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Arrigoni A, Rossettini G, Palese A, Thacker M, Esteves JE. Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study. Musculoskelet Sci Pract 2024; 73:103164. [PMID: 39151365 DOI: 10.1016/j.msksp.2024.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs. AIM This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference. METHODS The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions. RESULTS The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation. CONCLUSION Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.
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Affiliation(s)
| | - Giacomo Rossettini
- School of Physiotherapy, University of Verona, Via Bengasi 4, 37134, Verona, Italy; Department of Physiotherapy, Faculty of Sport Sciences, Musculoskeletal Pain and Motor Control Research Group, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Spain.
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy.
| | - Mick Thacker
- Department of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Jorge E Esteves
- Malta ICOM Educational, Santa Venera, Malta; UCO School of Osteopathy, Health Sciences University, London, UK; Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.
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2
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Cook D, Pearson J. Musculoskeletal physiotherapists' experiences of using remote consultations during the COVID-19 pandemic: A qualitative study. Musculoskelet Sci Pract 2024; 72:102930. [PMID: 38552401 DOI: 10.1016/j.msksp.2024.102930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic. OBJECTIVES To explore musculoskeletal physiotherapists' experiences of using remote consultations in one area of England during the COVID-19 pandemic. DESIGN Qualitative study using hermeneutic phenomenology based on the approach of Gadamer. METHODS Semi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics. FINDINGS Musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists. CONCLUSION The findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services.
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Affiliation(s)
- Darren Cook
- School of Health and Social Wellbeing, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom.
| | - Jennifer Pearson
- School of Health and Social Wellbeing, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom.
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3
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Schuber AA, Gernert M, Schaller A. Therapist competencies in the context of group-based exercise programs in medical rehabilitation: a qualitative study with patients and exercise therapists from Germany. BMC Sports Sci Med Rehabil 2023; 15:64. [PMID: 37085945 PMCID: PMC10120238 DOI: 10.1186/s13102-023-00674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Group-based exercise programs account for nearly half of exercise therapy services provided in German medical rehabilitation facilities. However, information about necessary therapist competencies for the successful execution of these programs is sparse. Thus, the aim of this qualitative study was to explore relevant therapist competencies in the context of group-based exercise programs from the patients' and therapists' perspective. METHODS Semi-structured interviews were conducted with five rehabilitation patients following a 3-week inpatient orthopedic rehabilitation program as well as five exercise therapists with work experience in group-based exercise therapy. Data were analyzed using structuring content analysis according to Kuckartz. RESULTS From 155 topic-related text passages, collected over 10 interviews, four competency categories with 16 subcategories and respective characteristics were identified. In addition to professional expertise like biomedical knowledge, exercise therapists were expected to possess a multitude of didactic-methodological, personal, and social-communicative abilities. CONCLUSION Our results suggest that the psychosocial, behavioral and educational goals of group-based exercise programs necessitate a wide range of therapist competencies. These conform to the multidimensional nature of exercise therapy and should therefore be covered in vocational and continuing education.
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Affiliation(s)
- André Arik Schuber
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Madeleine Gernert
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Andrea Schaller
- Institute of Movement Therapy and Movement-Oriented Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
- Institute of Sport Science, Department of Human Sciences, University of the Bundeswehr Munich, Munich, Germany
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4
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McLean BD, Strack DS, Martin DT. 'Avoidance Preening', Displacement Behavior and Co-Dependency in Professional Team Sport: When Wants Become More Important Than Needs. Int J Sports Phys Ther 2022; 17:945-949. [PMID: 35949384 PMCID: PMC9340827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/04/2022] [Indexed: 10/29/2022] Open
Abstract
An athlete's body plays an important role in their performance and well-being. However, game-relevant skills are better determinants of success, compared with physical fitness, in technically-driven team sports. In the professional era, over utilization of resources, in pursuit of physical optimization, can detract from time spent on priorities. Athletes' non-strategic, time-demanding focus on physical preparation/treatments resembles avian 'avoidance preening', whereby stressful situations trigger birds to excessively preen in place of more productive activities. The purpose of this commentary is to explore the behaviors of resource-rich professional teams and the roles of staff dedicated to optimizing physical performance, including circumstances that foster avoidance behavior and create the potential for practitioners to encourage co-dependent relationships with athletes. To cultivate healthy/productive environments, the following is recommended: I) recognition of non-productive avoidance behaviors; II) eschewing unjustified, fear promoting, pathoanatomical language; III) fostering collaborative approaches; IV) encouraging utilization of psychology services; V) recognizing that optimal physical function and feeling good is rarely the primary goal in professional team sports. Level of Evidence 5.
