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Research on patient-centeredness within physiotherapy points to a need for clarification about what the concept entails in science and practice and how research positions itself within health care. Thus, the aim is to systematically map the characteristics of research on patient-centeredness in physiotherapy and critically discuss the dominant understandings within. A systematic research mapping was carried out, based on searches in leading bibliographic databases. Four categories were selected in order to characterize the research field: focus, design, theoretical approach and inherent logic. Of 5,324 studies, 101 were included in the final mapping, pointing to a limited amount of research. The papers included were published in 47 different journals. Two major research foci emerges: one testing or developing technologies (tools) to promote patient-centeredness and one exploring patients' or professionals' experiences related to physiotherapy practice. Most papers reported on empirical research and there seems to be a dearth of conceptual papers. The theoretical approaches applied were mainly psychological, pedagogical and biomedical. The papers included were divided into equal amounts of studies carried out within inherent logics of causality and complexity. The mapping suggests an incipient awareness of patient-centeredness within the research field of physiotherapy. Empirical studies dominate the field, whereas conceptual and critical papers seem in need of wider acknowledgment. The research field is divided into two mutually disconnected trends: one concerned with understanding the complexity of clinical practice and patients' experiences of treatment and illness, and another trend concerned with solving "the problem" of patient involvement. [ABSTRACT FROM AUTHOR]

Background and Purpose: The impact of the COVID-19 pandemic on physiotherapy education meant that innovative responses were needed quickly. This paper describes a scholarly approach to changes within an entry-level physiotherapy program where one of its clinical placements was replaced with a fully online unit during 2020, as well as exploring the experiences of students who completed this newly developed online unit. Methods: A mixed methods approach was used. Sixteen of a possible 31 students responded to an online survey comprising quantitative and open-ended questions. Results: The majority of participants were satisfied with the unit and reported that: the unit helped them to learn valuable skills; feedback from educators was helpful; and that they were able to apply to future contexts. Small numbers of students were more ambivalent about the use of online media and tools including discussion boards, the workload and being part of a learning community. Conclusion: The online unit described in this research is evidence that non-traditional forms of clinical education might also address clinically important learning outcomes, provide sustainable options and alleviate some of the stresses that both tertiary providers and healthcare settings endure. However, these types of placement experiences require a paradigm shift from educators, the profession, accrediting bodies and even future students. [ABSTRACT FROM AUTHOR]

In this paper, we draw on an example of heuristic inquiry – (Re)imagining becoming a physiotherapist: a phenomenological approach – to illustrate the role that reflexivity and representation can play in physiotherapy research outcomes and the meaning they might have for moving the profession forward. Qualitative research in physiotherapy tends to acknowledge reflexivity as a route to objectivity by making researcher biases overt, yet the debate about data representation (a researcher’s decision-making about how data are represented in a text) barely feature. This contrasts with qualitative research in other fields, including other health professions, where matters of representation (i.e., how knowledge is conveyed) are routinely debated and contested. Reflexivity, in fact, is much more than being transparent. Together with representation, reflexivity helps to position both the voices of participants and researchers within the research. The heuristic inquiry described in this paper offers new insights about learning to be a physiotherapist; it challenged assumptions about care in physiotherapy practice and it changed the first researcher’s identity and practice. These insights were generated through the synergies between reflexivity and representation, and we argue that physiotherapy research has an opportunity to be more expansive by taking a commitment to reflexivity and representation more seriously. [ABSTRACT FROM AUTHOR]

Several shifts in physiotherapy treatment of patients with rheumatoid arthritis (RA) have occurred over time. This paper aims to identify shifts in physiotherapy practice for patients with RA based on the author's work experiences from the 1980s until today at two Norwegian rheumatism hospitals, and to explore why shifts may have happened. A narrative was developed by describing events making a difference, categorizing, and ordering them with the help of narrative analysis and a sensitizing analytic lens on discourses. The storyline from the 1980s to approximately the turn of the millennium is called 'Shifts determined mainly by clinical context-driven events' which occurred in response to medical advances and physiotherapists' clinical experiences. These shifts were later justified by physiotherapists' research in the clinical context. The other storyline covers mainly the 2000s and is called 'Shifts increasingly determined by events beyond clinical physiotherapy context.' They include adjustments to further medical advances and implementation of biopsychosocial understanding of disease at the hospital, and to external research-based recommendations, health reforms, and economy. These processes have moved physiotherapy practice at the hospital from mainly providing individualized remedial and rehabilitative physiotherapy for the purpose to normalize physical function to an increasing focus on generic health measures for the purposes of health promotion and cardiovascular disease prevention. However, this shift may not fully match the complex needs presented by patients in disease remission with unrelenting fatigue and work inability and those who have multiple functional challenges and comorbidities. [ABSTRACT FROM AUTHOR]

Movement has always been central to physiotherapy practice and theory. But physiotherapists have largely focused on forms of human bodily movement governed by the neuro-mechanical body system in illness or injury. Many other forms of movement exist though, and we argue here that the exploration of these other movements might give physiotherapists new language, concepts, and tools, to guide its adaptation to forms of healthcare that are becoming increasingly complex, diverse, and inclusive. Drawing on Hannah Arendt's concept of vita activa (or "active life"), we examine how physiotherapists have traditionally captured and defined movement. Critiquing past practices for over-emphasizing what Arendt called labor, and work, we suggest that an approach governed by her concept of action, might offer physiotherapists a way to give movement greater significance. We explore what active life might mean for a revised approach to movement, and highlight examples of vita activa already emerging in physiotherapy. We close the paper by calling for a reevaluation of what movement means for the profession and its clients. [ABSTRACT FROM AUTHOR]

Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations. [ABSTRACT FROM AUTHOR]

Background/PurposeMethodsKey ResultsConclusionTherapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice.This is a perspective paper drawing on examples from existing research.Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual’s social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body – which is the main point of contact with patients – and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship’s trajectory.Social support and therapeutic relationships are complementary aspects of one’s health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

