive group training. The data from the interviews were analyzed from a phenomenological perspective. RESULTS Three categories emerged from the data analyzes (i) training intensity, (ii) motivation and meaningfulness, and (iii) expectations and concerns. Both groups experienced that the training after implementation of the Activity block had become more intense and that motivation was increased induced by the group setting. Also, both groups found self-management enhanced. Some challenges were also reported. Patients expressed concerns to finding a balance between rest and activity, while the health professionals mentioned practical challenges, i.e., planning the content of the day and finding their role in the Activity block. CONCLUSION Activity block benefitted a heterogeneous group of patients with acquired brain injury and was perceived as an overall positive experience by patients and health personnel. Matching the training to the individuals' need for support, finding a balance between rest and activity and using tasks that support patients' motivation, appeared important.
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Affiliation(s)
- Gunhild Mo Hansen
- Hammel Neurorehabilitation Centre and University Clinic, Aarhus University, Aarhus, Denmark
| | - Iris Brunner
- Hammel Neurorehabilitation Centre and University Clinic, Aarhus University, Aarhus, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Clinic, Aarhus University, Aarhus, Denmark
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22
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The why, where, and how clinical reasoning model for the evaluation and treatment of patients with low back pain. Braz J Phys Ther 2020; 25:407-414. [PMID: 33371952 DOI: 10.1016/j.bjpt.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/19/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients. OBJECTIVE The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases. METHODS This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm. CONCLUSIONS This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.
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23
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Toro J, Martiny K. New perspectives on person-centered care: an affordance-based account. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:631-644. [PMID: 32886295 DOI: 10.1007/s11019-020-09977-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.
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Affiliation(s)
- Juan Toro
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark.
- The Enactlab, Copenhagen, Denmark.
| | - Kristian Martiny
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
- The Enactlab, Copenhagen, Denmark
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24
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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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25
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Martínez-Pernía D. Experiential Neurorehabilitation: A Neurological Therapy Based on the Enactive Paradigm. Front Psychol 2020; 11:924. [PMID: 32499741 PMCID: PMC7242721 DOI: 10.3389/fpsyg.2020.00924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
With the arrival of the cognitive paradigm during the latter half of the last century, the theoretical and scientific bases of neurorehabilitation have been linked to the knowledge developed in cognitive neuropsychology and cognitive neuroscience. Although the knowledge generated by these disciplines has made relevant contributions to neurological therapy, their theoretical premises may create limitations in therapeutic processes. The present manuscript has two main objectives: first, to explicitly set forth the theoretical bases of cognitive neurorehabilitation and critically analyze the repercussions that these premises have produced in clinical practice; and second, to propose the enactive paradigm to reinterpret perspectives on people with brain damage and their therapy (assessment and treatment). This analysis will show that (1) neurorehabilitation as a therapy underutilizes body-originated resources that aid in recovery from neurological sequelae (embrained therapy); (2) the therapeutic process is based exclusively on subpersonal explanation models (subpersonal therapy); and (3), neurorehabilitation does not take subjectivity of each person in their own recovery processes into account (anti-subjective therapy). Subsequently, and in order to attenuate or resolve the conception of embrained, subpersonal and anti-subjective therapy, I argue in support of incorporating the enactive paradigm in rehabilitation of neurological damage. It is proposed here under a new term, "experiential neurorehabilitation." This proposal approaches neurological disease and its sequelae as alterations in dynamic interaction between the body structure and the environment in which the meaning of the experience is also altered. Therefore, when a person is not able to walk, remember the past, communicate a thought, or maintain efficient self-care, their impairments are not only a product of an alteration in a specific cerebral area or within information processing; rather, the sequelae of their condition stem from alterations in the whole living system and its dynamics with the environment. The objective of experiential neurorehabilitation is the recovery of the singular and concrete experience of the person, composed of physical and subjective life attributes.
