The phenomena movement quality and movement awareness : Theory construct and communication within mental health physiotherapy

Antecedentes: Desde la fisioterapia en salud mental y la psiquiatría, existe la necesidad de aclarar el fenómeno de la calidad del movimiento y un creciente interés en promoverlo a través del aprendizaje de la conciencia del movimiento. La tesis se basa en el enfoque de fisioterapia “Basic Body Awareness Therapy” (BBAT), bien conocida por su enseñanza/aprendizaje sobre la calidad del movimiento y su pedagogía específica del movimiento. Se implementan dos supuestos básicos en la tesis, un enfoque fenomenológico para investigar las experiencias de movimientos vividos y un enfoque proveniente de la salutogenesis que se centra en los activos para la salud. Objetivo: El propósito fue estudiar los fenómenos clínicos principales y el vocabulario del movimiento, así como sintetizar investigaciones previas sobre la calidad del movimiento y la conciencia del movimiento, para construir el dominio de la conciencia del movimiento en la fisioterapia y la salud mental. Material y métodos: En el “Estudio I” se siguió la técnica de grupo nominal para el proceso de creación de consenso sobre los fenómenos y las declaraciones principales a través de un seminario, con una cohorte de 21 expertos en movimiento provenientes de 10 países europeos. Los participantes priorizaron los datos a través de una estrategia formada por seis fases. El análisis de contenido se utilizó para extraer los datos y para realizar los cálculos del nivel de acuerdo para identificar las declaraciones priorizadas por los expertos. En el “Estudio II” se eligió un diseño fenomenológico para identificar fenómenos clínicos, con una cohorte de 15 expertos en movimiento, reclutados desde la neurología, atención primaria de la salud y psiquiatría, seleccionando términos característicos de salud, a través de entrevistas individuales y cualitativas. Se usó la condensación del texto como lo describe Malterud. El “Estudio III” sigue una meta-síntesis de tres publicaciones cualitativas previas sobre los fenómenos de la calidad del movimiento y la conciencia del movimiento, para revisar el material de texto y los modelos. El análisis de contenido se utilizó para la extracción de términos. Resultados: En el “Estudio I, Parte 1”, el resultado arrojó 138 fenómenos principales, de los cuales 106 fueron fenómenos clínicos, agrupados en tres categorías: fenómenos de calidad del movimiento, fenómenos de práctica del movimiento y terapias de concienciación del movimiento, así como fenómenos pedagógicos. En la “Parte 2”, los participantes alcanzaron el 100% de consenso en 16 de las 30 declaraciones que describen BBAT. En el “Estudio II”, el resultado identificó un vocabulario sobre el movimiento con múltiples perspectivas que incluye 122 términos relacionados con la salud y respecto a la calidad del movimiento. En el “Estudio III”, se muestra un mapa de pequeña y gran escala como constructo del dominio de conciencia de movimiento relevante en comunicación. Conclusión: El resultado de los tres estudios representa los fenómenos clínicos principales, el vocabulario del movimiento a través de términos característicos de la salud para la comunicación profesional, así como el mapa a pequeña y gran escala como constructo del dominio de conciencia del movimiento mediante el aprendizaje de 1) componentes de calidad del movimiento, 2) elección de componentes del movimiento, y 3) componentes del aprendizaje de la conciencia del movimiento, junto con las tres formas de aprendizaje de la conciencia del movimiento: aprender sobre, a través y estando en movimiento.Background: Within physiotherapy of mental health and psychiatry there is a need to clarify the phenomena of movement quality and movement awareness because of a growing interest in how to promote movement quality through movement awareness learning. The thesis is rooted in physiotherapy, and draws on inspiration from the physiotherapy approach Basic Body Awareness Therapy (BBAT), well-known for its teaching of movement quality and its specific movement pedagogy. Two basic assumptions are implemented in the thesis, a phenomenological approach to investigate lived movement experiences and a salutogenic approach to focus on assets for health. Purpose: The overall purpose of this thesis is directed towards the two phenomena of movement quality and movement awareness through studying core phenomena in the context of clinical physiotherapy, a movement vocabulary of movement quality for professional communication and, and synthesising previous research on movement quality and movement awareness, and mapping a construct of a movement awareness domain to communicate this construct within the field of mental health physiotherapy. Material and Methods: In Study I, Part 1 and Part 2, the nominal group technique (NGT) was chosen for a consensus-building process to identify core phenomena and statements describing BBAT. This was conducted in the form of a weekend-workshop, with a cohort of 21 physiotherapy experts, recruited as teachers in BBAT, from 10 European countries. The participants prioritised data through a six-step strategy. For data-analysis in Part 1, content analysis was used. In Part 2, data were calculated and organised according to the three levels 100%, 66% and 33% agreement. In Study II, a phenomenological design was chosen to identify clinical, movement-related phenomena, with a cohort of 15 national and local physiotherapy experts, recruited according to criteria from the field of neurology, primary health care and psychiatry. Data were collected through qualitative interviews. Data analysis followed recommendation from Giorgi, modified by Malterud. In Study III, a meta-synthesis of three previous qualitative publications on the phenomena of movement quality and movement awareness, was conducted to review text-material and models. Content analysis was used for data analysis. Ethical recommendations were followed. Results: In Study I, Part 1, a total of 138 phenomena were identified and clustered in three categories, clinical core phenomena, historical roots phenomena, and research and evaluation phenomena. The clinical core phenomena, were 106 phenomena organized into three clusters: movement quality phenomena, movement awareness practice phenomena, and movement awareness therapy and pedagogy phenomena. In Part 2, the participants reached 100% consensus on 16 of 30 statements describing BBAT. The statements represent descriptions ranked as important for communication with patients, health professionals and society. In Study II, a multi-perspective movement vocabulary of 122 health characteristic terms were identified for professional communication. A movement vocabulary is considered to be valuable within mental health rehabilitation as shared vocabulary for communication. In Study III, a construct of a movement awareness domain for physiotherapy in mental health was identified and visualised through a small- and a large-scale map of three learning pillars. The domain provides personcentred and involving coping strategies for rehabilitation purposes in mental health physiotherapy. Conclusion: The results from the three studies are: first, clarification of the phenomena of movement quality and movement awareness, with related phenomena and statements describing BBAT; second, a multi-perspective movement vocabulary of health-terms of movement quality for professional communication; and third, a construct of a movement awareness domain in mental health physiotherapy, visualised through a small-scale and large-scale map, including three learning pillars, Movement quality components, Choice of movement components and Movement awareness strategy components. On the background of the studies, the thesis provides a framework of future vision, mission and enabling pillars of a movement awareness domain in mental health physiotherapy