BackgroundPurposeResultsConclusionsIt has been two decades since the World Health Organization’s endorsement of the International Classification of Functioning, Disability and Health (ICF). It is timely to undertake a rigorous search that analyzes the discourses around the ICF’s conceptual framework within physiotherapy, the kinds of enquiry to date and the professional areas where this is happening and how.The aim of this research is to synthesize the literature related to how the physiotherapy profession (practice, research and education) thinks about and puts to use the WHO ICF.A final sample of 37 papers was agreed. Five overarching third-order interpretations were derived: (i) A way of thinking and practicing, (ii) Endorsed but not embedded, (iii) Striking a balance, (iv) Power of participation and (v) Moving forward. Together, these themes illustrate the evolving role of the ICF in physiotherapy over the previous two decades. They highlight the ICF’s potential for shaping the future of physiotherapy practice, education and research.Work is needed to connect existing literature about the ICF and related models and embed the ICF, its language and philosophy across physiotherapy education and practice. Re-representation of the model might help address misinterpretation of the ICF, but fundamentally, embedding the ICF in entry-level curriculum is likely to be the most significant driver of change in practice. [ABSTRACT FROM AUTHOR]

The history of physiotherapy in Latin America has received little attention thus far in the English-speaking literature. In this paper, we draw on narratives from activists, educators, and professional leaders who have been instrumental in shaping the development of physiotherapy in Argentina, Colombia, and Ecuador. Physiotherapists in the Latin American countries faced many similar challenges, including developing physiotherapy in the shadow of medicine, overcoming conservative attitudes toward women professionals, and frequent social upheaval. The paper explores the disputed story of physiotherapy's origins in the polio epidemics, the influence of Swedish remedial gymnastics, and the educational colonialism of North American and European educators. We examine some of the effects of social unrest and trauma, military rule, and economic instability on the professions attempts to establish itself in the face of competition from other professions allied to medicine. And we consider the efforts taken to establish the profession's autonomy and its shifting relationship with the state. We employed two different methods for data collection to explore aspects of physiotherapy's history in Latin America from a political and socio-cultural context: 1) A reconstruction of memories from activist physiotherapists in Colombia, Ecuador, and Argentina, who have seen, lived, and promoted the development of physiotherapy in their own countries, gleaned from in-depth interviews; and 2) Analysis of secondary sources. Data were analyzed following the method described by Maynes, Pierce, and Laslett (2008), exploring personal narratives. Textual data were analyzed using documentary research (Prior, 2003) using thematic analysis, to inductively discover, and describe relevant themes about the two main guiding study questions. A constant comparative method as outlined by Boeije (2002) was used to form categories, establish boundaries, and discerning conceptual similarities between participants' narrative. Five physiotherapists were interviewed. One from Colombia, two from Argentina and two from Ecuador. Three main themes were identified: 'A Female Profession?', 'training and education', and 'Present Day in Argentina, Ecuador, and Colombia'. Tensions between the interests of the State, professionals, patients, cultures, urban and rural services, and practices are prevalent throughout physiotherapy in Argentina, Colombia, and Ecuador. Operating within these tensions is very much the reality for physiotherapists in Latin America today. Multiple histories emerge from the research, opening up a space for a more nuanced, polyphonic reading of physiotherapy in Colombia, Ecuador, and Argentina than has been heard to date. [ABSTRACT FROM AUTHOR]

The "therapeutic relationship" in physiotherapy refers to the beneficial or healing relationship between the patient and physiotherapist. Interest in researching therapeutic relationships in physiotherapy is growing and there is a need for a measure of therapeutic relationship with a strong conceptual foundation. Body of paper:We begin with a general discussion of the state of therapeutic relationship measurement in physiotherapy research – notably, how current research is based on measures borrowed and adapted from psychotherapy. Then, we introduce Miciak's physiotherapy therapeutic relationship framework, discuss why it offers a solid foundation for measurement development, and describe the key concepts in the framework. We then discuss various approaches to measuring therapeutic relationship, illustrating how Miciak's framework could be used to inform their development. We end by discussing current challenges in measuring therapeutic relationship and how these could be addressed. [ABSTRACT FROM AUTHOR]

Background: Physiotherapists may use a diverse range of educational approaches during the treatment of people with chronic low back pain (CLBP). However, little is known about how physiotherapists clinically reason their use of education in practice. Purpose: The aim of this study was to develop insight into physiotherapists' clinical reasoning when using education for the treatment of people with CLBP. Methods: This qualitative study used a constructivist grounded theory inspired methodology. A purposive sample of five musculoskeletal physiotherapists from the United Kingdom were recruited via social media. Data were collected through audio recorded semi-structured interviews, field notes and memos, and were coded and analyzed using a constant comparative method. Findings: A concept of 'personalizing education' underpinned by three main categories termed 'exploring the person's world', 'making sense of the person's world' and 'tailoring education', has been constructed to explain the participating physiotherapists' clinical reasoning. Conclusion: The findings highlight how communication and interaction underpin the clinical reasoning process for using education with people who have CLBP. Participating physiotherapists explored and made sense of a person's world before tailoring their educational approach for the individual. Physiotherapists can use this paper to reflect on their practice to inform their own clinical reasoning. [ABSTRACT FROM AUTHOR]

Ethics is ever-present in all aspects of human interaction and, in any physiotherapy situation there is an inherent claim to act and care for the patient in the best possible way. The physiotherapy profession is provided with rules, guidelines and codes to support and ensure ethical professional conduct. In recent decades however, physiotherapy literature has emphasized how ethical agency is immersed in clinical reasoning in each particular situation, in the doing of physiotherapy. The Danish philosopher and theologian Knud E. Løgstrup offers a bottom-up approach to ethics, which may augment the philosophical underpinning of this development in ethical thinking. Løgstrup departs from the given pre-conditions of life; a point of departure where the ethical claim emerges from sensation in the concrete situations. This paper introduces Løgstrup's situational ethics and its ontological framing, with four foci: how we can tune in to sensation and sense the ethical claim of the other; how human interdependence can be heard in what Løgstrup calls sovereign life utterances; relational responsibility and ethical norms; and the metaphorical importance of poetic understandings of the world. In four themes we reflect on how these ethical issues are at stake in physiotherapy practice with regards to: (1) uncertainty, tuned sensation and therapeutic attitude in physiotherapy; (2) sensuous, narrative and poetic meaning-making in physiotherapy; (3) physiotherapy and coming to oneself in new embodied experiences; and (4) ethical claims and codes of conduct in physiotherapy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Care is central to many health professions, including physiotherapy. Different forms of care are enacted as part of being a caring professional. For example, a practitioner who provides good service to others and upholds standards while doing so is in-grained in education for professional formation. However, there are other topics and aspects of care that are not as well attended to, and that is care for the future of the profession. This too is an aspect of care, and it is an urgent objective in an era where societies and healthcare are changing at rapid rates. In this paper, I argue that Golde and Walker's (2006) idea of stewardship can help health professionals think about this often overlooked aspect of care. Stewardship adds a perspective that is centered on a deep authentic care for and responsibility towards the ongoing relevance of the profession. Stewardship keeps the question of what the profession is, and what a professional does, alive as part of its present and future practice. [ABSTRACT FROM AUTHOR]

