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This study explored the lived experience of transition from adolescence to adulthood for young people with cerebral palsy to inform occupational therapy practitioners as to what might promote positive life opportunities. A phenomenological methodology was used with six participants, aged 18 to 25 years with cerebral palsy. The findings are presented in the form of hermeneutic stories and three themes: The storm of uncertainty; time, space and the body, Capsizing in a world of others and, Securing anchorage; being heard and understood. Recommendations include service integration across health, social care and education based on partnership and provision of coordinators. peerReviewed

Kotona asumista korostavan hoivapolitiikan seurauksena on paljon iäkkäitä henkilöitä, jotka eivät pääse ulos kodistaan ilman apua. Tutkimuksessa tarkastellaan huonokuntoisten iäkkäiden ihmisten ja eläkeikäisten vapaaehtoistyöntekijöiden kokemuksia keskinäisestä kanssakäymisestään vapaaehtoistyöhön perustuvalla toimintajaksolla. Vapaaehtoistyöntekijät auttoivat kodin ulkopuolisiin aktiviteetteihin yksin asuvia iäkkäitä ihmisiä, joilla oli liikkumiskyvyn ongelmia. Tutkimuksessa oli mukana viisi iäkkään ihmisen ja eläkeikäisen vapaaehtoistyöntekijän muodostamaa paria. Tutkimusaineisto koostui iäkkäiden (79–87-vuotiaiden) ihmisten ja vapaaehtoistyöntekijöiden (61–71-vuotiaiden) yksilöhaastatteluista. Aineiston analysointi perustui tulkitsevaan fenomenologiseen analyysiin (Interpretative Phenomenological Analysis, IPA). Analyysin tuloksena aineistosta muodostui viisi pääteemaa, jotka kuvaavat iäkkäiden ihmisten ja vapaaehtoistyöntekijöiden kokemuksia keskinäisestä kanssakäymisestään: itsenäinen arki, auttamisen arvokkuus, vuorovaikutuksen toimivuus, odottamaton onnistuminen ja arjen haasteellisuus. Molemmille osapuolille merkityksellisiä pääteemoja olivat vuorovaikutuksen toimivuus, arjen haasteellisuus ja odottamaton onnistuminen. Lisäksi iäkkäille ihmisille kanssakäymisessä oli merkityksellistä itsenäinen arki ja vapaaehtoistyöntekijöille puolestaan auttamisen arvokkuus. Iäkkäiden ihmisten ja heidän eläkeikäisten toimijapariensa kokemukset kanssakäymisestä vapaaehtoistyössä voidaan ymmärtää molemmille osapuolille merkityksellisenä yhteistoimijuutena. Experiences of elderly individuals and retirement aged volunteers from their social interaction during voluntary work Because the elderly live at home until late in life, there are many senior citizens who cannot go out without help. The current study investigates the experiences of retirement-aged volunteers and elderly participants during their period of voluntary work-based interaction. The volunteers helped the elderly participants, who lived alone and had difficulty with mobility, to out-of-home activities. Five pairs of volunteer-elderly participants were selected. The data set consists of individual interviews of the volunteers (aged 61–71 years) and the elderly participants (aged 79–87 years). The data analysis is based on Interpretative Phenomenological Analysis. Five themes describe the experiences the participants had about their interaction: independent everyday life, the value of helping, functioning interaction, unexpected success, and the challenges of everyday life. Both the volunteers and the elderly participants found the interaction as meaningful co-agency. Independent everyday life manifested as meaningful to the elderly participants. The value of helping was central for the volunteers.