Physiotherapists’ conceptions of movement awareness : a phenomenographic study

The phenomenon of movement awareness requires more attention to make it explicit in physiotherapy. The aim of this study was to explore the variation in physiotherapists’ conceptions of movement quality, focusing on movement awareness. The informants were 15 physiotherapists from a variety of physiotherapy fields. We collected data through two group interviews and used the phenomenographic method to analyze them. Four themes emerged from the data: 1) Being in contact with one’s own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness. These themes varied by four descriptive categories of the movement awareness phenomenon: (I) Hesitation regarding own movement experiences; (II) Momentary contact with own movement experiences; (III) Presence in movement awareness and (IV) Better understanding of others’ movement awareness. The physiotherapists’ understanding of the movement awareness phenomenon widened through three critical aspects in the descriptive categories: Recognizing one’s own movement awareness, Distinguishing one’s own and others’ movement awareness and New insights into implementing actions related to movement awareness in physiotherapy. These results can expand the understanding of the phenomenon of movement awareness among physiotherapists, although further research is needed.peerReviewe

The phenomenon of movement quality : a phenomenographic study of physiotherapy students’ movement experiences

Background: This study aimed to explore how students in a physiotherapy bachelor program acquire awareness of their own movement quality and form conceptions of movement quality. Methods: The study was designed as an elective course, implementing Basic Body Awareness Therapy principles. The participants were six PT students. Two data sets – students’ diaries and reflective group interviews – were collected, one a week before the course ended, and one on its completion. Phenomenographic research methodology was used to transcribe and analyze the data. Results: Three descriptive categories emerged reflecting the PT students’ conceptions of movement quality phenomenon as a widening process: I: Coming into contact with movement experiences, II: Variety of movement qualities, and III: Movement quality as professional development. Within these, two critical aspects, Acceptance of own movement quality and Reflective reasoning based on own experiences of being in movement to gain quality, were identified, indicating aspects of pedagogical importance in deepening PT students’ understanding of the movement quality phenomenon. Conclusion: The three categories reflect the PT students’ variety, widening views on movement quality. The findings elucidate movement awareness learning, by being in movement, indicating a direction for future research on students’ learning of movement quality conceptions within physiotherapy education.peerReviewe

Physiotherapy in mental health and psychiatry : a scientific and clinical based approach/ Edit.: Michel Probst

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How Can Movement Quality Be Promoted in Clinical Practice? A Phenomenological Study of Physical Therapist Experts

Background. In recent years, physical therapists have paid greater attention to body awareness. Clinicians have witnessed the benefits of supporting their patients' learning of movement awareness through the promotion of their movement quality. Objective. The aim of this study was to investigate how physical therapist experts promote movement quality in their usual clinical settings. Design. A phenomenological research design that included a sampling strategy was devised. Using specific criteria, 6 lead physical therapists nominated a group of physical therapist experts from the fields of neurology, primary health care, and mental health. Fifteen informants, 5 from each field, agreed to participate. Methods. In-depth interviews were conducted with a semistructured interview guide. The informants were invited to simply describe what they had experienced to be successful therapeutic processes for promoting movement quality. Each interview was audiotaped and transcribed. The data analysis was based on a multistep model. Results. Three main themes emerged from the data. First, the physical therapists' embodied presence and movement awareness served as a precondition and an orientation for practice. Embodied presence is a bodily felt sense, a form of personal knowing that evokes understanding and fosters meaning. Second, creating a platform for promoting movement quality revealed implementation of psychological attitudes. Third, action strategies for promoting movement quality suggested a movement awareness learning cycle and components for clinical use. Conclusions. This study demonstrated specific attitudes and skills used by physical therapist experts to promote movement quality in their clinical practice. These results may serve as a therapeutic framework for promoting movement quality in clinical physical therapy, although further research is needed