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work, however, has emphasized the fluidity and collaborative nature of professionalization projects, and placed more emphasis on inter-professional negotiations and disciplinary coexistence. In this paper, we draw on this work to analyze the harmonization of the independent Mensendieck System of medical gymnastics in Norway, and the emerging state-sponsored physiotherapy system. Our contention is that over the course of the middle decades of the 20th century, advocates of the Mensendieck System and providers of orthodox, biomedically informed physiotherapy, came together and found a way to work collaboratively in a shared space without compromising their distinctive professional identities. We argue that this approach both points to ways we might revisit traditional conflict-based analyses of the history of physiotherapy, while also suggesting new ways of imagining how the profession might change in the years to come. [ABSTRACT FROM AUTHOR]

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the massage and electricity so vital to the success of the Rest Cure, used the opportunity to develop approaches to treatment that would form the backbone of the physiotherapy profession in England after 1894. Methods: Extensive primary and secondary texts were drawn from a wide range of sources and critically reviewed. Findings: This study argues that the management of neurasthenic cases in the 1880s and 90s created the conditions necessary for the development of the profession's relationship with medicine and the establishment of new practice roles for women, and that these would play an important role in shaping the physiotherapy profession in Britain after 1894. Read through the critical sociological writings of Magali Sarfatti Larson and Anne Witz, I argue that the work of the nurse-masseuses can be seen as a complex gendered negotiation between the need to be deferential to the dominant male medical profession; distinct from emerging notions of the angelic, motherly nurse; obedient, technically competent and safe. The creation of a space in the clinic room for a third practitioner who could deliver a different form of care to the doctor or the nurse, established an approach to practice that physiotherapists would later adopt almost without amendment. Discussion: I argue that this approach owes much to the work done by nurse-massueses who established and tested its principles in treating cases of neurasthenia. [ABSTRACT FROM AUTHOR]

Contemporary and future physiotherapists are, and will be, presented with challenges different to their forebears. Yet, physiotherapy tends to remain tied to historical ways of seeing the world: these are passed down to generations of physiotherapy graduates. These historical perspectives privilege particular knowledge and skills so that students gain competency for graduation. However, contemporary practice is inherently more complex than the focus on knowledge and skills would have us believe. Professional life requires students to develop the capability to deal with uncertain and diverse futures. This paper argues that physiotherapy needs to think differently about entry-level education; the focus on knowledge and competencies that has been the mainstay in physiotherapy education must now be understood in the context of an education that embraces knowing, doing, being. Two educational frameworks are offered in support of this argument – threshold concepts and ways of thinking and practicing (WTP). Taken together, these ideas can assist physiotherapy to think in fresh ways about disciplinary learning. Threshold concepts and WTP help to understand the nature of a discipline: its behaviors, culture, discourses, and methods. By interrogating the discursive aspects of the discipline, physiotherapy educators will be better placed to provide more relevant preparation for practice. [ABSTRACT FROM PUBLISHER]

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practices to meet this growing need. Aged care may therefore represent a testing ground for a new physiotherapy, and the lessons learned in reforming physiotherapy for older adults may extend to all aspects of practice. In this paper, I explore how our current approach to aged care came about, and make the case for change. Having critiqued biomedicine, I also argue that the newer holistic models of health care are equally inadequate, because they attempt to dissolve important philosophical differences between physical, experiential, and social paradigms into an amorphous whole. I argue that these 'embodied' models of health make a holistic approach to aged care impossible and, instead, suggest new materialism and object-oriented ontologies as alternative physiotherapy paradigms. [ABSTRACT FROM AUTHOR]

Having spent their first century anchored to a biomedical model of practice, physiotherapists have been increasingly interested in exploring new models and concepts that will better equip them for serving the health-care needs of 21st century clients/patients. Connectivity offers one such model. With an extensive philosophical background in phenomenology, symbolic interactionism, structuralism, and postmodern research, connectivity resists the prevailing western biomedical view that health professionals should aim to increase people’s independence and autonomy, preferring instead to identify and amplify opportunities for collaboration and co-dependence. Connectivity critiques the normalization that underpins modern health care, arguing that our constant search for deviance is building stigma and discrimination into our everyday practice. It offers provocative opportunities for physiotherapists to rethink some of the fundamental tenets of their profession and better align physiotherapy with 21st century societal expectations. In this paper, we provide a background to the place connectivity may play in future health care, and most especially future physiotherapy practice. The paper examines some of the philosophical antecedents that have made connectivity an increasingly interesting and challenging concept in health care today. [ABSTRACT FROM PUBLISHER]

