Women's conception of the menopausal transition--a qualitative study

Aim. To explore, with a qualitative approach, whether the conception of menopause varies between women seeking medical advice because of climacteric symptoms and, if so, to describe these different conceptions. Background. For many women, the menopausal transition is a troublesome period of life, often associated with decreased well‐being and a number of symptoms. Besides the hormonal changes, many other factors such as psychological, sociological and lifestyle factors affect how women perceive their menopause. Method. Semi‐structured interviews were held with 20 women after their first‐time visits at outpatient clinics of gynaecology for discussion of climacteric symptoms. The interviews were audio‐taped, transcribed and analysed using a phenomenographic approach. Results. A wide variation of conceptions was revealed. Two main categories were identified including different physical changes with varying symptoms and both positive and negative psychological changes. The menopausal transition was also described as a natural process and as a developmental phase of life. Conclusion. Women's conceptions of the menopausal transition were individual and contained both physical and psychological symptoms but also expressed a more holistic view of the menopausal transition. The transition was described as a natural process affected by endocrine and life‐style factors as well as by the psychosocial situation and by ageing per se. Relevance to clinical practice. It is important that health care providers are aware of women's conceptions about the menopausal transition to be able to communicate optimally, support and empower middle‐aged women in different health care situations and thereby optimize the result of care.     

Approaches to learning on placement: the students' perspective

Background and Purpose . With Continuing Professional Development activity, a requirement of Allied Health Professional registration in the UK and said to be most effectively supported by practitioners who adopt a deep approach to learning, a UK university has been exploring how its pre‐registration curriculum influences learner development. This paper investigates the possible influences of the clinical placement component of the curriculum that is structured as four 4‐week blocks during both Years 2 and 3 of the 3‐year BSc (Hons) programme. A range of placement models are used within this structure including the traditional 1:1 educator : student ratio and those that have a higher ratio of student(s) : educator(s). Methods . This phase of the larger project used a case study design framed about students from two academic year groups on one UK undergraduate, pre‐registration physiotherapy programme. Three questionnaires comprising a learning approaches inventory, a demographic questionnaire and a placement self‐assessment form were posted to Year 2 and 3 students during one clinical placement. The students were invited to complete the questionnaires halfway through their placement, but in advance of the first, formal placement education feedback meeting. The need for students' self‐assessment prevented follow‐up data collection. Results . Analysis of the data from the learning approaches inventory against the demographic variables and placement assessment scores suggest that students' learning strategies depend upon the number of students, educators and assessors involved in their placement. The paper explores the possible links between placement experience, learning strategy and academic outcome. The authors question assumptions about the perceived benefits of some placement education models. Conclusion . Increasing the ratio of student : educator or educator : student may have a detrimental effect on students' learning development when placements are of 4‐week duration. If such placement models are adopted, then students and placement educators must be adequately prepared and supported so that students' learning development towards the deep‐learning autonomous professionals of tomorrow can continue through placement education. Copyright © 2008 John Wiley & Sons, Ltd.     

The first encounter. Physiotherapists' conceptions of establishing therapeutic relationships.

The purpose of this study was to delineate physiotherapists' conceptions of establishing therapeutic relationships with patients and conceptions of activating the resources of the patients. Ten physiotherapists were interviewed about their ways of thinking and performing in the first encounter with the patient. The phenomenographic method was used and data were analysed qualitatively. Different categories of conceptions with reference to the preparations before the encounter, the proceeding of the encounter and the strategy within the encounter were found. Two main perspectives on the relationship between the physiotherapist and the patient were seen. One is that the relationship is based on a dialogue which aims to discover the patient's own conceptions of his problems and strategies to solve them. The second perspective is that the relationship is not based on a dialogue but that the physiotherapist perceives herself as authority. The physiotherapists' knowledge and understanding of establishing relationships with their patients can be described as personal, private and non-thematic.     

Legitimacy in clinical practice: How patients with chronic muscle pain position themselves in the physiotherapy encounter

Rationale, Aims & Objective

Patients who seek healthcare for long-lasting pain and symptoms without a detectable disease must put in extra work to be taken seriously and gain recognition as a patient. However, little is known about how patients' help-seeking is performed in clinical practice. The aim of the current study was to gain knowledge about the ways in which patients with chronic muscle pain position themselves as help-seekers during their first physiotherapy encounter.

Method

The material consisted of observation of 10 therapist-patient clinical interviews in primary care clinics and was analyzed using perspectives from discourse theory and the concept of positioning.

Results

The study highlights how the patients positioned themselves in continually shift between two discourses: that of disease (considering the patient as an object under study) and that of illness (positioning the patient as an active and participating but also troubled individual). This shifting of position was negotiated in interaction with the therapist: patients' opportunities to position themselves within the discourse of illness were limited by therapists' focus on facts and causal relationships within the discourse of disease.

Conclusion

Patients with chronic muscle pain seek to establish their legitimacy through the positivistic discourse of medicine and also through their compliance with the moral discourse of the patient as someone active, willing to take responsibility for their own health—and therefore worthy of treatment.     

