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To explore the lived experience of physical exertion for persons living with advanced multiple sclerosis (MS) An interpretive (hermeneutic) phenomenological approach was undertaken with 8 persons living with advanced MS. Interviews were conducted with exploratory questions that explored participants' experiences of physical exertion. Data was analysed using phenomenological methods and the findings presented as hermeneutic stories. Participants conveyed physical exertion as a means of influencing their connection with the world. Interpretation identified four subthemes; Lived Body, Sense of Self, Purpose of exertion, and Attributes of the World and an overarching superordinate theme Body-World engagement. Hermeneutic stories illuminated the intertwined relationship between the themes and the idiographic nature of physical exertion. The experience of physical exertion was meaningfully related to participants' sense of self, agency, and 'being in the world'. For persons living with advanced MS: Physical exertion has the potential to enhance sense of self through regaining a lost, or creating a new identity. Physical exertion can enhance bodily consciousness and cause individuals to dwell on inability, consequently health care professionals should consider how their language and therapy focus may intensify this. Attempting to meet societally accepted standards of normal had a shaping influence on the exertional experience. The meaning of physical exertion is influenced by an individual's preconceptions and healthcare professionals should take time to understanding these, in order to optimise engagement in physical exertion. [ABSTRACT FROM AUTHOR]

Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles. The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists. This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken. Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories. This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education. [ABSTRACT FROM AUTHOR]

This qualitative study explored students' experience of collaborating to undertake a neuromusculoskeletal group research project which was conducted in partial fulfilment of their MSc course. A phenomenological approach was adopted to gain insight into participants' experience of learning and working in a group. Six participants who were all alumni took part in individual telephone interviews conducted by an independent researcher. The interviews were digitally recorded and transcribed verbatim. Thematic analysis identified four main themes: the role of the supervisor, peer assisted learning, quality enhancement and learning to work in a research team. Participants felt that group projects facilitated their confidence in the research process. This has been demonstrated as two of the alumni have presented their projects at conferences and published in an international journal. Some of the alumni found working in a group challenging, but were able to reflect on the skills which they learned through managing the group dynamics. The potential benefits of group projects are an increase in peer assisted learning, the development of problem solving and critical reasoning, enhanced communication and team skills. The presence of a group member who fails to contribute has been identified as a potential constraint. Reflection on emerging themes highlighted the importance of the supervisor's role in facilitating the process. A framework for supervising group research projects work has been produced to facilitate others in supervising to best effect; this will feed into staff and curriculum development.

Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely. [ABSTRACT FROM AUTHOR]

Depression is often part of the embodied experience of persons living with pain and other health conditions. In addition to other benefits, exercise has been recognized to reduce depressive symptoms. Physiotherapists help persons to develop multidimensional understanding including an understanding of how exercise can help manage symptoms, and how they can individualize exercise to them. Thus, physiotherapists need insights into how exercise is experienced and meaningfully related to depression. This study aimed to explore the lived experience of exercise in persons with depression. In this interpretive (hermeneutic) phenomenological study, participants with depression were purposively recruited and data collected via semi-structured interviews. Hermeneutic analysis was used alongside the crafting of hermeneutic stories to reveal the meaning of exercise for these participants. Participants conveyed their experience of exercise as a journey to finding a sense of contentment. Two master themes: 1) Finding the exercise for me; and 2) the experienced importance of the environment, illuminated participants' journey to finding a sense of contentment through exercise. Two subthemes 1) changing sense of self; and 2) building resilience further described participants' experience. Physiotherapists may reflect on these individual exercise stories and share these insights with persons receiving their care to explore if exercise may help them to find a sense of contentment. [ABSTRACT FROM AUTHOR]

Aims: This qualitative study aimed to explore physiotherapists' clinical reasoning when prescribing exercise for persons with musculoskeletal disorders. Methods: A constructivist grounded theory inspired methodological approach was used. Six physiotherapists working in the United Kingdom were recruited via purposive sampling. Data collection and analysis included semi‐structured interviews, memo writing, coding, and a constant comparative method. Findings: A concept of 'building bespoke exercise' has been generated to conceptualise the participants' clinical reasoning when prescribing exercise. Conclusion: The findings of this study highlight processes of co‐designing and co‐constructing exercise programmes in collaboration with persons receiving care. Physiotherapists can use this study to reflect on their own clinical reasoning to inform their own practice. [ABSTRACT FROM AUTHOR]

Frozen Shoulder (FS) is a painful debilitating condition that is a significant burden to those experiencing it and healthcare systems. Despite research investigating the pathogenesis and effective treatment for the condition, there is a paucity of research exploring how having frozen shoulder is lived through and meaningful to persons experiencing it. To explore how living with Frozen Shoulder is experienced and meaningful. A qualitative research study design using hermeneutic phenomenology methodology was used. In-depth unstructured interviews were conducted with six purposively recruited participants. Interpretive Phenomenological methods were used to analyze the data forming emergent, superordinate and master themes to qualitatively expose the meaningful aspects of living through FS. Five Master themes were identified: 1) "Dropping me to my knees," an incredible pain experience; 2) The struggle for normality; 3) An emotional change of self; 4) The challenges of the healthcare journey; and 5) Coping and adapting. The overarching 'binding theme' was Frozen Shoulder: Living with uncertainty and being in "no-man's land." This study illuminated the struggle to maintain a normal life while living with the significant pain, physical restriction, sleep loss and disability experienced by persons with Frozen Shoulder. Attempts to cope and adapt were impeded by the challenges of the healthcare journey. The uncertainty of these experiences was conveyed as being in "no man's land" an expression that reflected the existential crisis and impact on persons' sense of self. [ABSTRACT FROM AUTHOR]