Background: Alleviating inflammation should be considered as one of the first steps of the treatment plan in patients with acute rotator cuff related shoulder pain (RCRSP). Objective: To compare the effects of triamcinolone/lidocaine ultrasonophoresis, injection on pain, disability, and quality of life in patients with acute RCRSP. Methods: A total of 28 acute RCRSP patients were randomly allocated into two groups of ultrasonophoresis and injection. Both groups received vitamin C and shoulder care education for 10 days and then were subjected to therapeutic interventions. Ultrasonophoresis group received triamcinolone (16 mg) and lidocaine (2mg) using ultrasonophoresis (frequency: 3 MHz, intensity: 1.50 W/Cm2), while the injection group received a single subacromial injection of triamcinolone (80 mg) and lidocaine (10 mg). The main outcomes measures were pain assessed by two scales (visual analog scale), and shoulder pain and disability index (SPADI), disability (SPADI), and quality of life (Western Ontario rotator cuff questionnaire). Results: Although the main effect of time was statistically significant for all dependent variables (P< 0.01), no significant interaction was found between group and time (P-value (0.12-0.55)). The ultrasonophoresis effect, size for pain, disability, and quality of life were 2.58, 1.43, 1.78, and 1.35, respectively. The injection effect, size for pain, disability, and quality of life were 1.98, 2.02, 1.40, and 1.60, respectively. Conclusions: Triamcinolone/lidocaine ultrasonophoresis demonstrated similar outcomes to injection in reducing pain, improving disability, and enhancing quality of life in patients with acute RCRSP in short time. According to our findings, ultrasonophoresis with triamcinolone/lidocaine cream is as effective as triamcinolone/lidocaine injection and can be proposed as a potential adjunctive treatment for patients with acute RCRSP. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is common and may lead to lasting adverse effects on health. Trauma-informed practice does not treat trauma but uses a strengths-based approach to encourage engagement in services. Objective: To understand how physiotherapy attends to trauma-informed principles. Methods: This qualitative ethnographic study was set in an Australian hospital. Three data collection methods were used, including observations of clinical practice, interactive reflexive group discussions with physiotherapists, and interviews with patients. Data analysis included an initial inductive phase followed by thematic mapping to trauma-informed principles. Critical reflexivity was used throughout to examine how the authors' perspectives and assumptions affected the analysis. Results: Twelve observations of consultations, ten interviews with people receiving physiotherapy, and five group discussions with physiotherapists were conducted. Themes produced within each of five principles of trauma-informed care included: Safety: not just a number, uncertainty beyond managing physical risks, upbeat approach as default needs balance, pragmatic environments inadequate; Trustworthiness: touch needs further consideration, assumed consent; Choice: limited options; Collaboration: let's do it together, variable consideration of the patient as expert, task focus, pushing the "right" treatment, missing insight into power imbalance; Empowerment: extending function and independence, building nonphysical skills but lack of clarity. Conclusion: Physiotherapy incorporates crucial aspects of trauma-informed care, but opportunities exist to enhance physiotherapists' skills and knowledge, particularly in relation to non-physical safety considerations. [ABSTRACT FROM AUTHOR]

Introduction: Clinical documentation is an integral component of effective physiotherapy practice. Minimal research has explored how new graduate physiotherapists transition to practice of documentation. Objective: To understand new graduate physiotherapists' experiences and support needs for transitioning into this professional role, from the perspectives of new graduates and clinical supervisors. Methods: This study utilized the qualitative methodology of reflexive thematic analysis, situated within a critical realist framework and informed by Duchscher's stages of transition theory. Semi-structured interviews of 16 new graduate physiotherapists (less than two years post-graduation) and seven clinical supervisors (of new graduate physiotherapists) were subjected to inductive analysis, where codes were organized into themes and subthemes. Results: Three overarching themes were generated with associated subthemes. Variable preparedness for documentation identified that new graduates were equipped with the basics of documentation, yet challenged by unfamiliarity and complexity. Documentation practices evolve over time outlined experiences of new graduates developing a "written voice" and improving documentation efficiency. Workplace support is necessary irrespective of preparedness, discusses: i) opportunities to practice, reflect and refine skills, ii) protected time for documentation, and iii) access to templates and examples. Conclusion: New graduate physiotherapists enter the workforce with variable levels of preparedness for clinical documentation, and may experience challenges when facing unfamiliar contexts and clinical complexity. Understanding expectations and engaging in opportunities to improve documentation skills were perceived as beneficial for enhancing new graduate practice of clinical documentation across workplace settings. Implications for workplace support to promote safe and effective practice of documentation are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP. Purpose: The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP. Methods: Focus group interviews were conducted with physiotherapists in 2018–2019, 14–18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis. Results: Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24–61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists. Conclusions: Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes. [ABSTRACT FROM AUTHOR]

Background: Digital health technology is progressively transforming physiotherapy practice. Despite a maturing body of literature relating to physiotherapy digital health capability, research examining digital health physiotherapy competency standards is both lacking and lagging. Objective: Examine international professional practice competency standards for physiotherapists to identify themes common to digital health practice competency, published by international peak organizations governing physiotherapy practice. Methods: Systematic meta-synthesis of international peak organization physiotherapy practice competency standards. The study was undertaken over nine stages. Competency statements related to digital health were extracted, and further coded into resultant themes. Results: Eleven documents were analyzed. Fifty-two statements explicitly referenced digital health competency. Identified themes were as follows: 1) digital health data governance; 2) digital health data translation; and 3) digital health technologies. Where digital health-related competency statements do exist, they are skewed toward health information management activities. Conclusions: Digital health practice is currently under-represented in competency standards for physiotherapists. Workforce advancement in light of the burgeoning impact of digital health will prompt further updates to professional competency standards set by our peak organizations. This will have a flow on effect, whereby education providers (e.g. universities and other professional development providers) should consider curriculum and training that prepares individuals for digitally enabled practice. [ABSTRACT FROM AUTHOR]

Background: Despite efforts to support physiotherapists in integrating psychosocial aspects of care to biological ones, clinical practice remains dominated by biomechanistic priorities. To facilitate change, attention and actions need to consider not only the individual level of the therapists but also the cultural and structural levels of the profession. How these multi-layered social dynamics shape practice have not previously been investigated. The Social Identity Approach (SIA) provides a relevant framework to this exploration. Aim: This study aimed to identify the social identity processes involved in the development of psychologically-informed physiotherapy (PIP) to understand how they may influence practice change. Methods: Nine semi-structured interviews were conducted with self-identified psychologically-informed physiotherapists. A Reflexive Thematic Analysis informed by SIA principles enabled to consider meaning as the product of social processes. Findings: The analysis of participants' experiences in moving from a primarily biomechanistic practice toward the integration of psychosocial aspects of health demonstrated: 1) a transformative "mind-blowing" identity journey; 2) a journey that is not made in isolation; and 3) where leadership matters. Conclusion: Changes in clinical practice involve dynamics at the collective level of the practice environment and of the physiotherapy profession itself, rather than solely at the individual level of clinicians. An understanding of these complex social processes at a managerial level could be important to better support leaders and clinicians in implementing PIP in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Reflection is promoted in health professional education as a way to learn in and on practice. 'Being reflective' is considered important to 'good' and 'expert' physiotherapy practice, yet there is limited research on reflective practices of experienced physiotherapists. For Aristotle, a good person reasons and acts in ways to promote human flourishing. Physiotherapists' perspectives on the place of reflection in good practice has the potential to advance professional understandings of how it may be enacted. Such knowledge may inform health professions education, regulatory guidelines, professional practices, and patient interactions. Purpose: The purpose of this research was to examine experienced musculoskeletal (MSK) practitioners' perceptions of reflection in the practice of a 'good' physiotherapist. Methods: A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of the qualities and practices that constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on ways of 'being reflective', which emerged as a major theme in the original study. Findings: Six themes were identified related to 'being reflective' in a 'good' physiotherapist: 1) learning from experience; 2) integrating multiple perspectives; 3) navigating indeterminate zones; 4) developing embodied knowledge; 5) questioning assumptions; and 6) cultivating wisdom. Conclusions: Findings support the notion that 'good' physiotherapy involves a disposition toward making wise judgments through reflection. This practice-based knowledge can inform educational initiatives that nurture practices that foster attention to reflective processes that inform phronesis in professional life. Through reflexivity on what the profession takes for granted, physiotherapists may be better prepared when navigating the indeterminate zones of practice. [ABSTRACT FROM AUTHOR]