运动性肌肉损伤物理治疗研究的可视化分析

目的 对运动性肌肉损伤物理治疗相关文献的研究现状、热点和发展趋势进行可视化分析。方法 检索从建库至2022年10月31日Web of Science核心合集收录的运动性肌肉损伤物理治疗的相关文献,采用CiteSpace 6.1.R3软件进行可视化分析。结果 共纳入357篇文献,涉及51个国家/地区,532位作者,346个机构;年发文量呈整体上升趋势,发文量最高的国家为美国、机构为Edith Cowan University、作者为Howatson Glyn;最近3年关注度较高的关键词有肌肉损伤后表现、离心训练、康复、肌肉酸痛;被引文献聚类词包括运动性肌肉损伤、延迟性肌肉酸痛、泡沫轴滚动按摩、运动功能。结论 运动性肌肉损伤为肌肉微损伤,关注最多的是损伤后肌肉酸痛、肌筋膜疼痛、超微结构改变等。运动性肌肉损伤物理治疗的研究呈上升趋势。主要的物理治疗方法包括冷冻疗法、冷水疗法、按摩、泡沫轴滚动按摩、离心训练;目前离心训练是该领域的研究热点,泡沫轴滚动按摩可能是该领域未来的研究方向。     

Addressing weight stigma in physiotherapy: Development of a theory-driven approach to (re)thinking weight-related interactions

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.     

Patients’ conceptions of the triage encounter at the Emergency Department

Scand J Caring Sci; 2010; 24; 746–754
Patients’ conceptions of the triage encounter at the Emergency Department Background: Little is known about patients’ conceptions of the triage encounter and what the point of the encounter is in the triage. Aim: To describe the patients’ conceptions of the triage encounter at the emergency department (ED). Method: Interviews with 20 patients from different triage categories visiting the ED at a central hospital in southern Sweden were analysed using the phenomenographic approach. Findings: Five encounters emerged based on 16 conceptions: the insecure, humanistic, logistical, information exchange and surrounding encounters. Conclusions: To facilitate more positive experiences of the triage encounter, the personnel need to care and treat the patients as whole human beings, i.e. in a holistic approach. An improved logistical and informative triage encounter is vital in order to minimize the waiting time and make the waiting time acceptable for patients, as well decreasing worries that arise because of illness in an unknown environment.     

An evaluation of students' perceptions of a college-based programme that involves patients, carers and service users in physiotherapy education

Background . There is little evidence of the integration of UK physiotherapy university education into clinical practice, and some students say that they are not adequately prepared for professional life. This was addressed by a college‐based programme involving patients, carers and service users as facilitators of learning to enhance the partnership between health professionals and patients. Purpose . This programme has been running for 2 years, and this paper is an evaluation of the students' perceptions of it, appraising the outcomes of their learning in order to discover the ways in which it can be enhanced, improved or changed. Methods . A grounded theory approach utilizing focus groups and semi‐structured interviews was conducted. Three focus groups representing the higher educational levels 4–6 in pre‐registration physiotherapy were carried out. Following the analysis of the focus groups, seven interviews reflecting the three educational levels were conducted in order to explore in greater depth the findings from the focus groups. The analysis of the focus groups and the subsequent interviews were carried out in accordance with a grounded theory framework. Results . The students perceived the programme as a context in which to think how their learning needs could be met within a ‘real’ framework but on their own territory. Equally, it created feelings of anxiety at being given such an open forum that created a challenge to their communication skills. Many expressed a wish for a more explicit mentoring–learning environment. They also perceived a tension between the technical–rational demands of academia and social practice and a need to view this as a basis for critical appraisal and self‐awareness. Conclusion . This programme appeared to be integral to the students' development as future physiotherapists. Copyright © 2011 John Wiley & Sons, Ltd.     

The impact of documentation on communication during patient-physiotherapist interactions: A qualitative observational study

Documentation is an essential component of physiotherapy practice for clinical, legal, and ethical reasons. Research in other healthcare contexts suggests that documentation impacts upon communication in patient–practitioner interactions. Thus, the objective of this qualitative study was to examine how physiotherapists and their patients communicate during episodes of documentation. The research was informed by ethnomethodology and ethnography. In total, 113 patient–physiotherapist interactions were observed in Switzerland and Australia with video-recordings, audio-recordings, and field notes collected as data. Episodes of documentation within these interactions were transcribed, and both verbal and non-verbal communication were analyzed inductively. Analysis identified that communication during documentation was characterized by: pauses in conversation, pre-established order of questioning, minimal eye contact, use of direct communication, and an emphasis on objectivity. The use of documentation was observed to alter the wording of questioning as well as the sequence and flow of conversation between patient and physiotherapist. In addition, the observed communicative features seemed to restrict patient participation, and may hinder the achievement of a patient-centered approach. Recognizing the importance of documentation, we address the challenges that our research highlighted by proposing strategies to assist educators and clinicians to optimize communication with patients when incorporating documentation into practice.     