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Affiliation(s)
- Blake D McLean
- University of Technology Sydney, School of Sport, Exercise and Rehabilitation, Faculty of Health; Oklahoma City Thunder, Human & Player Performance
| | | | - David T Martin
- School of Behavioural and Health Sciences, Australian Catholic University; APEIRON Life
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5
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McParlin Z, Cerritelli F, Rossettini G, Friston KJ, Esteves JE. Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care. Front Behav Neurosci 2022; 16:897247. [PMID: 35846789 PMCID: PMC9280207 DOI: 10.3389/fnbeh.2022.897247] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/24/2022] [Indexed: 12/05/2022] Open
Abstract
Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops "priors" necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding - and explaining - the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically - to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others - through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments.
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Affiliation(s)
- Zoe McParlin
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Francesco Cerritelli
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | | | - Karl J. Friston
- Institute of Neurology, Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Jorge E. Esteves
- Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Malta ICOM Educational, Gzira, Malta
- University College of Osteopathy, London, United Kingdom
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[Patient education for acute low back pain : Contents of pain education in patients with acute non-specific low back pain - a scoping review]. Schmerz 2022; 36:266-271. [PMID: 35133466 DOI: 10.1007/s00482-022-00622-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of the review is to map the content of intervention education in people with acute nonspecific lumbar low back pain (LBP) to make it available in a synopsis. BACKGROUND In the care of people with acute non-specific LBP, education is recommended as an elementary treatment component. However, the proposed content is proving to be heterogenic and the question arises as to how education should be designed in the future. METHOD A systematic literature search and content analysis of studies with content on pain education was conducted as part of a scoping review. Inclusion criteria were: provision of relevant information on the content of pain education, patients with acute nonspecific low back pain, 18 years or older, publication in English or German. The search was conducted in the Medline, CINAHL, Cochrane Library, and PEDro databases and supplemented by a hand search. The search was completed in February 2021. RESULTS A total of 4239 hits were identified, of which 90 studies were included. A wide range of content was found and clustered into ten categories. The most frequent statements were in the categories "recommendations for dealing with LRS," "education, reassuring aspects, and relieving basic messages," and "information and recommendations about medications." CONCLUSION The teaching of pathoanatomical information can potentially trigger or increase anxiety and worry, whereas information on neurophysiological mechanisms of pain development and processing is more likely to have an anxiety-reducing effect. The results can contribute to the design of the intervention in different settings.
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Lepesis V, Marsden J, Paton J, Rickard A, Latour JM. Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial. J Foot Ankle Res 2022; 15:7. [PMID: 35093130 PMCID: PMC8801130 DOI: 10.1186/s13047-022-00512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/12/2022] [Indexed: 01/18/2023] Open
Abstract
Background The benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered. Aim To explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period. Design An embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis. Participants Purposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited. Results Analysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities. Conclusion Our findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00512-z.
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Ogwumike OO, Bashir-Bello F, Kaka B. Patients' Experiences About Exercise Prescription and Education in the Physiotherapy Management of Nonspecific Low-Back Pain. J Patient Exp 2021; 7:1458-1465. [PMID: 33457602 PMCID: PMC7786732 DOI: 10.1177/2374373520968997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Low-back pain (LBP) is highly prevalent in the society, and its socioeconomic consequences are quite evident. Physiotherapists play a prominent role in the management of individuals with this condition, and it is, therefore, of utmost importance that physiotherapists engage in the most efficient and effective management practices available. For perceptions of good performance and quality health care, patient experience is an important indicator of effective care and management. A mixed-methods research design—a cross-sectional survey (quantitative research) and a focus group discussion (FGD; qualitative research)—was employed in this study, investigating patients’ experience in physiotherapy management of nonspecific LBP. An adapted questionnaire was used for data collection from purposively selected participants recruited from 3 hospitals in Kubwa, Abuja, from April to August 2018. The FGD involved 6 patients recruited by simple random sampling using the fishbowl technique. Descriptive and thematic analyses were done on data collected. A total of 126 patients (male = 41, female = 85) were included, with a mean age of 51.0 ± 14.6 years, while the modal age-group was 60 to 69 years. Of these, 41 (32.5%) had nonspecific LBP for less than a year, and the 2 most applied interventions were exercise and heat therapy, followed by education/advice. In all, 110 (87.3%) reported positive experience about education, while 119 (94.4%) reported positive experience about exercise prescription. The result from the qualitative research is in conformity with that of the quantitative analysis. Patients with nonspecific LBP received adequate education regarding their condition and had good experience in the course of their physiotherapy management.