Background: Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope. Objective: To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress. Methods: A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically. Results: 3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management. Conclusion: While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress. [ABSTRACT FROM AUTHOR]

Background: Peer assisted learning (PAL) has become increasingly popular in higher education, and a range of benefits have been reported for students. However, there is scant knowledge on PAL study groups in physiotherapy undergraduate training. Objectives: This study aimed to generate in-depth knowledge about the experiences of PAL study groups from the perspective of physiotherapy students. Methods: We conducted focus group interviews with 15 first-semester students who had attended PAL study groups, and 8 third-semester students who had been PAL leaders. The interviews were analyzed using an inductive, thematic analysis. Results: Four main themes were generated: 1) An overwhelming transition – Eased by PAL study groups; 2) The significant role model – Creating safe learning environments; 3) Building a bridge between theory and practice through scaffolding; and 4) Time to mature and filtered knowledge. Conclusion: Overall, we found that PAL study groups formed an important community of practice, and that the PAL leaders became important role models, providing academic, social, and emotional support. Students learning from students in PAL study groups seemed beneficial to bridge theory and practice. Our findings support the implementation of PAL study groups as a supplement to formal teaching and suggest that PAL aids students' transition to the university environment. [ABSTRACT FROM AUTHOR]

Background: A person-centered and collaborative practice is considered crucial in contemporary physiotherapy. These ideals are often embraced in theory but are difficult to put into practice. As problems and solutions are related, understanding and refining theory on practical problems can close the knowing-doing gap and link the problem to the development of possible solutions. Objective: To explore the challenges with providing physiotherapy as part of collaborative and person-centered rehabilitation services. Methods: This article reports on an all-day interactive workshop with eight focus group discussions where physiotherapists from six different professional settings participated. We draw on theories of institutional logics to interpret the results. Results: Challenges were linked to: 1) Professional level: Services being based on what the profession can offer – not on users' needs; 2) Organizational level: Rewarding efficiency instead of user outcomes; and 3) System level: Not knowing the other service providers involved or what they are doing. Conclusion: An innovative practice was constrained by multilevel social systems: the professional logic shaping the perceived professional scope, the organizational logic shaping the understanding of what was expected in the organizational context, and a system logic within a biomedical paradigm. Transforming and transcending these social systems is needed to realize collaborative and person-centered practice. [ABSTRACT FROM AUTHOR]

Background and Introduction: Pain is a subjective phenomenon, that is often misunderstood and invalidated. Despite recent advances in health professional training, it remains unclear how students should be taught about the subjectivity of pain. This study explored how a novel teaching activity that integrated physiotherapy students' first-hand experiences with laboratory-induced pain could address this gap. Objective: The study aimed to explore the experiences and perceptions of physiotherapy students in relation to a workshop where physiotherapy students experienced laboratory induced pain. Methods: We used a descriptive qualitative research design. Eighteen students participated in interviews. Transcripts were analyzed using an inductive conventional content analysis. Results: We identified four overarching themes: 1) First-hand pain experiences facilitated engagement in learning; 2) Reflecting on these personal and peer pain experiences helped students make sense of pain; 3) The learning activity helped students understand the inherent subjectivity and complexity of pain; and 4) Students saw benefits for clinical practice. Conclusion: Integrating first-hand pain experiences within entry-level physiotherapy training appears to have novel value in helping students understand pain subjectivity. Future research should use robust and controlled designs to explore how this novel approach can be used to facilitate further understanding and empathy within clinical interactions with people living with pain. [ABSTRACT FROM AUTHOR]

Although provoked vestibulodynia (PVD) represents a significant challenge for many young women in the Western world, little is known about how these women experience therapeutic efforts. The aim of this paper is to enhance our knowledge of the way that the therapeutic process is experienced by women with PVD undergoing somatocognitive therapy (SCT). The study enhances insight into this recently developed therapy through a detailed description of the physiotherapy approach. The empirical data are based on interviews with six women who participated in SCT. The empirical data analysis is guided by thematic analysis. Our findings demonstrate how the women experience SCT as a bodily process of wholeness. The process of wholeness relates to new experiences in the women's own bodies, awareness of muscular and mental tension and relaxation, breathing patterns, and perceptions focusing on pain. The findings are presented as three interrelated themes: 1) sensitizing the body as an interconnected unit; 2) incorporating the painful pubic region into the body; and 3) developing a new understanding of oneself. The women who participated in this study found that SCT contributed significantly to the process of their recovery from PVD. [ABSTRACT FROM AUTHOR]

To identify common characteristics of landmark physiotherapy clinical trials. The Physiotherapy Evidence Database (PEDro) top five trials were compared to 91 physiotherapy trials published in top medical journals and 99 trials randomly selected from PEDro on the following characteristics: PEDro score, sample size, number of trial sites, use of prospective registration, positive or negative trial, citations, citations in guidelines, Altmetric score, impact factor, publications and citations of first and last author, and PEDro codes (sub-discipline, topic, problem, therapy, and body part). Trials were published from 2014 to 2019. One-way independent ANOVA and Chi–squared test evaluated between-group differences. Compared to a random sample of physiotherapy trials, the PEDro top five trials and trials in top medical journals have higher PEDro scores, larger sample sizes, more study sites, more citations (including in guidelines), higher Altmetric scores, more likely to be prospectively registered, less likely to be positive trials, and have first and last authors with more citations and publications. The problem was the only PEDro code was distributed differently across the trial groups. The PEDro top five trials and physiotherapy trials published in the top medical journals have characteristics that may inform the design, conduct, and reporting of future physiotherapy trials. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, there are more than 264 million people with depression, which is the second-leading cause of years lived with disability. Physical activity can be useful in both preventing and treating mild to moderate depression, but few studies have explored patients' experience of physical activity. Purpose: To explore experiences of facilitators to initiate and maintain regular physical activity in people with depression. Methods: Adults of working age with mild to moderate depression participated in semi-structured interviews. Two researchers analyzed the data using qualitative content analysis. Results: Four categories were identified: 1) Getting over the threshold; 2) Hoping for improvement; 3) A wish to be independent but needing help; and 4) Feeling safe on one's own terms. Conclusion: The results indicate that knowledge and personal experience of how physical activity affects well-being, and an environment including social support, increase the possibilities for people with depression to initiate and maintain physical activity. To promote physical activity, it is important to be receptive to the person's experiences, desires, and needs and to involve them in the planning and adjustment of physical activity. Follow-up appointments, a stepwise approach, and encouragement are important to increase motivation. [ABSTRACT FROM AUTHOR]