Physiotherapy in mental health and psychiatry : a scientific and clinical based approach/ Edit.: Michel Probst

xi, p. 338 hal.; 25 c

Reliability and validity of the Body Awareness Rating Scale (BARS), an observational assessment tool of movement quality

Movement quality assessed by the Body Awareness Rating Scale (BARS) is used as an indicator of health and self-efficacy in patients with long-lasting musculoskeletal and mental health problems. The objective of the study was to examine reliability and construct validity of the movement quality scale. 25 patients and 25 healthy persons were included. Internal consistency was examined by Cronbach's α, reliability by intraclass correlation coefficient (ICCagreement) and measurement error reported by standard error of measurement (SEM) and smallest detectable change (SDC). Construct validity was examined by testing hypotheses of moderate association between the observational scale and the self-report Short-Form Health Survey (SF-36) subscales and the General Perceived Self-Efficacy Scale (GPSES). A hypothesis about the difference in scores between groups being expected to differ in health states was tested. Internal consistency (α) was 0.92. Inter-tester reliability was ICC = 0.99 and SEM = 0.8. The test-retest reliability was ICC = 0.96 and SEM = 1.4, implying that improvement should be above 3.3 (SDC) to claim a treatment effect. BARS was moderately correlated (0.30 ≤ rs < 0.60) with most SF-36 subscales and GPSES. The patients demonstrated less movement quality than healthy persons. Evidence was provided of high internal consistency and reliability in qualified testers. Construct validity was indicated, as BARS reflected various aspects of health and self-efficacy

A vocabulary describing health-terms of movement quality–a phenomenological study of movement communication

Purpose: The aim of the study was to develop a vocabulary targeting communication of health-terms of movement quality, establishing professional knowledge of a movement terminology usefull within rehabilitation. Methods: A phenomenological study design was chosen, inviting movement experts working in rehabilitation to describe movement observations when a change into more functional, health related ways of moving appeared in the rehabilitation processes. 15 physiotherapy experts were recruited, five from the field of neurology, primary health care and psychiatry. The informants had between 12-38 years of clinical practice, treating patients of all ages with a wide specter of diagnoses. Data collection followed a qualitative study design, of individual, in-depth interviews, based on a semi-structured interview guide. The interviews were taped, transcribed and sent to the informants for validation. Data analysis followed recommendation of Giorgi, modified by Malterud. Ethical considerations were followed. Results: Data revealed a vocabulary, clustered in five themes, Biomechanical, Physiological, Psycho-socio-cultural, Existential and Overarching perspective, 16 underlying categories and 122 descriptive health-terms of movement quality. Conclusion: The study demonstrated a multi-perspective movement vocabulary of 122 health characteristic terms, developed to facilitate movement communication within the broad field of rehabilitation. The result calls for further research concerning a movement vocabulary.Implications for Rehabilitation The phenomenon of movement quality has a potential for promoting rehabilitation-specific skills. A vocabulary describing health-terms of movement quality is useful within the overall rehabilitation field providing enhanced and specific health directed communication. A movement specific health-terminology will have impact on implications and facilitating a person-centered and goal directed rehabilitation. Rehabilitation professionals will have a multi-perspective, movement specific and structured terminology to communicate direct and concretely with patients, the multi-professional team, in society, and with politicians

Considering the role of physical therapists within the treatment and rehabilitation of Individuals with eating disorders: an international survey of expert clinicians

Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research.status: publishe

Systematic Review of the Benefits of Physical Therapy Within a Multidisciplinary Care Approach for People With Schizophrenia

Background. Although schizophrenia is the fifth leading cause of disability-adjusted life years worldwide in people aged 15 to 44 years, the clinical evidence of physical therapy as a complementary treatment remains largely unknown. Purpose. The purpose of this study was to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of physical therapy for people with schizophrenia. Data Sources. EMBASE, PsycINFO, PubMed, ISI Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were searched from their inception until July 1, 2011, for relevant RCTs. In addition, manual search strategies were used. Study Selection. Two reviewers independently determined study eligibility on the basis of inclusion criteria. Data Extraction. Reviewers rated study quality and extracted information about study methods, design, intervention, and results. Data Synthesis. Ten RCTs met all selection criteria; 6 of these studies addressed the use of aerobic and strength exercises. In 2 of these studies, yoga techniques also were investigated. Four studies addressed the use of progressive muscle relaxation. There is evidence that aerobic and strength exercises and yoga reduce psychiatric symptoms, state anxiety, and psychological distress and improve health-related quality of life, that aerobic exercise improves short-term memory, and that progressive muscle relaxation reduces state anxiety and psychological distress. Limitations. The heterogeneity of the interventions and the small sample sizes of the included studies limit overall conclusions and highlight the need for further research. Conclusions. Physical therapy offers added value in the multidisciplinary care of people with schizophrenia