| 1. |
- Afrell, Maria, 1953-
(författare)
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Att leva med en kropp som värker : samtal med fysioterapeuten
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Physiotherapists in primary care meet, assess and treat patients with long-standing benign musculoskeletal pain. As a clinical condition, long-standing pain is common but nonetheless it is quite complex. The aim of this thesis has been, from a bodily existential perspective, to investigate and conceptualise the experience of living with longstanding benign musculoskeletal pain, and from there, to work out a method for conversation and assessment within non-specialised physiotherapy.Methods: Our first study was an interview study where we applied a phenomenological approach and investigated the ways individuals suffering from long-standing pain experienced their body and their illness. Four aspects of body experience were described, and based on these aspects, four typologies of attitudes to pain were distinguished. In the second study, we made two group interviews with six physiotherapists about their experiences of using, in their clinical work, questions from the interview guide in study I that had given particularly rich responses. Transcripts were analysed using phenomenography. In the third study, patients’ verbal responses to the key questions, directed to them by physiotherapists in clinical situations, were investigated, and the four aspects of body experience from study I formed the concepts of a deductive analysis. In study IV, finally, the key questions and typologies were tried by a larger group (31), and their experiences and the possible applicability of the method were studied by qualitative content analysis combined with the counting of codes.Results: We created four typologies of attitudes to long-standing pain: “Surrendering to one’s fate”, “Accepting by an active process of change”, “Balancing between hope and resignation” and “Rejecting the body”. These typologies, in turn, were based on four aspects of body experience: “The body as an aspect of identity”. “Body reliance”, “Body awareness”, and “Ways of understanding pain”. In study II, by the aid of key questions, patient and physiotherapist managed to have a conversation on bodily existential matters. The physiotherapist learnt to know the patient as a person, a process appeared to be initiated in the patient, and their relation changed. The patient was willing to talk about her body in pain, and had the words to do this. In study III, the key questions opened ways to reflections on body, existence, and biography. The four aspects of body experience were central to the patients’ descriptions. In study IV, the participating physiotherapists reported by large positive experiences from applying key questions and typologies. The patients reflected, emotions were evoked, and the relation and the communication often improved. The typologies helped in giving a comprehensive perspective of the patient’s problem, and to grasp where in the process of rehabilitation the patient was to be found.Conclusions: The method, seven key questions combined with the tentative frame of interpretation of the answers, seemed to be easily applied by interested physiotherapists in non-specialised practice. The application of the method addresses the need of developing the professional role of the physiotherapist. The challenge is to face the whole person, who is her lived body as well as her identity crisis, carried by emotions such as grief and anger. This may inspire the use of the full potential of the physiotherapist’s professional role in the clinical encounter.
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| 2. |
- Abrandt Dahlgren, Madeleine, 1956-, et al.
(författare)
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Understanding clinical reasoning : A phenomenographic study with entry-level physiotherapy students
- 2022
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 38:13, s. 2817-2826
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Entry-level students' conceptualizations of clinical reasoning can provide a starting point for program planning related to clinical reasoning development with a focus on patient-centered care.OBJECTIVE: The aim of the study is to explore how physiotherapy students understand clinical reasoning midway through their education. Nine physiotherapy students were interviewed at the end of their third semester.METHODS: Semi-structured individual interviews were conducted, recorded and transcribed verbatim. A phenomenographic approach to qualitative data analysis, seeking to explore variations in students' conceptions was applied.RESULTS: The students' ways of understanding clinical reasoning could be described as: 1) the cognitive process of the physiotherapist; and 2) the relational process of the collaborative partnership between the physiotherapist and the patient. A contrastive analysis shows how the cognitive and relational perspectives are developed through the relationships among three dimensions of clinical reasoning: 1) problem-solving; 2) context of working; and 3) own learning.CONCLUSION: By identifying the critical variation in students' conceptions of clinical reasoning, focus can be placed on pedagogical arrangements to facilitate students' progression toward a person-centered approach.
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| 3. |
- Bernhardsson, Susanne, 1958-
(författare)
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Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.