Background: Recruitment rates to rehabilitation trials are variable among cancer survivors, and deeper investigation into the causes for declining participation is needed. The aim of this study was to qualitatively explore the experiences of people with myeloma referred for autologous stem cell transplant who were approached to take part in a physiotherapist-led exercise trial but declined. Methods: Participants were asked to participate in this qualitative study after declining to participate in a trial conducted at a UK tertiary cancer center. Semi-structured interviews were conducted. Data was analyzed inductively using reflexive thematic analysis. Results: Interviews from 18 myeloma patients (56% male, mean age 62 years) were analyzed. Four themes were identified: 1) Traveling to the specialist center is challenging, not just logistically; 2) Individualized approach valued but recall of research information variable; 3) Being less active has profound impact yet ameliorative support is lacking; and 4) Common side-effects of treatment are expected and endured but personal impact underestimated and unaddressed. Conclusion: A number of barriers to participation were identified. Travel, a commonly cited reason for declining research participation, is more than a logistical issue for cancer survivors experiencing side-effects and the time burden of clinical appointments. Expectation or knowledge of the typical side-effects from myeloma and its treatment may lead to under-reporting of concerns to care providers, despite their impact upon daily activities and quality of life. Approaches used for research recruitment should consider the timing and consequences of ongoing cancer treatment to reduce potential barriers to participation. [ABSTRACT FROM AUTHOR]

Background: Social media offer opportunities for informal learning and are increasingly adopted by health professionals as learning tools. However, little is known of how new graduate physiotherapists engage with social media for learning. Purpose: This study aimed to explore new graduate physiotherapists' perceptions and use of social media as learning tools during their transition into professional practice. Methods: This study used a qualitative general inductive approach. New graduate physiotherapists (n = 16) were recruited through purposive snowball sampling and participated in semi-structured interviews. Data were subjected to a general inductive analytical method. Results: Four themes were generated: 1) social media as tools for learning; 2) navigating and engaging with social media as a learner; 3) thinking critically about social media; and 4) relevance to practice. Conclusion: New graduate physiotherapists use social media as adjunct learning tools which can be positioned within several frameworks, including the Situated Learning Theory. However, new graduates voice uncertainties regarding information credibility, the importance of critical thinking skills in navigating information, and concerns regarding blurred work-life boundaries. Recommendations are made for research to further understand social media as emerging learning tools, especially for new graduates who are experiencing insufficient workplace support. [ABSTRACT FROM AUTHOR]

Expressing a desire for surgery before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has been shown to contribute to poorer outcomes from the interventions, but we lack knowledge on how these patients reflect on health care and self-management of OA. To explore and describe patients' perspectives of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA interventions. Sixteen patients with hip or knee OA referred to participate in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were analyzed using inductive qualitative content analysis. One theme of meaning "A multifaceted picture of needs, expectations, and individual choices" and five categories were identified as perspectives from the participants regarding health care and self-management of OA: 1) lacking control and needing support; 2) standing alone in an unsupportive environment; 3) going with the flow; 4) having expectations; and 5) taking ownership. Patients who express a desire for surgery before participating in first-line interventions for OA are not a homogeneous group. They describe a broad range of perspectives on how they reason and reflect on health care and self-management of OA based on their own needs, expectations, and choices. Findings from this study strengthen insights on the importance of exploring the patient's perspectives and individualizing OA interventions to achieve the lifestyle changes that first-line interventions strive to accomplish. [ABSTRACT FROM AUTHOR]

A best practice physiotherapy model of care (BetterBack MoC) for low back pain (LBP) aimed to improve patients' illness perceptions and self-care enablement, according to the Common-Sense Model of Self-Regulation (CSM). To confirm if illness perceptions and patient self-care enablement, in line with the CSM, are mediators of treatment effects on disability and pain of the BetterBack MoC for patients with LBP compared to routine primary care. A secondary aim was to explore if illness perceptions and patient self-care enablement are mediators of guideline adherent care. Pre-planned single mediation analyses tested whether hypothesized mediators at 3 months mediated the treatment effect of the MoC (n = 264) compared to routine care (n = 203) on disability and pain at 6 months. Secondary mediation analyses compared guideline adherent care with non-adherent care. No indirect effects were identified. The BetterBack intervention did not have superior effects over routine care on the hypothesized mediators. Illness perceptions and self-care enablement were significantly associated with disability and pain at 6 months. Secondary analyses showed significant indirect effects of guideline adherent care through tested mediators. Despite no indirect effects, patients' illness perceptions and self-care enablement were associated with disability and back pain intensity outcomes and are potentially relevant treatment targets. [ABSTRACT FROM AUTHOR]

Previous research suggests physiotherapists' perceived frequency of contact with clients experiencing psychological distress is common; however, there is significant variation in the frequency of such contact. The study aimed to 1) investigate Australian physiotherapists' perceived frequency of contact with clients experiencing various forms of psychological distress; 2) identify potential factors that predict perceived frequency of contact; and 3) explore physiotherapists' beliefs regarding their role and self-reported capability to identify and assess psychological distress. A nationwide online survey of 340 Australian physiotherapists was conducted, and the data were analyzed using descriptive analysis and regression analysis. Physiotherapists' perceived frequencies of contact with psychologically distressed and severely distressed clients expressed as proportions of all clients seen each week were 36.1% and 15.6%, respectively. Factors related to the clinical setting were stronger predictors of the perceived frequency of contact (Cohen's f2 = 0.16) than factors related to the physiotherapists themselves (Cohen's f2 = 0.03). Despite believing that identifying psychological distress was within their scope of practice, the physiotherapists in the study felt that assessing and managing this distress fell outside or on the boundary of their scope of practice. Australian physiotherapists frequently encounter clients they perceive to be experiencing psychological distress. Future research into physiotherapists' capability to assess and respond to client psychological distress, using non-self-reported measures, is required. [ABSTRACT FROM AUTHOR]