Kuntoutuksen ja kasvatuksen yhteistoiminnan on pitkään kuvattu olevan murrosvaiheessa, jossa yksilöasiantuntijuuteen perustuvista toimintamalleista pyritään kohti yhteistoimintaa ja lapsen arjessa tapahtuvaa kuntoutusta. Yhteistoimijuudella pyritään tuen oikea-aikaiseen tarjoamiseen lapselle siten, että siitä hyötyy koko varhaiskasvatusyhteisö. Tutkimustehtävänä oli kuvata ammattilaisten sekä lasten vanhempien käsityksiä yhteistoimijuudesta varhaiskasvatuksen yhteistoiminnassa. Aineisto kerättiin yksilöhaastatteluina (n = 10) osana kehittämishanketta varhaiskasvatusympäristössä, jossa oli pidempään toiminut yhteisöllinen puheterapeutti ja hankkeen ajan myös toimintaterapeutti. Aineisto kerättiin ja analysoitiin fenomenografisella menetelmällä. Käsitykset yhteistoimijuudesta jakaantuivat neljään hierarkkisesti laajenevaan kuvauskategoriaan: tiedon jakaminen, eri näkökulmien yhdistely, yhteistä päämäärää kohti työskentely ja yhdessä arjessa toimiminen. Kategorioiden välisiä kriittisiä eroja tarkasteltiin kolmen sisällöllisesti varioivan teeman kautta: toimijoiden roolit, yhteistoiminnan eri muodot ja lopputulos. Tutkimuksen tulokset mukailevat aiempaa tutkimustietoa yhteistoimijuudesta ja terapeuttisesta yhteistoiminnasta, mutta tuovat esiin vanhempien ja ammattilaisten laadullisesti erilaisia käsityksiä yhteistoimijuudesta. Varhaiskasvatuksen yhteistoiminnassa tarvitaan uudenlaisia kasvatusta ja kuntoutusta yhdistäviä toimintatapoja ja malleja, sekä erityisesti vanhempien roolin ja toimijuuden vahvistamista., The co-operation between rehabilitation and education has long been described as being in transition, in which action models based on individual expertise are aimed at joint collaboration and community-based rehabilitative work. This newly implemented approach is aimed to offer timely needed pedagogical and developmental support so that the whole community can benefit. The aim of this study was to explore professionals and parents’ conceptions of shared agency related to community-based rehabilitation in early education settings. The qualitative data were collected by individual interviews with ten participants: four early childhood educators, four parents and two therapists (one occupational therapist and one speech and language therapist). The data were analysed using the phenomenographic methodology. Based on the data the conceptions were divided into four categories of description. In these categories shared agency was perceived as sharing knowledge, connecting different aspects, working towards shared goals and doing things together in everyday life situations. Three themes that varied within the categories were identified: roles, methods and the end results of shared agency. The results of the study reflect the same trend that is seen in previous studies of shared agency related to the categories of sharing information, working towards shared goals and doing things together in everyday life situations. The study brings out the qualitatively different conceptions of the professionals and parents. To deepen the agency of the parents, new strategies are needed. Also, the current models of the rehabilitation needs to be developed to suit community-based rehabilitation in early education.

Purpose: In acute care, effective goal-setting is an essential phase of a successful rehabilitation process. However, professionals’ knowledge and skills in rehabilitee-centered practice may not always match the ways of implementing goal-setting. This study aimed to describe the variation in how acute hospital professionals perceive and comprehend rehabilitee participation in rehabilitation goal-setting. Methods: Data were collected by interviewing 27 multidisciplinary rehabilitation team members in small groups shortly after rehabilitation goal-setting sessions. A qualitative research design based on phenomenography was implemented. Results: We identified four conceptions of rehabilitee participation, based on four hierarchically constructed categories: 1) Professional-driven rehabilitee participation; 2) Awakening rehabilitee participation; 3) Coaching participation; and 4) Shared participation. These categories varied according to four themes: 1) Use of power; 2) Ability to involve; 3) Interaction process; and 4) Atmosphere. Three critical aspects between the categories were also identified: 1) Appreciative listening; 2) Trustful relationship; and 3) Collaborative partnership. Conclusion: The study generated new insights into the meaning of rehabilitee participation, as conceptualized in relation to rehabilitation goal-setting and an acute hospital context. The identified critical aspects can be useful for planning and developing continuing professional education (CPE) in rehabilitation goal-setting for professionals. peerReviewed

