The perceptions of danish physiotherapists on the ethical issues related to the physiotherapist-patient relationship during the first session: a phenomenological approach

Background: In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice. Methods: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework. Results: Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective. Conclusions: Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well

Tortured refugees' expectations of a multidisciplinary pain rehabilitation programme: An explorative qualitative study

Background: Refugees have often been exposed to torture in their countries of origin. Rehabilitation of tortured refugees living in Denmark is offered by the specialized Rehabilitation and Research Centre for Torture Victims in Copenhagen. After an interdisciplinary assessment eligible patients are recommended rehabilitation. Objective: To explore tortured refugees' expectations of the multidisciplinary pain rehabilitation programme offered at our centre. Design: Explorative qualitative interview study. Patients: Fifteen consecutive Arabic-speaking men, waiting for rehabilitation after having been assessed by a physician, a psychologist, a physiotherapist and a social worker, were interviewed. Methods: Individual qualitative interviews were performed by an Arabic-speaking psychologist, and analysed with content analyses. Results: One theme: different expectations of multidisciplinary pain rehabilitation and 4 categories emerged: general expectations of the rehabilitation programme; specific expectations of professional treatment; expectations of mutual participation and communication; and expected rehabilitation outcomes. Conclusion: The tortured refugees had different, mostly positive, expectations of the multidisciplinary pain rehabilitation programme. General expectations of the rehabilitation content, as well as specific expectations of the professionals' treatment, were expressed. Mutual and active participation and communication between patients and therapists were important expectations. In addition, positive outcomes, such as improved health, improved coping ability and decreased pain, were expected

Perceived risks for slipping and falling at work during wintertime and criteria for a slip-resistant winter shoe among Swedish outdoor workers

The leading cause of work related accidents in Sweden is falls. Many slips and falls occur on icy and snowy surfaces, but there is limited knowledge about how to prevent accidents during outdoor work in winter conditions. The purpose of this study was to describe risk factors of slips and falls and criteria for slip-resistant winter shoes from a user perspective. The result is based on focus group interviews with 20 men and women working in mail delivery, construction and home care in Sweden. The data was analyzed with qualitative content analysis. Risk factors described were related to physical work environment, risky work situations, individual and organizational factors. User criteria for winter work shoes focused on safety, adaptation to the environment, usability and own priorities. The mechanisms of slips and falls during outdoor work are complex. There is a need for more functional and user friendly work shoes than those available and user preferences should be considered by shoe designers. Future challenges include finding ways to make individually adapted shoes suitable for changing work environments, situations and tasks. (C) 2014 Elsevier Ltd. All rights reserved

Lower Urinary Tract Symptoms, Erectile Dysfunction, and Quality of Life in Poststroke Men:A Controlled Cross-Sectional Study

The aim of the current study was to compare lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and quality of life (QoL) in poststroke and healthy men. Thirty poststroke men with stroke-related LUTS, and as controls, 96 healthy men participated in this controlled, cross-sectional study. Participants filled in the Danish Prostate Symptom Score (DAN-PSS-1) Questionnaire, the International Index of Erectile Function (IIEF-5), the 36-Item Short Form (SF-36), the Nocturia Quality-of-Life (N-QoL) Questionnaire. In the age group ≤55 years, comparing poststroke men with healthy controls both with LUTS, the results indicated DAN-PSS-1, total score median 13 (4-17) versus 3 (2-6), p =.05; IIEF-5 25 (14-25) versus 24 (23-25), p =.06; SF-12, total score 499 (360-679) versus 695 (644-734), p =.02; and N-QoL 98 (70-100) versus 96 (90-100), p =.65. In the age group >55 years, comparing poststroke men with healthy controls both with LUTS, the results indicated DAN-PSS-1, total score 13 (8-24) versus 5 (2-7), p <.01; IIEF-5 13 (5-20) versus 25 (24-25), p <.01; SF-36, total score 585 (456-718) versus 742 (687-772), p <.01; and N-QoL, total score 81 (66-95) versus 98 (80-100), p <.01. The results demonstrated that in age group above, but not below 55 years, poststroke men with LUTS had significantly higher frequency of severe and bothersome LUTS and ED than the healthy controls with LUTS, while QoL and N-QoL were significantly lower in comparison. It is recommended to identify and assess older poststroke men for LUTS, ED, and QoL