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Affiliation(s)
- Omoyemi O Ogwumike
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria.,Department of Physiotherapy, University College Hospital, Ibadan, Nigeria
| | - Fatima Bashir-Bello
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - Bashir Kaka
- Department of Physiotherapy, College of Health Sciences, Bayero University, Kano, Nigeria
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Zahari Z, Ishak A, Justine M. The effectiveness of patient education in improving pain, disability and quality of life among older people with low back pain: A systematic review. J Back Musculoskelet Rehabil 2020; 33:245-254. [PMID: 31356191 DOI: 10.3233/bmr-181305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to gain an overview of patient education and the effects of patient education for older people with low back pain (LBP). METHODS The search strategies were performed via EBSCO MEDLINE, EBSCO CINAHL, Science Direct, PubMed, and PEDro databases from 2006 to 2016. The keywords "patient education", "low back pain", "elderly", "older adults", "older persons" and "older people" were used during the literature search. Boolean operators were used to expand or limit the searching scope and manual exclusion was performed to choose articles eligible for this study. RESULTS A total of 2799 articles were retrieved but only five articles were related with patient education for older people with LBP. Findings suggest that patient education for older people may differ in terms of its contents such as health education, self-management, video education, and postural education. The high methodological quality of the studies revealed that patient education showed improvement in terms of pain, disability and quality of life among older people with LBP. CONCLUSIONS Patient education improved pain and had positive effects on disability and quality of life among older people with LBP. However, due to the limited number of RCTs more studies are needed to provide evidence for its effectiveness.
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Affiliation(s)
- Zarina Zahari
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor Campus, 42300 Puncak Alam Selangor, Malaysia
| | - Azizah Ishak
- Physiotherapy Services, Kluang Utama Specialist Hospital, Kluang Johor, Malaysia
| | - Maria Justine
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor Campus, 42300 Puncak Alam Selangor, Malaysia
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Horler C, Hebron C, Martyn K. Personalizing education: The clinical reasoning processes of physiotherapists using education for the treatment of people with chronic low back pain. Physiother Theory Pract 2020; 38:412-421. [DOI: 10.1080/09593985.2020.1765437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Christopher Horler
- School of Health Sciences, University of Brighton, Eastbourne, UK
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Kathy Martyn
- School of Health Sciences, University of Brighton, Eastbourne, UK
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Søndenå P, Dalusio-King G, Hebron C. Conceptualisation of the therapeutic alliance in physiotherapy: is it adequate? Musculoskelet Sci Pract 2020; 46:102131. [PMID: 32217276 DOI: 10.1016/j.msksp.2020.102131] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The Therapeutic Alliance (TA) is an emerging concept within physiotherapy practice, reflecting the ongoing paradigm shift from a biomedical- (BMM) towards a biopsychosocial model (BPSM) of care. Current conceptual understanding of the TA is commonly based on Bordin's (1979) definition, developed within a psychotherapy context. A concept analysis was conducted in order to provide conceptual clarity of the TA within physiotherapy literature. METHOD An evolutionary method of concept analysis was followed. An extensive literature search was conducted, and eligible articles were submitted to inductive, semantic thematic analysis. FINDINGS A total of 14 articles were included within this concept analysis. 5 master attribute themes, and 4 corresponding sub-themes were identified following thematic analysis. The master attribute themes were: 'Seeing the person', 'Sharing the journey', 'Communication', 'Therapeutic space' and 'Fostering autonomy'. The 4 Sub-themes were: 'Giving of self', 'Legitimising the experience', 'Physiotherapist characteristics matter' and 'Interpersonal collaboration'. CONCLUSION A heuristic interpretation of the TA within a physiotherapy context is offered. The TA is a dynamic construct within the clinical encounter and is influenced reciprocally between the person seeking care and the physiotherapist by biological, social and psychological contributing factors. 'Communication' may act as a catalyst in operationalising the TA in a physiotherapy context. Continued efforts are needed in physiotherapy education and training in both enhancing theoretical awareness of the role of the TA within physiotherapy practice, as well as guidance on its implementation in clinical practice.
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Affiliation(s)
- Petter Søndenå
- University of Brighton, School of Health Sciences, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom
| | - Georgi Dalusio-King
- University of Brighton, School of Health Sciences, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom
| | - Clair Hebron
- University of Brighton, School of Health Sciences, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom.
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12
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Kaakinen P, Meriläinen M, Putila P, Kääriäinen M. The quality of counselling in rehabilitation evaluated by orthopaedic surgery patients at a university hospital: A cross sectional study. Int J Orthop Trauma Nurs 2019; 37:100717. [PMID: 31836417 DOI: 10.1016/j.ijotn.2019.100717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 07/03/2019] [Accepted: 09/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Pirjo Kaakinen
- University of Oulu, Research unit of Nursing Science and Health Management, Medical Research Center, Oulu, Finland.
| | - Merja Meriläinen
- Oulu University Hospital, Medical Research Center, Oulu, Finland.
| | - Pauliina Putila
- Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Finland.
| | - Maria Kääriäinen
- University of Oulu, Research unit of Nursing Science and Health Management, Medical Research Center, Oulu, University Hospital of Oulu, Finland.