Background: Professional rugby is an aggressive sport. Consequently, injuries are an inevitable part of a rugby player’s career. It is therefore crucial for sports medicine professionals to understand the subjective experience of injured athletes in order to optimize their care. Objectives: The purpose of this study was to take a lifeworld perspective to explore how living with injury was meaningful to professional rugby players. Methods: A purposive sample of five participants were recruited and data collection undertaken via semi-structured interviews. Audio-recordings were transcribed verbatim and analyzed using interpretative phenomenological analysis methodology to develop the themes. Findings: Three master themes emerged from the analysis, each comprising of two subthemes; 1) Sense of Uncertainty (1a. Fear of the Unknown, 1b. Lack of Control), 2) Experienced Change in Relationships (2a. Lived Human Relations, 2b. Coping), 3) Sense of Self (3a. Isolation and Belonging, 3b. ‘’Being” an Athlete). Conclusion: Participants described the challenge to their sense of self and ‘being’ athletes’, as the isolation from the team deprived them of their sense of belonging. Participants illustrated the experienced significance of their relationships, the uncertainty over their lives and the unique strategies to cope. Emotions of anxiety, grief, anger, and shock reverberate throughout their accounts. peerReviewed

Transitioning from adolescence to adulthood appears to be a challenging period for young people living with cerebral palsy. The aim of this review was to highlight the challenges that might be experienced during this period. A systematic search of the literature and meta-ethnographic review examined seven qualitative research papers providing a detailed synthesis in the form of three domains summarised as ‘meaningful preparation for transition’, ‘becoming empowered’, and, ‘overcoming vulnerability’. These inform a discussion which shows that adolescents living with cerebral palsy are not prepared adequately for adult life. Examination of the literature stimulates curiosity as to the nature of living with cerebral palsy whilst transitioning from adolescence to adulthood. No studies have been carried out exploring this experience in the UK and lifeworld research to inform policy and practice in this area is recommended. peerReviewed

Objectives The aim of this study was to explore the physiotherapists' lived experiences of providing pain education (PE), to people living with non-specific low back pain (NSLBP). In previous studies, PE has been associated with positive clinical outcomes within the physiotherapeutic management of NSLBP. However, the meaning of providing PE, as experienced by physiotherapists, has not been specifically explored. Methods This study adopted a hermeneutic phenomenological approach to explore PE experiences. Six semi-structured interviews were conducted, interviews were transcribed and analysed in line with the 'interpretative phenomenological analysis' framework. Results Five main thematic meaning structures emerged: Experienced significance of assessment in understanding NSLBP, PE as explaining the nature of NSLBP, Experienced challenges in providing PE, individualisation as key to PE for NSLBP and Reassurance as central to PE for people living with NSLBP. Conclusions The significance of subjective assessment, was a key component of PE, as experienced by participants. However, differences were noted between participants in addressing the sense of assessment; in seeking a physiotherapeutic understanding of the NSLBP, and in seeking to understand the situation of those who are in pain. Within the participant experience, the significance of 'patient' reassurance was highlighted, related to the individualisation and outcome of PE. Reassurance, as described by participants, was emotive and practically grounded and linked with physical activity promotion. Individualisation in PE was meaningfully related to language modification and developing positive therapeutic relationships. Physiotherapists described PE particularly challenging related to pain chronicity and psychosocial factors, which may have significant implications to practice.

Despite substantial reorganisation of stroke unit provision in the United Kingdom, limited qualitative research has explored how stroke survivors experience the acute stroke unit. This hermeneutic phenomenological study used accounts from four stroke survivors who experienced one of two acute stroke units. Through detailed analysis, the acute stroke unit emerged as a meaningful space, in two distinct but interconnected forms. As holding space, the unit was understood to offer protection and safe haven, as the stroke survivors looked to cope and respond to the temporal, bodily, biographical disruption and significant vulnerability brought about by stroke and by being in hospital. Holding was fulfilled by different people (including their fellow stroke survivors) and reflected a human response to human need and existential vulnerability. This space, and the practices within it, functioned to hold them intimately but also at a distance from their prestroke lifeworld. As such, the acute stroke unit holding space was intertwined with how it supported, encouraged or provoked transition. In the transitional space of the acute stroke unit, stroke survivors described how they survived the hospital‐healthcare space, stroke unit and poststroke space. This paper articulates how transition was meaningfully signified through its absence or presence, as they transformed, relinquished or re‐asserted their ‘self’, and in one case, recovered whilst ‘in there’. The findings of this study provide phenomenological insight into stroke survivors’ lived experience, the meaningful holding and transitional contribution of the unit, and how these spatial forms were intertwined. These insights are discussed in relation to the existing evidence base and stroke unit provision.

Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians’ experiences of communicating their understanding of this diagnosis to their patients. Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences. Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients “on board” (2a. the “selling” process; and 2b. paternalism and the clinician’s perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty). Conclusions: Personal conflicts were identified between clinicians’ descriptions of their wishes to “sell” their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients’ beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients’ reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training. peerReviewed

This hermeneutic phenomenological study was undertaken in response to the recent re-organization of stroke unit provision in the United Kingdom. Through the analysis of four acute stroke unit practitioners' subjective accounts, the acute stroke unit emerged as a dynamic, meaningful space, where they experienced authenticity and belonging. The findings showed how these practitioners navigated their way through the space, thriving, and/or surviving its' associated vulnerabilities. They offer a different gaze on which to attend to the complexity and challenge that is interwoven with health professionals’ flourishing, the spatiality of healthcare practice, and perhaps other demanding places of work.

Background: Impaired sensation in the feet is a commonly reported symptom experienced by people with multiple sclerosis. Aim: To explore the lived experiences of people living with multiple sclerosis-related impaired sensation in their feet. Method: Five open, unstructured interviews were analysed using a descriptive phenomenological method developed by Amedeo Giorgi. Findings: The essential structure of the research phenomenon consists of six key constituents: sense of heightened awareness of body sensation; sense of changed relationship to the feet; sense of changed participation in daily life; sense of the self with multiple sclerosis; sense of the meaning of interaction with others; and sense of being with impaired sensation. Conclusions: Findings imply that the experience of impaired sensation in the feet related to multiple sclerosis is a complex, lived-through phenomenon, interrelated to other aspects experienced with the condition. Clinicians are encouraged to consider implications of the phenomenon during encounters with people with multiple sclerosis, being well-placed to provide meaningful support.

The aim of this article is to bring philosophical thinking closer to practice-based empirical work. Using Martin Heidegger’s philosophy, it offers a bridge between these two worlds, attempting to provide philosophical depth to the findings of a hermeneutic phenomenological study. This process unfolded through the appearance of three intertwined, potential, meaningful modes of being in the lifeworld: space as a condition for being and being for worlding the world; temporal and spatial self-being, the existence of multiple selves in time and space; and suffering and thriving as modes of being. The article extends the dialogue and concludes with key reflections and insight for research practice. peerReviewed

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To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT).As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions.The analysis revealed four descriptive categories: "hung out to dry," "stuck," "making sense and taking control," and "holistic approach to care and living," that varied based on six themes.Although the participants accepted this approach to care well, there was significant variation in patients' conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes.Implications for rehabilitationThe participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives.This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don't feel abandoned by the system.Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.

Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as exercise prescription, education and communicating diagnosis. There is a paucity of studies exploring decision making in whiplash‐associated disorder (WAD); thus, the aim of this study was to explore the physiotherapists' lived experiences of decision making related to treating persons with WAD. A qualitative research design based on hermeneutic phenomenological methodology was used in this study. Five participants (physiotherapists) were purposefully recruited, and data are collected via semistructured interviews, which were recorded and transcribed verbatim. Interpretative phenomenological analysis (IPA) was used as a method for analysing the data. Emergent, superordinate and master themes emerged from the data to illuminate the lived experiences under exploration. Three master themes were identified: (1) sense of collaboration; (2) sense of being out of control; and (3) sense of emotional engagement (subthemes: feeling of satisfaction and feelings of distress and uncertainty). A sense of collaboration revealed varied meaning related to the role of persons receiving care, suggesting a lack of conceptual clarity related to shared‐decision making. A perceived loss of a sense of being in control was related to experienced emotions, such as feelings of distress and uncertainty. The findings of this study highlight the importance of providing space for reflection and mentoring in the workplace. peerReviewed

This paper is an illustration of the application of a hermeneutic phenomenological study. The theory of meaning and interpretation, drawing on philosophical hermeneutics and the work of Gadamer and Heidegger, and its alignment with phenomenological thought is presented. The paper explains and aims to make visible how key concerns in relation to the fusion of horizons, hermeneutic understanding, hermeneutic circle and hermeneutic phenomenological attitude were implemented. The purpose is to provide practical guidance and illustrate a fully worked up example of hermeneutic phenomenological work as research praxis. This present paper makes a case that hermeneutic phenomenological work is detailed, lengthy, rigorous and systematic in its own philosophical and theoretical frame. It articulates the philosophical and methodological alignment of hermeneutics in a specific hermeneutic phenomenological study and makes visible the work of hermeneutic phenomenology. It concludes by sharing key reflections and insights on the hermeneutic phenomenological process.