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Affiliation(s)
- David Martínez-Pernía
- Center for Social and Cognitive Neuroscience, School of Psychology, Adolfo Ibáñez University, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN), Neurology Service, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
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26
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Bertilsson I, Gard G, Sjödahl Hammarlund C. Physiotherapists ' experiences of the meaning of movement quality in autism: a descriptive phenomenological study. Physiother Theory Pract 2020; 38:299-308. [PMID: 32351158 DOI: 10.1080/09593985.2020.1759166] [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: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Ingrid Bertilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Habilitation, Habilitation & Health, Skövde, Sweden
| | - Gunvor Gard
- Department of Health Sciences, Lund University, Lund, Sweden
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27
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Sviland R, Martinsen K, Nicholls DA. Løgstrup’s thinking: a contribution to ethics in physiotherapy. Physiother Theory Pract 2020; 38:1-13. [DOI: 10.1080/09593985.2020.1741051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Randi Sviland
- Faculty of Health and Social Sciences, Department of Health and Function, Western Norway University of Applied Sciences (HVL), Bergen, Norway
| | - Kari Martinsen
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - David A Nicholls
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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28
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Roenn-Smidt H, Larsen K, Pallesen H. The practices of body in rehabilitation after stroke: a qualitative study of how physiotherapy affects identity reconstruction. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1730440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Helle Roenn-Smidt
- Hammel Neurorehabilitation Centre, University Research Clinic, Hammel, Denmark
| | - Kristian Larsen
- Center of Health Research, University Hospital, Copenhagen, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation and University Research Clinic, Hammel, Denmark
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29
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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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Sebelski CA, Hoogenboom BJ, Hayes AM, Held Bradford E, Wainwright SF, Huhn K. The Intersection of Movement and Clinical Reasoning: Embodying "Body as a Teacher" to Advance the Profession and Practice. Phys Ther 2020; 100:201-204. [PMID: 31595947 DOI: 10.1093/ptj/pzz137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/05/2019] [Accepted: 06/09/2019] [Indexed: 02/09/2023]
Affiliation(s)
- Chris A Sebelski
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, 3437 Caroline Mall Ste 1026, St Louis, MO 63104 (USA)
| | - Barbara J Hoogenboom
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan
| | - Ann M Hayes
- Department of Physical Therapy and Athletic Training, Saint Louis University, St Louis, Missouri
| | | | - Susan F Wainwright
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Huhn
- School of Physical Therapy, Husson University, Bangor, Maine
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31
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Gregor S, Vaughan-Graham J, Wallace A, Walsh H, Patterson KK. Structuring community-based adapted dance programs for persons post-stroke: a qualitative study. Disabil Rehabil 2020; 43:2621-2631. [PMID: 31905043 DOI: 10.1080/09638288.2019.1708978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke. METHODS A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (n = 9), rehabilitation therapists (n = 6), and dance instructors (n = 8). Focus groups were audio-recorded and transcribed verbatim, providing the raw data. Analysis of the focus group transcripts were completed using the DEPICT model of collaborative qualitative analysis. RESULTS This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes. CONCLUSION Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke.IMPLICATIONS FOR REHABILITATIONDance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community.A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class.Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves.The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1-2 h.