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| 4. |
- Billinger, Kajsa, 1949-
(författare)
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Få dem att vilja : motivationsarbete inom tvångsvården av vuxna missbrukare
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The coercive care of adult substance abusers is aimed at motivating them to seek voluntary treatment. The purpose of the present study is to throw light on how motivational work is perceived and articulated by care providers working in coercive care.To select the LVM institutions for the study, an initial survey was made of the motivational work being carried out in the entire area of substance abuser care, both coercive and voluntary care. From this survey four institutions were strategically selected on the basis of their therapeutic points of departure. The focus group method was used for the data collection.The care providers at the four LVM institutions gave different pictures of coercive care, although they worked under the same paragraph of the law. The differences could be attributed to their different therapeutic points of departure. It was impossible to discern an explicit description of motivational work at any of the LVM institutions. The care providers did not present any methods or techniques that clearly differed from what we call diagnosis, education or upbringing. In their view, everything they did aimed at increasing their clients’ motivation. There were three main tools the care providers used to accomplish their central task of transforming unmotivated clients into persons who choose not to be substance abusers: assessment, treatment and the establishing of a relationship with the client and working within its framework. The clients’ needs were described in a corresponding way. They were to be led, taught or compensated. Only one of the four LVM institutions specifically treated the clients’ substance abuse problems. At the other three institutions, substance abuse was considered either secondary to the clients’ other problems, a symptom of underlying problems, or a topic to be avoided in order to focus on future solutions. The clients’ resistance and negative attitudes to coercive care were obstacles that care providers tried to overcome by various means. They encouraged clients to regard coercion as a privilege or tried to make them feel at home, or else the care providers worked as if the coercion did not exist. All in all, the picture that emerges is that because of the coercive element the care provided was without contours, the clients did not have a range of options from which to choose. The only thing the care providers could do was to get the clients to stay at the institution, or bring them back if they ran away. The goal of getting clients to take the next step into voluntary treatment had to give way to the less tangible goal of exerting a positive influence on them - of “sowing the seeds of change”.
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| 5. |
- Westerlund, Stina, 1968-
(författare)
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Lust och olust : elevers erfarenheter i textilslöjd
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis is to investigate and analyse students’ expressions of pleasure and displeasure and how these are manifested in actions in the teaching of textile sloyd in lower secondary education. The study’s focus is on students’ expressions of pleasure and displeasure in social action in the working processes of textile sloyd and on how these expressions can be related to learning. The empirical material consists of observations, video and audio recordings, individual interviews and focus group interviews, where video and audio recordings were used as stimulated recall. In all, 32 lessons in textile sloyd and 49 students aged 14-15 years were observed at four different schools. Theoretically, the thesis is based on Mead’s practical intersubjectivity and on Dewey’s theory of experience-based learning and dependence on emotions and actions. Pleasure and displeasure constitute valuating partial aspects of emotions. Based on a socio-cultural perspective, emotions are regarded as practices which arise from different predispositions’ dependence on the social context. The study’s analytical approach is hermeneutical. Critical incidents regarding students’ expressions of pleasure and displeasure in social action found in observations and video and audio recordings were analysed in terms of Mead’s concept of gestures. The events were combined with what the students describe as critical incidents of pleasure and displeasure in the interviews and focus group talks. The material was then thematised. Several situations were then subjected to deeper analysis based on sociality and a change in perspective and related to different concepts of learning. The result of the thesis shows a tripartite semantic structure where students’ pleasure and displeasure in textile sloyd are mainly based on textile sloyd’s specific educational community, students’ relationship to the sloyd object and their experience of the working process. Social interaction, humour and mutual acknowledgement proved to be of importance for the function of pleasure and displeasure in the students’ working processes. The students’ experience of pleasure and displeasure depended on their control of the work, the characteristics of different craft techniques and their awareness of time. Pleasure and displeasure in textile sloyd found an expression in four overarching emotional practices with decisive importance for the students’ opportunities for learning: the repudiating, insecure, accepting and incorporating emotional practice. The study also provides an insight into how different cultural factors enable a certain scope for pleasure and displeasure. In this connection, social changes in relation to objects are discussed, as are changes in sociality and emotionality. Based on the pair of concepts of authenticity and ephemerality and closeness and intensity, cultural changes are visualised that are conceivably important for the students’ experiences of pleasure and displeasure in textile sloyd.
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