“Peers, parents and phones”—Swedish adolescents and health promotion

Many unhealthy behaviors are created during adolescence and follow the individual into adulthood. In addition, health behaviors often occur in clusters as those who are inactive are more likely to eat unhealthy food and smoke. This makes the early foundation of healthy behaviors vital. The aim was to describe and develop an understanding of adolescents’ awareness and experiences concerning health promotion. Data was collected using focus groups with a total of 28 seventh graders and was analysed with latent qualitative content analysis. One main theme was identified; being competent, ambivalent and creative at the same time. The following three subthemes also emerged: being a digital native for better and for worse, knowing what is healthy, and sometimes doing it, and considering change and having ideas of how change could be supported. The main theme elucidates how the majority of students were informed and able but they did not always prioritize their health. The concept of health promotion relies upon the engagement of the individual; however, although the students had clear ideas about how they would like to change their own behaviors, they felt a need for support. Interestingly, the students were able to make several suggestions about the kind of support that would make a difference to their adoption to more healthy modes of living. They suggested information and communication technology (ICT), for example encouraging text messages (SMS), and social support, for example parents setting rules and peers inspiring them to adhere to a healthy behavior. The knowledge gained from this study echoes our view of inclusion and this could be helpful for those who encounter the challenge of promoting health among adolescents

Concepts of functioning and health important to people with systemic sclerosis: a qualitative study in four European countries

OBJECTIVE: To describe the experiences of people with systemic sclerosis (SSc) in different European countries of functioning and health and to link these experiences to the WHO International Classification of Functioning, Disability and Health (ICF) to develop a common understanding from a bio-psycho-social perspective. METHOD: A qualitative multicentre study with focus-group interviews was performed in four European countries: Austria, Romania, Sweden and Switzerland. The qualitative data analysis followed a modified form of 'meaning condensation' and the concepts that emerged in the analysis were linked to the ICF. RESULTS: 63 people with SSc participated in 13 focus groups. In total, 86 concepts were identified. 32 (37%) of these were linked to the ICF component body functions and structures, 21 (24%) to activities and participation, 26 (30%) to environmental factors, 6 (7%) to personal factors and 1 (1%) to the health condition itself. 19 concepts (22%) were identified in all four countries and included impaired hand function, household activities, paid work, drugs, climate and coldness, support from others and experiences with healthcare institutions, non-pharmacological treatment, social security and benefits. CONCLUSION: Concepts identified in all four countries could be used for guiding clinical assessment, as well as interdisciplinary team care and rheumatological rehabilitation for patients with SSc. For a full understanding of the aspects of the disease that were most relevant to people with SSc, people with SSc from multiple countries needed to be involved

Effects of work ability and health promoting interventions for women with musculoskeletal symptoms: A 9-month prospective study

<p>Abstract</p> <p>Background</p> <p>Women working in the public human service sector in 'overstrained' situations run the risk of musculoskeletal symptoms and long-term sick leave. In order to maintain the level of health and work ability and strengthen the potential resources for health, it is important that employees gain greater control over decisions and actions affecting their health – a process associated with the concept of self-efficacy. The aim of this study was to describe the effects of a self-efficacy intervention and an ergonomic education intervention for women with musculoskeletal symptoms, employed in the public sector.</p> <p>Methods</p> <p>The design of the study was a 9-month prospective study describing the effects of two interventions, a comprehensive self-efficacy intervention (<it>n </it>= 21) and an ergonomic education intervention (<it>n </it>= 21). Data were obtained by a self-report questionnaire on health- and work ability-related factors at baseline, and at ten weeks and nine months follow-up. Within-group differences over time were analysed.</p> <p>Results</p> <p>Over the time period studied there were small magnitudes of improvements within each group. Within the self-efficacy intervention group positive effects in perceived work ability were shown. The ergonomic education group showed increased positive beliefs about future work ability and a more frequent use of pain coping strategies.</p> <p>Conclusion</p> <p>Both interventions showed positive effects on women with musculoskeletal symptoms, but in different ways. Future research in this area should tailor interventions to participants' motivation and readiness to change.</p

Women's experiences of sexual health when living with Rheumatoid Arthritis - an explorative qualitative study

<p>Abstract</p> <p>Background</p> <p>The ICF core sets for patients with Rheumatoid Arthritis (RA) acknowledge sexual function and intimate relationships as important since the patients' sexual health can be affected by the disease. About 36-70% of all RA-patients experience a reduced sexual health, and their perceived problems are directly or indirectly caused by their disease. Physiotherapy is often used as non-pharmacological treatment for RA. Mobility treatment, pain reduction, and physical activities are often included in physiotherapy for patients with RA. The aim of the study was to explore sexual health in relation to physiotherapy in women living with RA.</p> <p>Method</p> <p>An explorative qualitative interview study with a phenomenological approach was performed. The study consisted of ten interviews with women with RA. The analysis was performed according to Giorgi.</p> <p>Results</p> <p>The main theme that emerged in the material was that the body and the total life situation affected sexual health. Three categories were included in the theme: 1) sexual health - physical and psychological dimensions, 2) Impacts of RA, and 3) Possibilities to increase sexual health - does physiotherapy make a difference?</p> <p>Conclusions</p> <p>Sexual health was affected by RA in different ways for the informants. Possibilities to improve sexual health were improved partner communication and physiotherapy. Physiotherapy can play an active role in improving sexual health for patients with RA.</p