Characteristics and processes of physiotherapy clinical decision making: a study of acute care cardiorespiratory physiotherapy

Background and Purpose . Physiotherapists have been increasingly interested in investigating physiotherapy clinical reasoning and decision‐making processes. Cardiorespiratory physiotherapy has received little attention within this increasing body of research. This study aimed to investigate characteristics and processes of cardiorespiratory physiotherapy decision making and to contribute to the broader understanding of physiotherapy reasoning and decision making. Methods . Fourteen cardiorespiratory physiotherapists took part in the study. Qualitative research methods were used, guided by a philosophical hermeneutic approach. Participants were observed undertaking their usual daily patient care activities and were later interviewed about their decision making. In‐depth, iterative hermeneutic strategies were used to interpret the texts created by these processes to identify the nature and processes of decision making. Results . Clinical decision making in cardiorespiratory physiotherapy is focused on making decisions about the nature of patients' problems, physiotherapeutic intervention and interaction, and evaluation of effectiveness of actions. Cardiorespiratory physiotherapy decisions varied in their difficulty according to the attributes of the decisions. The variable nature of decisions influenced the reasoning processes used. Clinical decision making involved complex reasoning processes that were cyclic, evolving and flexible in nature, with interdependence and interrelation between the different foci of clinical decision making. Clinical decision making was also found to be a social and collaborative process. Conclusions . This study contributes to the body of literature on physiotherapy reasoning and decision making by revealing details about the characteristics and processes of cardiorespiratory physiotherapy decision making. This research can be used to shape the education of beginning practitioners and provide practicing physiotherapists with a basis for critical appraisal of their decision making. Copyright © 2008 John Wiley & Sons, Ltd.     

Health professionals' and consumers' views on the role of the pharmacy personnel and the pharmacy service in Hanoi,Vietnam--a qualitative study

OBJECTIVES: To explore the views of health professionals and consumers concerning (i) the role of the pharmacy personnel and (ii) the pharmacy service in Hanoi, Vietnam. METHOD: A qualitative approach influenced by both content analysis and phenomenography was used. The different groups of participants were selected by purposive sampling, whereas the representatives from each group were selected based on availability. Data were collected by means of face-to-face interviews. Pre-tested, semi-structured interview guides were used. The interviews were tape-recorded and transcribed. The analysis followed commonly applied procedures in qualitative research. The views of the respondents were categorized and described concerning the main issues. RESULTS: A total of 21 interviews were conducted with six pharmacists, five medical doctors, five pharmacy students and five pharmacy customers. An interpreter was used in 16 cases. The role of the pharmacy personnel was viewed in three different ways, as: counsellor, doctor's assistant or businessman. It was also believed that sometimes the pharmacy personnel might play a double role--both as doctor and pharmacist. They were considered to have a passive or active role in the provision of information to the customers. Some of the subjects put emphasis on the quality of the information given, and some others considered the information given at the pharmacies as merely a reiteration of the doctor's instruction. Concerning the pharmaceutical field in general, three different categories could be discerned, which describe the interviewee's perspective on the main actors influencing pharmacy practice: a mutual, a central and an individual perspective. CONCLUSION: This study describes different ways of viewing the role of the pharmacy personnel and the pharmacy service in Hanoi. The estimation of the impact of the different views on the pharmacy profession in Hanoi requires another kind of study.     

The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: A randomized controlled trial

ABSTRACT

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients’ adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants’ satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants’ clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence.     

Leadership capabilities of physiotherapy leaders in Ireland: Part 2. Clinical specialists and advanced physiotherapy practitioners

ABSTRACT

Background: Investigation of the leadership capabilities of physiotherapy managers found that they report predominantly demonstrating capabilities associated with the human resource and structural frames. However, little is known about the leadership capabilities of clinical specialists and advanced physiotherapy practitioners (APPs) who also are identified as having responsibility for leadership. Objective: To explore clinical specialists´ and APPs’ perceptions of their leadership capabilities and compare them with the reported leadership capabilities of physiotherapy managers. Methods: Semi-structured interviews were conducted with a purposive sample of 17 physiotherapy clinical specialists and APPs from a range of practice settings across Ireland. The interviews were analyzed using template analysis and the coding template was based on the Bolman and Deal Leadership framework. Results: The participants described demonstrating leadership capabilities associated with each of the four leadership frames. However, the language used by the clinical specialists/APPs suggested that they work predominantly through the human resource frame. Structural frame capabilities were reported by the clinical specialists/APPs and there were some differences to those reported by the managers. In keeping with the reported leadership capabilities of the physiotherapy managers, the employment of capabilities associated with the political frame varied between participants and symbolic frame capabilities were underused. Conclusion: There are many similarities in the self-reported leadership capabilities of managers and clinical specialists/APPs. However, differences were also noted. Both cohorts of physiotherapy leaders may benefit from specific development programs to develop leadership capabilities associated with the political and symbolic frames.