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Affiliation(s)
- Sarah Gregor
- KITE Research Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Julie Vaughan-Graham
- KITE Research Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Aaron Wallace
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Hilary Walsh
- Department of Occupational Sciences & Occupational, Therapy - University of Toronto, Toronto, Canada
| | - Kara K Patterson
- KITE Research Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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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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33
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Arntzen EC, Øberg GK, Gallagher S, Normann B. Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study. Physiother Theory Pract 2019; 37:1080-1095. [PMID: 31657262 DOI: 10.1080/09593985.2019.1683923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Group-based physiotherapy is effective for individuals with MS; nevertheless individualization within groups is questioned and little is known regarding individuals´ experiences with individualization in small groups.Objective: We aimed to explore the short- and long-term experiences of individuals with MS participating in a 6-week, group-based, individualized physiotherapy-intervention.Methods: Within a randomized controlled trial (RCT), 25 in-depth interviews with a strategic sample of 13 people (9 women; age 25-79 years old; European Disability Status Scale (EDSS) 1-6.5) were conducted at weeks 7 and 30 using systematic text condensation, with dynamic systems theory and phenomenology as analytical frameworks.Results: The main categories were: 1) movement control, orientation and insights: Bodily improvements were associated with targeted exercises, specific adjustments by the physiotherapist, emotional engagement and re-access to activities; and 2) the individual within the group: Equal distributions of one-to-one interactions and attention were important for experiencing success. Less attention and improvements turned attention toward own disability. Physical changes felt particularly emotional short term, implying that individuals' feelings of ownership and control of body and movement, new views of themselves and changed affordances in daily life were involved.Conclusion: Equally distributed attention and engagement, targeted exercises and hands-on adjustments resulting in visible and perceived bodily changes were experienced as key factors of individualization in small groups.
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Affiliation(s)
| | | | - Shaun Gallagher
- The Lillian and Morrie Moss Chair of Excellence in Philosophy, Department of Philosophy, University of Memphis, Memphis, TN, USA
| | - Britt Normann
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway.,UiT, The Arctic University of Norway, Tromsø, Norway
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Roenn-Smidt H, Jensen M, Pallesen H. Body and identity in physiotherapy after stroke. Physiother Theory Pract 2019; 37:1067-1079. [PMID: 31642722 DOI: 10.1080/09593985.2019.1681041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Stroke has been described as a rupture of current life, causing changes in the patient's identity. This has important consequences for the patient's life after stroke. Nevertheless, there is still a lack of science on the subject and also a lack of consistency in how to confront this in rehabilitation.Aim: The aim of this study is to explore how interaction between patient and physiotherapist is conducted and how an approach inspired by phenomenology might support and develop identity.Design and Methods: A qualitative study based on empirical data consisting of 146 short videos of physiotherapist and patient interactions as well as observations and interviews of physiotherapists and patients. Twelve patients were included, and data was constructed throughout their rehabilitation process (on average 2.5 years). Data was analyzed using an analytical model for multimodal interaction.Result: Four themes emerged: 1) feedback as a bodily knowledge; 2) control of the process; 3) adjustment; and 4) the bodily approach. The results revealed the importance of approaching the patient body as both an object and a subject in order to interact with the patient's bodily knowledge.Conclusion: A phenomenological approach to the patient can support the patient's embodied knowledge, and can thereby support and develop the patient's identity.
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Affiliation(s)
- Helle Roenn-Smidt
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Hammel, Denmark
| | - Marianne Jensen
- Department of research, Municipality of Randers, Hammel, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Hammel, Denmark
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Blixt L, Solbrække KN, Bjorbækmo WS. Physiotherapists' experiences of adopting an eTool in clinical practice: a post-phenomenological investigation. Physiother Theory Pract 2019; 37:1005-1017. [PMID: 31635512 DOI: 10.1080/09593985.2019.1681042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Purpose: The purpose of this investigation was to gain insights into the experience of adoption and integration of an electronic tool in physiotherapy. Case Description: The research data was generated through close observation of eight clinical encounters in primary health care, where the electronic tool was used, and then the physiotherapists were interviewed in-depth on the experience of adopting and using it. Outcomes: The analysis, inspired by post-phenomenological theory and research, reveals how physiotherapists deploy their clinical reasoning skills in an active, critical appropriation of the eTool. Despite an ambiguous attitude toward the tool, they develop an ownership to the eTool that enables them to balance and combine two modes of practice; that of collecting data for research purposes and that of treating the patient. Discussion: It seems that this ownership development is crucial to stimulate continued use of the eTool.
