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Approaches to Physiotherapy Interventions Focusing on Client-Centredness

Larsson, Ingalill LU (2010) In Lund University, Faculty of Medecine Doctural Dissertation Series 2010:74
Abstract (Swedish)
Popular Abstract in Swedish

Syftet med sjukgymnastik är att främja hälsa och välbefinnande och hjälpa människor till aktivitet och delaktighet vid sjukdom och skada. Professionen är påverkad av olika hälsoparadigm som hör samman med olika kunskapstraditioner. Det biomedicinska hälsoparadigmet har en dualistisk syn på människan, där normalitet ses som standard, och där syftet är att kurera och korrigera svagheter. Det biopsykosociala hälsoparadigmet har en holistisk syn på människan och beskriver hälsa som en dynamisk interaktion mellan å ena sidan komponenterna kroppsfunktion/struktur, aktivitet och delaktighet, och å andra sidan omgivningsfaktorer och personliga faktorer. Genom att använda ett klientcentrerat arbetssätt... (More)
Popular Abstract in Swedish

Syftet med sjukgymnastik är att främja hälsa och välbefinnande och hjälpa människor till aktivitet och delaktighet vid sjukdom och skada. Professionen är påverkad av olika hälsoparadigm som hör samman med olika kunskapstraditioner. Det biomedicinska hälsoparadigmet har en dualistisk syn på människan, där normalitet ses som standard, och där syftet är att kurera och korrigera svagheter. Det biopsykosociala hälsoparadigmet har en holistisk syn på människan och beskriver hälsa som en dynamisk interaktion mellan å ena sidan komponenterna kroppsfunktion/struktur, aktivitet och delaktighet, och å andra sidan omgivningsfaktorer och personliga faktorer. Genom att använda ett klientcentrerat arbetssätt kan sjukgymnasten i olika interventioner öka klienters aktivitet och delaktighet. Detta kan ske genom att sjukgymnasten skapar en större förståelse för klientens sjukdom och dennes uppfattning av sin sjukdom. En annan förutsättning är att sjukgymnasten bygger en klientcentrerad terapeutisk allians mellan sig och klienten. Det övergripande syftet med föreliggande avhandling var att studera fenomenet sjukgymnastisk intervention med fokus på klientcentrering. Utifrån kvalitativ fenomenografisk tradition identifierades och beskrevs olika sätt att uppfatta, uppleva och förstå fenomenet från ett andra ordningens perspektiv. Ett strategiskt urval gjordes av dels sjukgymnaster och klienter som intervjuades med semistrukturerade frågeformulär, dels vetenskapliga artiklar som granskades. Strategin i urvalet var en maximal variation. Resultatet i artiklarna I, III och IV visar att sjukgymnaster använder tre olika ansatser i sina interventioner: sjukgymnastcentrerad ansats, sjukgymnastledd ansats, och klientcentrerad ansats. Ansatserna demonstrerar en kritisk variation av hälsoparadigm vilket influerar uppfattningar av kunskap, interventionsfokus, sjukgymnastens roll, målsättning samt aspekter av motoriskt lärande. De olika ansatserna är teoretiska kategorier och är inte knutna till enskilda sjukgymnaster. I artikel II framkom att kvinnor som var på bättringsvägen efter cancerbehandling uppfattade fysisk aktivitet, rekommenderad av sjukgymnaster, på fyra olika sätt; Följsamhet till instruktioner och behov av stöd, Kamp för att komma tillbaka till det normala och rädsla för negativa sidoeffekter, Önskan att förbli normal och att inte tillåta begränsningar, samt Få kontroll över situationen med nya strategier. I beskrivningskategorierna fanns kritisk variation i hur de uppfattade begränsningar som sjukdomen och behandlingen medfört och hur dessa influerade deras kontroll av situationen. Sjukgymnasters förståelse av klientens egen uppfattning av sin fysiska aktivitet är fördelaktigt i den sjukgymnastiska interventionen för att utveckla klientcentrering och empowerment. Klienten behöver olika sjukgymnastiska ansatser beroende på uppfattningen av sin sjukdom, begränsning och kontroll som denna medför. Hur ansatsen utformas kommer an på den terapeutiska alliansen mellan sjukgymnast och klient. Avhandlingen bidrar till att lyfta fram den teoretiska kunskapsbas som ligger bakom olika sjukgymnastiska interventioner och kan därmed bidra till att öka medvetenhet och reflektion över valet av intervention. (Less)
Abstract
The aim of physiotherapy is to promote health and well-being, and to facilitate increased activity and participation of individuals with diseases and injuries. The profession is influenced by different health paradigms which have emerged from different knowledge traditions. The biomedical paradigm of health adopts a dualistic view of mankind in which the normal is regarded as the standard, and the aim is to cure or correct impairments. The biopsychosocial paradigm of health takes a holistic view of mankind, and describes health as the dynamic interaction between the components of body function/structure and activity/participation on the one hand, and environmental and personal factors on the other. By applying a client-centred approach the... (More)
The aim of physiotherapy is to promote health and well-being, and to facilitate increased activity and participation of individuals with diseases and injuries. The profession is influenced by different health paradigms which have emerged from different knowledge traditions. The biomedical paradigm of health adopts a dualistic view of mankind in which the normal is regarded as the standard, and the aim is to cure or correct impairments. The biopsychosocial paradigm of health takes a holistic view of mankind, and describes health as the dynamic interaction between the components of body function/structure and activity/participation on the one hand, and environmental and personal factors on the other. By applying a client-centred approach the physiotherapist can, by various interventions, increase the client’s activity and participation. This can be achieved by the physiotherapist’s understanding of the client’s disease and the way in which the client experiences his/her illness. Another prerequisite is that the physiotherapist develops a client-centred therapeutic alliance with the client. The overall purpose of the work presented in this thesis was to study the phenomenon of physiotherapy interventions focusing on client-centredness. A qualitative method in the tradition of phenomenography was used to identify various ways of experiencing, conceiving and understanding this phenomenon in a second-order perspective. Physiotherapists and clients were carefully selected and interviewed with semi-structured interviews, and strategically selected