Context: Health practitioner registration boards require health professionals to evaluate and maintain “fitness to practice” (FTP). This encompasses the professional behavior, clinical competence, and freedom from impairment required for safe and effective service provision. We developed and implemented policies to promote student self-assessment and support of FTP that were pre-emptive and designed to be helpful and sought clinician feedback on this initiative.Method: An innovative student-centered FTP approach was devised with consideration of defensible ethico-legal practice. A survey explored clinical educators’ perceptions of the FTP policy and the associated education and support. Closed and open survey questions were analyzed using descriptive statistics, qualitative evaluation, and thematic analysis.Results: Seventy-nine physiotherapy clinical educators from 34 sites across eight Australian health services returned surveys. Educators had positive perceptions of policy components, particularly incorporating professionalism as a hurdle requirement and the attendance and incident reporting policies.Conclusions: The benefits of a student-centered FTP approach included clarity and consistency in managing FTP issues and facilitation of student awareness through active engagement in maintaining their FTP. To our knowledge, this paper is the first to report a comprehensive approach to the range of FTP issues incorporating student self-declaration of issues that may affect desirable progression through clinical placements. The policy and program of education and support are likely to be generalizable to health professional training programs that utilize workplace training. [ABSTRACT FROM PUBLISHER]

In this article, we propose a theory-driven approach to developing interventions for reducing weight stigma in physiotherapy and discuss the design and exploratory trial of such an intervention. Weight stigma has been identified in physiotherapists in empirical investigations. However, there has been little consideration of how this stigma might be addressed. We highlight Goffman’s work on stigma that provides social and embodied understandings of stigma. Goffman’s approach, however, is notably apolitical, ahistorical and lacks mechanisms for understanding power. We suggest that post-structuralist perspectives can provide insight into these areas. Drawing on these theories, we critically examine the literature on weight stigma reduction, finding that trials have largely been unsuccessful. We argue that this may be due to overly passive and simplistic intervention designs. As context-specific understandings are desirable, we examine the nature of physiotherapy to determine what might be relevant to (re)thinking weight in this profession. We then discuss the development of a multifactorial, active weight stigma intervention we trialed with eight physiotherapists. Supported by theory, the outcomes of the exploratory study suggest that physiotherapy-specific factors such as fostering professional reflexivity and improving understandings of stigma need to be incorporated into an active intervention that considers the complex determinants of weight stigma. [ABSTRACT FROM PUBLISHER]

To understand the perspectives of physiotherapists on the contribution of students to the delivery of health services during clinical placements. Focus groups with a semi-structured interview guide were completed separately with new graduate physiotherapists reflecting on their student experience and experienced physiotherapists from five Queensland public health-sector hospitals. Interviews were transcribed verbatim in preparation for thematic analysis. Interview manuscripts were read independently and initially coding completed. Codes were compared and further refinement of themes occurred. Themes were reviewed by two investigators. There were 38 new graduate participants across nine focus groups and 35 experienced physiotherapists across six focus groups who participated in this study. Students participate in a range of activities during clinical placements some of which contribute to delivery of health services and others which support student learning. Three major themes were identified: 1) tangible student contribution; 2) non-tangible student contribution; and 3) factors that influence the student contribution. Overwhelmingly, both new graduate and experienced physiotherapists felt that students do contribute to the delivery of health services however careful consideration of a variety of factors is necessary to maximize the student contribution. [ABSTRACT FROM AUTHOR]

There is an urgent need to develop an international competency and capability framework to support standardization of education and roles in advanced practice physiotherapy (APP). This need arose due to the rapid growth of the APP model of care, implemented out of necessity in the absence of agreement as to the competencies and capabilities or formal education required for the roles. This study explores the views and perceptions of practitioners and key stakeholders on a draft competency and capability framework for advanced practice physiotherapists. The purpose of this study was to: 1) gather feedback from key stakeholders (advanced practice physiotherapists, researchers, and leaders) on a draft competency and capability framework and 2) use that feedback to revise and improve the draft framework. Qualitative study using a series of four multi-national online focus groups. Thematic analysis was conducted according to Braun and Clarke. Sixteen participants from the United Kingdom, Ireland, Canada, Australia, and New Zealand participated in the study. Five themes were generated after data analysis: clinical expert, experienced communicator, strong leader, collaborator, and knowledge creator). A modified competency and capability framework was developed based on feedback from the focus groups and input from subject matter experts (SMEs). This study provides a modified core competency and capability framework comprising 24 competencies grouped under six domains. This study is a step toward international standardization of advanced practice physiotherapy based on a commonly agreed framework for the education and training of advanced practice physiotherapists. [ABSTRACT FROM AUTHOR]

Psychological distress is a common response to many conditions physiotherapists treat. It is also common for a person's experience of distress to be associated with multiple stressors. This qualitative study explored physiotherapists' perceptions of the types of patient psychological distress they encountered in their clinical practice. A qualitative research approach was adopted. Twenty-three physiotherapists were recruited through purposive maximum variation sampling. To participate, physiotherapists had to self-report having encountered at least one patient they perceived to be experiencing psychological distress in the last 12 months. Data analysis was completed using Iterative Thematic Inquiry. Five themes were identified in the study: 1) distress extends beyond physical health issues; 2) fear of the future; 3) the emotional toll of loss; 4) trauma is often part of the story; and 5) losing hope. The results of this study highlight that patient psychological distress presents in a variety of forms and appears to be multifaceted and multifactorial in nature. As patients' experiences of psychological distress are relevant to physiotherapy practice, mental health capabilities need to be embedded within physiotherapy training. [ABSTRACT FROM AUTHOR]