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13
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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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14
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Wijma AJ, Bletterman AN, Clark JR, Vervoort SC, Beetsma A, Keizer D, Nijs J, Van Wilgen CP. Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies. Physiother Theory Pract 2017; 33:825-840. [DOI: 10.1080/09593985.2017.1357151] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amarins J Wijma
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, The Netherlands
- Pain in Motion International Research Group, Brussels, Belgium
| | | | - Jacqui R Clark
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Sigrid C.J.M Vervoort
- UMC Utrecht Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anneke Beetsma
- Department of Physiotherapy, Hanze University of Applied Sciences, School of Health Studies, Groningen, The Netherlands
| | - Doeke Keizer
- Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, The Netherlands
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - C. Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare, Transdisciplinary Outpatient Treatment Centre, Groningen, The Netherlands
- Pain in Motion International Research Group, Brussels, Belgium
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15
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What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis. Phys Ther 2016; 96:609-22. [PMID: 26427530 DOI: 10.2522/ptj.20150240] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/13/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Musculoskeletal physical therapy involves both specific and nonspecific effects. Nonspecific variables associated with the patient, therapist, and setting may influence clinical outcomes. Recent quantitative research has shown that nonspecific factors, including patient-therapist interactions, can influence treatment outcomes. It remains unclear, however, what factors influence patient-therapist interaction. PURPOSE This qualitative systematic review and meta-synthesis investigated patients' and physical therapists' perceptions of factors that influence patient-therapist interactions. DATA SOURCES Eleven databases were searched independently. STUDY SELECTION Qualitative studies examining physical therapists' and patients' perceptions of factors that influence patient-therapist interactions in musculoskeletal settings were included. DATA EXTRACTION Two reviewers independently selected articles, assessed methodological quality using the Critical Appraisal Skills Programme (CASP), and performed the 3 stages of analysis: extraction of findings, grouping of findings (codes), and abstraction of findings. DATA SYNTHESIS Thirteen studies were included. Four themes were perceived to influence patient-therapist interactions: (1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication), (2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients), (3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account), and (4) organizational and environmental factors (ie, time and flexibility with care and appointments). LIMITATIONS Only studies published in English were included. CONCLUSIONS A mix of interpersonal, clinical, and organizational factors are perceived to influence patient-therapist interactions, although research is needed to identify which of these factors actually influence patient-therapist interactions. Physical therapists' awareness of these factors could enhance patient interactions and treatment outcomes. Mechanisms to best enhance these factors in clinical practice warrant further study.
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Evaluative language in physiotherapy practice: How does it contribute to the therapeutic relationship? Soc Sci Med 2015; 143:128-36. [DOI: 10.1016/j.socscimed.2015.08.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/23/2022]
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Roussel NA, Neels H, Kuppens K, Leysen M, Kerckhofs E, Nijs J, Beetsma AJ, Van Wilgen CP. History taking by physiotherapists with low back pain patients: are illness perceptions addressed properly? Disabil Rehabil 2015; 38:1268-79. [DOI: 10.3109/09638288.2015.1077530] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Harman K, MacRae M, Vallis M. The Development and Testing of a Checklist to Study Behaviour Change Techniques used in a Treatment Programme for Canadian Armed Forces Members with Chronic Non-specific Low Back Pain. Physiother Can 2014; 66:313-21. [PMID: 25125787 DOI: 10.3138/ptc.2013-55bc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE There are reports of increased use of a variety of behaviour change techniques (BCT) by physiotherapists and findings of beneficial effects of use. However, there is a lack of physiotherapy-specific definitions of these techniques, as well as a sense of how physiotherapists use them in practice. Through this study, the authors created and field tested a preliminary nomenclature and description for BCT in patients with chronic non-specific low back pain (CNSLBP). METHODS Items for the Physiotherapy Behaviour Change Technique (PT-BCT) checklist were derived from a nomenclature created for use in psychology and also from publications of studies using cognitive behaviour therapy-based approaches in physiotherapy. Content validity was tested via survey of clinical and research experts. Videotapes of a 6-week patient self-management rehabilitation programme were used for training, reliability testing, and field testing of the PT-BCT checklist. RESULTS Checklist items were endorsed by the majority of experts surveyed; intra- and inter-rater reliability were moderate to high. In the field study, a broad range of BCT types (behavioural, cognitive, and motivational) were observed in both classroom and gym settings. CONCLUSIONS The BCT nomenclature arising from this study and the PT-BCT checklist will be useful to further explore behaviour change in physiotherapy practice. The observation in this study that BCT were integrated into physiotherapists' practice illustrates how physiotherapists can play a role in changing behaviour, specifically in the presence of CNSLBP.
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Affiliation(s)
| | | | - Michael Vallis
- CFB Stadacona ; Behaviour Change Institute, Capital District Health Authority, Halifax, N.S
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