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Affiliation(s)
- Line Blixt
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kari Nyheim Solbrække
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Wenche Schrøder Bjorbækmo
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Kelly M, Ellaway R, Scherpbier A, King N, Dornan T. Body pedagogics: embodied learning for the health professions. MEDICAL EDUCATION 2019; 53:967-977. [PMID: 31216603 DOI: 10.1111/medu.13916] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/08/2019] [Accepted: 04/25/2019] [Indexed: 05/02/2023]
Abstract
MEDICINE AS EMBODIED PRACTICE Bodily dysfunctions bring patients to their doctors and even diseases of the mind can originate in patients' bodies. Doctors respond by using their own bodies - hands, eyes, ears and sometimes noses - to make diagnoses and treat diseases. Yet, despite the embodied nature of practice, medicine typically treats the body as an object, paying scant attention to the subjective embodied experiences of patients and doctors. Much health professions education (HPE) reflects this, prioritising cognition over learners' sense of embodiment. Hence there is a gap between the embodied realities of practice and the disembodied nature of medical education. This article introduces readers to 'body pedagogics' as a framework that can help to re-establish embodiment as a central principle of HPE. BODY PEDAGOGICS This embodiment theory, drawn from sociology, anthropology and phenomenology, has informed such disparate fields as glassblowing education and military training. Body pedagogics emphasises learning as a physically embodied process. It illustrates how multisensory experience causes embodied changes that become an automatic part of physician expertise. We introduce core body pedagogic concepts using physical examination as an example, examining the bodily means of HPE, students' bodily experiences and the resulting bodily changes. IMPLICATIONS Body pedagogics can help us to focus attention on embodiment as a central principle of HPE that transcends the discipline-specific teaching of clinical skills. Moreover, it provides a set of conceptual foundations for an interdisciplinary practice within HPE with implications for instructional design. Body pedagogics can also help us to make strange the habits and disregarded aspects of embodied learning and in so doing help us to consider embodiment more critically and directly in practice and education, and in the ways we research them.
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Affiliation(s)
- Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert Scherpbier
- School of Health Education, Maastricht University, Maastricht, the Netherlands
| | - Nigel King
- Department of Applied Psychology, University of Huddersfield, Huddersfield, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Melin J, Nordin Å, Feldthusen C, Danielsson L. Goal-setting in physiotherapy: exploring a person-centered perspective. Physiother Theory Pract 2019; 37:863-880. [PMID: 31448979 DOI: 10.1080/09593985.2019.1655822] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To analyze definitions and related requirements, processes, and operationalization of person-centered goal-setting in the physiotherapy research literature; to discuss those findings in relation to underlying principles of person-centeredness; and to provide an initial framework for how person-centered goal-setting could be conceptualized and operationalized in physiotherapy. Methods: A literature search was conducted in the databases: CINAHL, PubMed, PEDro, PsycINFO, REHABdata and Scopus. A content analysis was performed on how person-centered goal-setting was described.Results: A total of 21 articles were included in the content analysis. Five categories were identified: 1) Understanding goals that are meaningful to the patients; 2) Setting goals in collaboration; 3) Facing challenges with person-centered goal-setting; 4) Developing skills by experiences and education; and 5) Changing interaction and reflective practice. These categories were abstracted into two higher-ordered interlaced themes: 1) To seek mutual understanding of what is meaningful to the patient; and 2) To refine physiotherapy interaction skills, which we suggest would be useful for further conceptualization.Conclusion: In this analysis, we interpreted person-centered goal-setting in physiotherapy as a process of interaction toward a mutual understanding of what is meaningful to the patient. Future research may explore how to integrate mindful listening, embodied interaction and continuous ethical reflection with different assessments and treatment methods.