Background: Physiotherapy is recommended for upper limb movement impairments (ULMI) following breast cancer treatment. There is limited research into the pathophysiology and management of ULMI. Care is provided in different health-care contexts by specialist and nonspecialist physiotherapists, with referrals set to increase. This study explores physiotherapists' experiences of managing ULMI. Design: Qualitative study using a hermeneutic phenomenological approach. Method: We interviewed six physiotherapists from various UK treatment settings. The data were analyzed using interpretative phenomenological analysis. Findings: Four master themes were identified: (1) lack of confidence surrounds various aspects of practice, influenced by limited evidence to guide treatment of ULMI, fear of causing harm, and working in a less-established area of physiotherapy; (2) increasing confidence in practice develops with experience, reinforcing perceptions of the benefits of physiotherapy; (3) physiotherapy is understood to empower and enable patients to regain their sense of self and quality of life; and (4) provision of care is perceived to be subject to many barriers. Conclusion: Physiotherapy for ULMI has professional challenges but is seen as beneficial, encompassing psychosocial and physical effects. Experiences in this area of practice suggest a need for increased professional support, further research to guide treatment, and better patient and health professional awareness of ULMI and the role of physiotherapy.

Objectives To investigate the use of outcome measures for children with cerebral palsy (CP) by paediatric physiotherapists (PTs) who are based in the United Kingdom, as limited research exists regarding their use in this population, and to explore therapists' use of measures within different Gross Motor Function Classification System (GMFCS) levels and for different types of CP. Methods A six-item online survey was advertised through two paediatric therapy special interest groups inviting physiotherapists to participate. Descriptive statistics (range, frequencies, and percentages) were used to analyse survey data. Results Two hundred and seven physiotherapists returned completed survey questionnaires. One hundred and seventy-six (85%) therapists reported using a wide variety of outcome measures (57). Eighty-one per cent of therapists' responses for having "most difficulty" in identifying responsive outcome measures were for children with impaired mobility at GMFCS Levels IV-V and children with more significant body involvement (76%), for example, spastic quadriplegia or dyskinesia. Eighty-six per cent of therapists' responses for having "greatest ease" of identifying responsive outcome measures were for children within GMFCS Levels I-III and for children with less significant body involvement (72%), for example, hemiplegia. The variety of outcome measures used by therapists with children within GMFCS IV-V was less (16). Conclusions The majority (85%) of the PTs surveyed used outcome measures with children with CP, but 81% perceived a difficulty in identifying responsive measures for children with more severe impairments who are classified as GMFCS IV-V. The reasons for this perceived difficulty warrant investigation and may suggest a need for training regarding relevant measures and/or a need to develop new measures for this group of children.

Despite advocates for aesthetic forms of presentation in qualitative enquiry, for going beyond thin description, to share evocative forms of representation that resonate with that (Todres, 2008; Todres & Galvin, 2008), qualitative research in the health care field continues to favor conventional methods. This article adds to existing knowledge by articulating the innovative creation and value of aesthetic offerings in the unique form of visual maps to evoke the lived experience of being on an acute stroke unit, drawn from phenomenological interview findings. The maps helped embody the meaningful lived space and conveyed the complexity, spatiality, and holistic understanding being developed. They embodied the researcher’s involvement, position, and place as she imaginatively lived through the space of the acute stroke unit and proceed to invite others to join the dialogue. This article articulates the methodical alignment of creative mapmaking within three stages, for the development of phenomenological understanding, dialogue in-between, and ongoing life of dialogue for future projections toward practice and within the phenomenological project. This article illustrates the underutilized potential of mapmaking for the human sciences, understanding health care spaces, other meaningful lived spaces, and qualitative research methods.

This chapter will illustrate a combination of problem-based learning (PBL), information and communication technologies (ICT), and leadership in the context of health care education. It is argued that they form a coherent alliance that meets the challenges of education and leadership in health care. The topic and the research questions have emerged from expanding criticism against traditional educational programmes, and our own experiences of the research and development work in the context of problem-based pedagogy and the use of information and communication technologies in Finnish higher education.