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. The purpose of this study was to take a lifeworld perspective to explore how living with injury was meaningful to professional rugby players. 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. 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). 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. [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]

Purpose: It is considered that implementation of the biopsychosocial model (BPSM) within physiotherapy is affected by its lack of conceptual clarity. This concept analysis explores the meaning and offers conceptual transparency to the BPSM and expands upon its current conceptual framework for practice. Method: Literature was selected through a systematic search. The studies were analyzed and the data themed following thematic analysis. Results: From the seventeen articles included, five master themes and four subthemes were constructed. The master themes were: 1) 'Bio-medical factors'; 2) 'Psychological factors'; 3) 'Social factors'; 4) 'Communication'; and 5) 'Individualized Care'. The subthemes were: 1) 'Education'; 2) 'Cognitive'; 3) 'Behavioral factors'; 4) 'Occupational factors'; and 5) 'Therapeutic Alliance'. Conclusion: A contemporary visual representation of the BPSM is presented which represents a holistic, humanist perspective. 'Communication' scaffolds the framework and supports the exploration of the person's lifeworld through the 'therapeutic alliance'. [ABSTRACT FROM AUTHOR]

Objective: Low back pain (LBP) is the leading cause of disability worldwide; however, the majority of LBP is non‐specific in nature with no clearly identifiable source of pain. Contemporary understanding of LBP highlights the multidimensional nature of LBP and as a result clinical practice and guidelines have evolved and advocate a multidimensional approach to managing persons with LBP. This change in understanding and practice provides challenges for physiotherapists and persons with LBP, many who have biomedical views. The aim of this study was to explore musculoskeletal physiotherapists conceptions towards the management of LBP. Method: The research employed a phenomenographic inspired approach which aims to explore variations in conceptions, beliefs and understanding of a phenomenon. Six participants (physiotherapists) were interviewed via semi‐structured interviews to explore their experiences of managing persons with LBP and the data was analysed using a phenomenographic framework. Results: Three main categories emerged from the participants descriptions: the perceived role of preferences and expectations, therapeutic alliance development and getting the person "on board". Conclusion: Participants descriptions implied a therapist centred view towards the care they provided for persons with LBP. The perceived role of expectations was a significant aspect within the participants descriptions of the management of LBP. Last, the participants described the perceived development of a therapeutic alliance. These categories suggest how the physiotherapists interviewed in this study conceive the management of LBP, and these findings will provide a greater understanding around the physiotherapy management of LBP. [ABSTRACT FROM AUTHOR]

Introduction: Cauda equina syndrome (CES) is rare, but its symptoms are not and musculoskeletal physiotherapists frequently encounter persons with suspected CES. Given that delayed diagnosis of CES can result in devastating consequences for affected persons and costly litigation for healthcare organisations, it is imperative that persons presenting with suspected CES are well managed. However, this may present a challenge to physiotherapists. Therefore, the aim of this study is to explore physiotherapists' experiences of managing persons with suspected CES. Methods: Semi‐structured interviews were conducted with musculoskeletal physiotherapists. Verbatim transcripts were analysed using an interpretive paradigm and thematic analysis. Ethical approval: Ethical approval was obtained from a university Ethics committee and NHS Research and Development. Findings: Five interlinking themes emerged. The themes of worry in relation to risk management and communication difficulties seemed to represent significant challenges. The remaining themes were described as antidotes to these challenges: Lightening the load with teamwork and shared responsibility, the usefulness of a clear pathway and perception of improved confidence and competence with experience and training. Discussion: The findings are discussed in the context of other literature, and practical recommendations are made relating to pathway implementation, team working, communication aids, training on CES and measures to care for staff wellbeing. Conclusion: Findings suggest that it is important to be aware of and address the challenges faced by physiotherapists in order to care for clinicians' wellbeing and ensure a safe and smooth journey for persons with suspected CES. Summary Video: https://www.youtube.com/watch?v=lIHqCKIQ1jk&t=90s [ABSTRACT FROM AUTHOR]

Background: Sustaining high‐quality, critical care practice is challenging because of current limits to financial, environmental, and social resources. The National Health Service in England intends to be more sustainable, although there is minimal research into what sustainability means to people working in critical care, and a theoretical framework is lacking that explains the social processes influencing sustainability in critical care. Aims and objectives: This study aimed to explain the concept of sustainability from the perspective of practitioners caring for critically ill patients. Design The qualitative research followed a Charmazian constructivist grounded theory approach, including concurrent data collection and interpretation through constant comparison analysis. Methods: In‐depth interviews were conducted online or by telephone with 11 health care professionals working in critical care in the South of England (8 nurses, 2 physiotherapists, and 1 technician). Schatzman's dimensional analysis and Straussian grounded theory techniques supplemented the data analysis. Results: Sustainability was defined as maintaining financial, environmental, and social resources throughout the micro, meso, and macro systems of critical care practice. The most pertinent social process enabling sustainability of critical care was satisficing (satisfaction of achieving a goal of quality care while sufficing within the limits of available resources). Increased satisficing enabled practitioners to fulfil their sense of normative, responsible, sustainable, and flourishing practice. Satisficing was bounded by the cognitive and environmental influences on decisions and an ethical imperative to ensure resources were used wisely through stewarding. Conclusions: An explanation of the concept of sustainability and significant social processes, in relation to critical care, are presented in a theoretical framework, with implications for how financial, environmental, and social resources for critical care practice can be maintained. Relevance to clinical practice: This theory offers clinicians, managers, educators, and researchers a definition of sustainability in critical care practice and provides a structured approach to addressing critical care sustainability issues. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]