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Affiliation(s)
- Jeanette Melin
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,RISE, Research Institutes of Sweden, Gothenburg, Sweden
| | - Åsa Nordin
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Feldthusen
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Danielsson
- Angered hospital, Research Unit, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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O'Brien SR, Durr K, Laubisch E, Losi L, Parrillo V, Pericozzi S, Poirier B, Poirier L, Ray K, Sackett A, Simoneau D. Every person is an individual: physical therapist clinical reasoning used in inpatient rehabilitation for walking assistive device prescription in patients with stroke and brain injury. Disabil Rehabil Assist Technol 2019; 16:1-8. [PMID: 31429328 DOI: 10.1080/17483107.2019.1647568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE A complete description of the process of physical therapy clinical reasoning for walking assistive devices in patients with stroke and brain injury has never been undertaken. Describing the clinical reasoning process used in post-acute inpatient rehabilitation is important to shed light on the clinical activities and factors used in practice, prevent device abandonment, and, inform entry-level clinical training. The two purposes were first, to describe the clinical reasoning process used during inpatient rehabilitation for walking assistive devices in patients with stroke and brain injury, and second, to determine whether clinical reasoning differed by two facility types and by diagnosis. METHODS A mixed methods study of 67 participants in either an online survey or focus groups. RESULTS A consistent and comprehensive method to determine the need and justification for a walking assistive device regardless of diagnosis or facility type was found. The clinical reasoning process included five primary factors, considered throughout the rehabilitation stay (safety, balance, cognition, strength, and function). The three therapist-related factors (experience/preference, training parameters, and use of objective tools), and seven patient-related factors (experience/preference, fluctuations, fear, age, diagnosis/comorbidities, discharge environment, and payer) individualized care. Definitions of the five primary factors were derived from participants' responses. CONCLUSIONS Results from this study revealed complexity in the clinical reasoning process used in physical therapy practice to determine the best walking assistive device for patients with stroke and brain injury during inpatient rehabilitation. Information from this study can inform post-acute physical therapy practice and education, and may reduce device abandonment. Implications for rehabilitation Clinical reasoning (CR) is a complex process in which a clinician must consider multiple factors, which requires non-linear and iterative thinking, and involves many people, making it shared among the patient, caregivers, and the healthcare team. Describing the actual CR process used by physiotherapists when prescribing a walking assistive device (WAD) will identify the factors considered, thus more accurately explain the process of care. Such a description could lead to better justification of rehabilitation for patients with stroke and brain injury, and furthermore, determine whether treatments are rendered consistently and when, if ever, divergent approaches occur. Better understanding of the CR process of WAD prescription may also reduce the possibility of device abandonment.
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Affiliation(s)
- Suzanne R O'Brien
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Katherine Durr
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | | | - Lauren Losi
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Vincent Parrillo
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Sarah Pericozzi
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Brett Poirier
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Lauren Poirier
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Katlynne Ray
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Alyssa Sackett
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
| | - Drew Simoneau
- Department of Physical Therapy, Nazareth College, Rochester, NY, USA
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Tuttle N, Hazle C. An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments. Physiother Theory Pract 2019; 37:775-786. [PMID: 31385748 DOI: 10.1080/09593985.2019.1650405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Most literature on decision processes within physiotherapy relates to "reasoning that results in action" - decisions based on information including assessments that are gathered prior to treatment decisions. A process of "reasoning in interaction" that is often used, particularly by expert clinicians, has received less attention. Objective: To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient's active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Results: Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. Conclusion: A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature. .