Active patient participation is an important factor in optimizing post-stroke recovery, yet it is often low, regardless of stroke severity. The reasons behind this trend are unclear. To explore how people who have suffered a stroke, perceive the transition from independence to dependence and whether their role in post-stroke rehabilitation influences active participation. In-depth interviews with 17 people who have had a stroke. Data were analyzed using systematic text condensation informed by the concept of autonomy from enactive theory. Two categories emerged. The first captures how the stroke and the resultant hospital admission produces a shift from being an autonomous subject to "an object on an assembly line." Protocol-based investigations, inactivity, and a lack of patient involvement predominantly determine the hospital context. The second category illuminates how people who have survived a stroke passively adapt to the hospital system, a behavior that stands in contrast to the participatory enablement facilitated by community. Patients feel more prepared for the transition home after in-patient rehabilitation rather than following direct discharge from hospital. Bodily changes, the traditional patient role, and the hospital context collectively exacerbate a reduction of individual autonomy. Thus, an interactive partnership between people who survived a stroke and multidisciplinary professionals may strengthen autonomy and promote participation after a stroke. [ABSTRACT FROM AUTHOR]

Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups. Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months. 115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group. For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention. [ABSTRACT FROM AUTHOR]

Contemporary discourses in the health sciences vary in their treatment of aging bodies and the mind–body relationship, yet our understanding of aging experiences and health care practices can be limited by an overreliance on biomedical or social constructionist approaches alone. This paper offers a conceptual exploration of embodiment as an innovative approach to enhance our understandings of aging bodies and health in physiotherapy practice. Embodiment attends to body and mind, nature and culture, structure and agency, while appreciating differences in aging bodies and health in aging. Conclusions consider embodiment in the practice and disciplinary discourse of contemporary physiotherapy, specifically, considering the ways embodied perspectives can support therapists in their health care practice and relationships with people with aging bodies. [ABSTRACT FROM AUTHOR]

Background: Longstanding gynecological pain affects large numbers of women in the Western world. In recently published studies, we have found that a hybrid of physiotherapy and cognitive psychotherapy called somatocognitive therapy (SCT) ameliorates physical symptoms and psychological distress. In this paper, we report on the experiences of undergraduate physiotherapy students performing the therapy to patients with provoked vestibulodynia (PVD). Aim: The study aimed to investigate the nature of the collaborative interaction between female physiotherapy students and patients with PVD, focusing on critical factors for the students' learning of professional skills through SCT applied on patients suffering from an especially demanding pain condition. Methods: In a qualitative study design, data were collected from two group interviews with four female students in pairs, and subjected to a thematic analysis. Results: We found that students perceive the patient encounter as critical incidents in the sense of strong emotional encounters. From the data material, there emerged a four-step process ranging from distance to proximity, highlighting factors that influence the development of professional skills. The four steps are defined respectively as: (1) the students' prejudices; (2) identification and empathy; (3) senses of responsibility in the therapeutic relationship and (4) collaborative engagement for change. Comments: Contrary to expectations, the students experienced the application of this combined approach (SCT) as an interesting and rewarding way of working with patients, and that they had achieved skills and a sufficient set of tools to cope with the challenges that patients with longstanding gynecological pain represent. [ABSTRACT FROM AUTHOR]

People with severe traumatic brain injury (sTBI) are often young and need long-term follow-up as many suffer complex motor, sensory, perceptual and cognitive impairments. This paper aims to introduce phenomenological notions of embodiment and self as a framework to help understand how people with sTBI experience reorientation to everyday life, and to inform clinical practice in neurological physiotherapy. The impairments caused by the sTBI may lead to a sense of alienation of one's own body and changes in operative intentionality and in turn disrupt the reorganization of self, identity, everyday life and integration/co-construction of meaning with others. Applying a first-person conception of the body may extend insights into the importance of an adapted and individualized approach to strengthen the sensory, perceptual and motor body functions, which underpin the pre-reflective and reflective aspects of the self. It seems important to integrate these aspects, while also paying attention to optimizing co-construction of meaning for the person with sTBI in the treatment context. This requires understanding the patient as an experiencing and expressive body, a lived body (body-as-subject) and not just the body-as-object as is favored in more traditional frameworks of physiotherapy. [ABSTRACT FROM AUTHOR]

Evidence is accumulating that medical students and practitioners have particular difficulty in neurology and have neurophobia. However, little is known about attitudes toward neurology in physiotherapy students. This study aimed to assess the attitudes of physiotherapy students toward neurology and compare it with other core specialties, identify contributors to difficulties of neurology, and obtain feedback for improving the quality of neurology and neurological rehabilitation education. A structured survey was distributed to final-year physiotherapy students in different universities across Turkey. Perceived level of knowledge, confidence, interest, difficulty, and desire to pursue a career in four main physiotherapy specialty areas (neurology, musculoskeletal, cardiopulmonary, and pediatric) were assessed. Reasons for perceived difficulty and ways to improve neurological physiotherapy education were asked by Likert-type and open-ended questions. Three hundred ninety-one students participated from 12 universities. Neurology was perceived as the most challenging discipline (p <.001), but a lack of knowledge, interest, and confidence were not reported. The reasons for perceived difficulties with neurology were the need-to-know basic neuroanatomy and neurophysiology, difficulty integrating information into the clinic, and the complexity of the subject. To improve learning, most students recommended increasing clinical teaching, including bedside tutorials, exposure to more patients, and case discussions. Physiotherapy students considered neurology as the most challenging discipline. Improving the integration of basic neurosciences into the clinic may improve neurology learning along with increased clinical teaching. [ABSTRACT FROM AUTHOR]

Understanding the concept of pain and its underlying biological mechanisms is an essential part of physiotherapists' professional knowledge. The first aim of the study was to translate and cross-culturally adapt the revised Neurophysiology of Pain Questionnaire into Finnish (RNPQ-FI) and to evaluate its reliability (internal consistency and test-retest reliability) in a sample of Finnish physiotherapists and physiotherapy students. The second aim was to compare the knowledge of pain neurophysiology between these two groups. Translation and cross-cultural adaptation followed the COSMIN Study Design checklist. Participants (202 physiotherapists and 97 physiotherapy students) completed an online survey containing RNPQ-FI. Internal consistency was assessed with Cronbach's alpha and test-retest reliability using Intraclass correlation coefficient (ICC3,1). Cronbach's alpha was 0.44 and ICC was 0.70 (p <.001). The mean percentage of correct responses was 61.4% for physiotherapists and 62.1% for students. Forty-seven percent of the physiotherapists and 35.1% of the students reported difficulties in understanding the items. A higher amount of pain education was associated with higher RNPQ-FI scores. The RNPQ-FI showed low internal consistency and moderate test-retest reliability among Finnish physiotherapists and physiotherapy students. Physiotherapists and students had equal amount of pain neurophysiology knowledge. Pain education is encouraged. [ABSTRACT FROM AUTHOR]