scientific articles were examined. The selection strategy was employed to ensure maximum variation. The results presented in Papers I, III and IV show that physiotherapists use three different approaches in interventions: the physiotherapist-centred approach, the physiotherapist-led approach, and the client-centred approach. These approaches demonstrate critical variations in health paradigms that influence the conceptions of health, physiotherapy knowledge, intervention focus, the role of the physiotherapist, goal-setting and aspects of motor learning. The different approaches are general theories not associated with individual physiotherapists. Paper II describes how women recovering from breast cancer experience physical activity recommended by physiotherapists in four different ways: Compliance with instructions and need for support, Struggle to get back to normal and fear of negative side-effects, A wish to stay normal and not allow limitations, and Getting control of the situation with new strategies. The descriptive categories exhibit critical variations in how these clients experience the limitations resulting from their illness and the treatment and how these, in turn, affect their control over the situation. Physiotherapists’ understanding of their clients’ experience of physical activity is beneficial in clinical practice in order to develop empowerment and client-centredness. Different approaches are required at different times depending on how clients are dealing with their limitations and the way in which they experience control. The design of the approach is dependent on the therapeutic alliance between the physiotherapist and the client. The results presented in this thesis contribute to strengthening the theoretical frameworks behind different physiotherapeutic interventions, and can thus increase awareness and reflection on the choice of intervention. (Less)
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author
supervisor
opponent
  • Professor Abrandt Dahlgren, Madeleine, Linköping University Department of Behavioural Science and Learning
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Physiotherapy interventions, client-centredness, phenomenography
in
Lund University, Faculty of Medecine Doctural Dissertation Series 2010:74
pages
117 pages
publisher
Lund University, Faculty of Medicine
defense location
Moritzsalen, Health Sciences Centre, Baravägen 3 Lund
defense date
2010-10-29 13:00
ISSN
1652-8220
language
English
LU publication?
yes
id
873d96e3-01a4-4fde-b03f-73dea524ead0 (old id 1690242)
date added to LUP
2010-10-12 14:13:51
date last changed
2018-05-29 09:49:23
@phdthesis{873d96e3-01a4-4fde-b03f-73dea524ead0,
  abstract     = {The aim of physiotherapy is to promote health and well-being, and to facilitate increased activity and participation of individuals with diseases and injuries. The profession is influenced by different health paradigms which have emerged from different knowledge traditions. The biomedical paradigm of health adopts a dualistic view of mankind in which the normal is regarded as the standard, and the aim is to cure or correct impairments. The biopsychosocial paradigm of health takes a holistic view of mankind, and describes health as the dynamic interaction between the components of body function/structure and activity/participation on the one hand, and environmental and personal factors on the other. By applying a client-centred approach the physiotherapist can, by various interventions, increase the client’s activity and participation. This can be achieved by the physiotherapist’s understanding of the client’s disease and the way in which the client experiences his/her illness. Another prerequisite is that the physiotherapist develops a client-centred therapeutic alliance with the client. The overall purpose of the work presented in this thesis was to study the phenomenon of physiotherapy interventions focusing on client-centredness. A qualitative method in the tradition of phenomenography was used to identify various ways of experiencing, conceiving and understanding this phenomenon in a second-order perspective. Physiotherapists and clients were carefully selected and interviewed with semi-structured interviews, and strategically selected scientific articles were examined. The selection strategy was employed to ensure maximum variation. The results presented in Papers I, III and IV show that physiotherapists use three different approaches in interventions: the physiotherapist-centred approach, the physiotherapist-led approach, and the client-centred approach. These approaches demonstrate critical variations in health paradigms that influence the conceptions of health, physiotherapy knowledge, intervention focus, the role of the physiotherapist, goal-setting and aspects of motor learning. The different approaches are general theories not associated with individual physiotherapists. Paper II describes how women recovering from breast cancer experience physical activity recommended by physiotherapists in four different ways: Compliance with instructions and need for support, Struggle to get back to normal and fear of negative side-effects, A wish to stay normal and not allow limitations, and Getting control of the situation with new strategies. The descriptive categories exhibit critical variations in how these clients experience the limitations resulting from their illness and the treatment and how these, in turn, affect their control over the situation. Physiotherapists’ understanding of their clients’ experience of physical activity is beneficial in clinical practice in order to develop empowerment and client-centredness. Different approaches are required at different times depending on how clients are dealing with their limitations and the way in which they experience control. The design of the approach is dependent on the therapeutic alliance between the physiotherapist and the client. The results presented in this thesis contribute to strengthening the theoretical frameworks behind different physiotherapeutic interventions, and can thus increase awareness and reflection on the choice of intervention.},
  author       = {Larsson, Ingalill},
  issn         = {1652-8220},
  keyword      = {Physiotherapy interventions,client-centredness,phenomenography},
  language     = {eng},
  pages        = {117},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medecine Doctural Dissertation Series 2010:74},
  title        = {Approaches to Physiotherapy Interventions Focusing on Client-Centredness},
  year         = {2010},
}