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Affiliation(s)
- Neil Tuttle
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Charles Hazle
- Division of Physical Therapy, Center for Rural Health, University of Kentucky, Hazard, Kentucky, USA
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Olsen AL, Strand LI, Magnussen LH, Sundal MA, Skjaerven LH. Descriptions of movement experiences in the Body Awareness Rating Scale - Movement Quality and Experience evaluation. A qualitative study of patients diagnosed with hip osteoarthritis. Physiother Theory Pract 2019; 37:486-496. [PMID: 31257979 DOI: 10.1080/09593985.2019.1636434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Aarid L Olsen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Liv I Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv H Magnussen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Mary-Anne Sundal
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv H Skjaerven
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Gjengedal E, Sviland R, Moi AL, Ellingsen S, Flinterud SI, Sekse RJT, Natvik E, Råheim M. Patients’ quest for recognition and continuity in health care: time for a new research agenda? Scand J Caring Sci 2019; 33:978-985. [DOI: 10.1111/scs.12696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Eva Gjengedal
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Randi Sviland
- Department of Health and Functioning Western Norway University of Applied Sciences Bergen Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
- Department of Plastic Surgery and Burn Center Haukeland University Hospital Bergen Norway
| | - Sidsel Ellingsen
- Faculty of Health Studies VID Specialized University Bergen Norway
| | - Stine Irene Flinterud
- Centre of Diaconia and Professional Practice VID Specialized University Bergen Norway
| | - Ragnhild Johanne Tveit Sekse
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Obstetrics and Gynaecology Haukeland University Hospital Bergen Norway
| | - Eli Natvik
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Førde Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
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Daly A, Gallagher S. Towards a Phenomenology of Self-Patterns in Psychopathological Diagnosis and Therapy. Psychopathology 2019; 52:33-49. [PMID: 31018215 PMCID: PMC6878753 DOI: 10.1159/000499315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/19/2022]
Abstract
Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions.
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Affiliation(s)
- Anya Daly
- School of Philosophical and Historical Studies, The University of Melbourne, Melbourne, Victoria, Australia,
| | - Shaun Gallagher
- Lillian and Morrie Moss Chair of Excellence in Philosophy, Department of Philosophy, University of Memphis, Memphis, Tennessee, USA
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Huhn K, Gilliland SJ, Black LL, Wainwright SF, Christensen N. Clinical Reasoning in Physical Therapy: A Concept Analysis. Phys Ther 2019; 99:440-456. [PMID: 30496522 DOI: 10.1093/ptj/pzy148] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/29/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. OBJECTIVE The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research. DESIGN/METHODS The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified. RESULTS Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. LIMITATIONS Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded. CONCLUSIONS A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.
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Affiliation(s)
- Karen Huhn
- School of Physical Therapy, Husson University, Bangor, ME 04401-2999 (USA)
| | | | - Lisa L Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska
| | - Susan F Wainwright
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicole Christensen
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
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Øberg GK, Ustad T, Jørgensen L, Kaaresen PI, Labori C, Girolami GL. Parents’ perceptions of administering a motor intervention with their preterm infant in the NICU. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1503718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gunn Kristin Øberg
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Tordis Ustad
- Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lone Jørgensen
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Section of Physiotherapy, University Hospital North Norway HF, Tromsø, Norway
| | - Per Ivar Kaaresen
- Pediatric and Adolecent Department, BUK, University Hospital of North Norway HF, Tromsø, Norway
- Department of Clinical Medicine, University of Tromsø The arctic university of Norway, Tromsø, Norway
| | - Cathrine Labori
- Section of Physiotherapy, University Hospital North Norway HF, Tromsø, Norway
| | - Gay L. Girolami
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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45
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Sørvoll M, Obstfelder A, Normann B, Øberg GK. Perceptions, actions and interactions of supervised aides providing services to children with cerebral palsy in pre-school settings: a qualitative study of knowledge application. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2018. [DOI: 10.1080/21679169.2018.1452978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marit Sørvoll
- Department of Health and Care Sciences, UIT – The Artic University of Norway, Tromsø, Norway
| | - Aud Obstfelder
- Center for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Britt Normann
- Department of Health and Care Sciences, UIT – The Artic University of Norway, Tromsø, Norway
- Physiotherapy Department, Nordland Hospital Trust, Bodø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, UIT – The Artic University of Norway, Tromsø, Norway
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46
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Thomson OP, Abbey H, Tyreman S, Draper-Rodi J, Evans DW, Vogel S. 'The ghost in the machine' - But whose ghost is it and what machine? A response to Wallden and Chek's editorials. J Bodyw Mov Ther 2018; 22:1022-1024. [DOI: 10.1016/j.jbmt.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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47
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Lahelle AF, Øberg GK, Normann B. A group-based, individualized physiotherapy intervention for people with multiple sclerosis-A qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1734. [PMID: 30039598 DOI: 10.1002/pri.1734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Group-based interventions for people with multiple sclerosis (MS) have gained increased attention in the field of physiotherapy research. However, no studies have investigated whether or how the prevailing principle of individualization is embedded in such interventions. The purpose of this study was to investigate how professional actions and interactions affect individualized exercise adaptations in a group intervention for people with MS. METHODS This study had a qualitative design and investigated and analysed the actions and interactions of six different physiotherapists (PTs) with expertise in neurology and 40 patients (27 female and 13 male, mean age 52.2 years, mean Expanded Disability Status Scale 2.45) in a group-based exercise intervention (GroupCoreDIST) for people with MS. We performed nonparticipatory video observations of 13 group exercise sessions, each consisting of three patients, followed by 13 semistructured in-depth interviews with the PTs. Systematic text condensation analysis was conducted within an enactive theoretical framework. RESULTS The results of our study indicated that the extent of embodied interaction and patient participation affect the possibilities and challenges regarding individualization within a group intervention. Handling, facilitation, emphasis on movement quality, and PTs who invited their patients to play an active role in the encounter enriched the reasoning and decision-making processes and yielded opportunities to adapt exercises to the specific patient's impairments. However, the combination of individuality and collectivity within a group context brings forth challenges in which the PTs are obligated to both preserve the benefits of being in a group and simultaneously attend to individual patients. CONCLUSIONS Our study indicates that despite challenges, the PTs' integration of embodied interaction and mutual participation enables the patients to concurrently benefit from individualization and being in a group. These findings contribute to the question regarding the significance of individual adaptations in group interventions and point toward a need for future effect studies that compare standardized and individualized exercise protocols.
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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
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway.,Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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48
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Normann B. Facilitation of movement: New perspectives provide expanded insights to guide clinical practice. Physiother Theory Pract 2018; 36:769-778. [DOI: 10.1080/09593985.2018.1493165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Britt Normann
- Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø the Arctic University of Norway, Tromsø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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49
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Lahelle AF, Øberg GK, Normann B. Physiotherapy assessment of individuals with multiple sclerosis prior to a group intervention - A qualitative observational and interview study. Physiother Theory Pract 2018; 36:386-396. [PMID: 29985730 DOI: 10.1080/09593985.2018.1488022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Assessment prior to both individual and group interventions is fundamental to neurological physiotherapy practice. However, knowledge is limited regarding how assessments are carried out, particularly assessments conducted prior to group interventions, which have recently gained increasing attention in clinical research. In this qualitative study, we investigated how physiotherapy assessments of patients with multiple sclerosis prior to a group exercise intervention were carried out and what physiotherapists considered vital elements in the assessment process. Data were gathered through 12 qualitative non-participatory video observations followed by in-depth interviews of physiotherapists. Systematic text condensation analysis was conducted within an enactive theoretical framework of participatory sense making. In the assessments, patients' bodily perceptions of movement changes appeared to be vital in establishing patient expectations for the forthcoming intervention. The extent of patient participation and an embodied approach to communication influenced both the physiotherapists' and patients' insights into the patients' movement problems, which were further utilized in the initial intervention planning. Significant differences in context from the assessment to the intervention require a systematic completion of the assessments in the course of the first clinical meeting, which should be considered in the further development of research and clinical practices.
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Affiliation(s)
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway
| | - Britt Normann
- Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway.,Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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50
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Osteopathic clinical reasoning: An ethnographic study of perceptual diagnostic judgments, and metacognition. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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