Exploring the potential of a standardized test in physiotherapy: making emotion, embodiment, and therapeutic alliance count for women with chronic pelvic pain

Introduction: There has been an increased use of standardized measurements in health care meant to provide objective information to enhance the quality and effectivity of care. Patient performance tests are based on standardized predefined criteria with a limited focus. When facing multifaceted health conditions, information expanding the predefined criteria in a standardized test may be required to understand the patient’s complex symptoms. Relying on test information based on measurements according to functional biology, one risks missing information communicated by the sensitive and expressive body of the individual patient. The aim of this article is to investigate how body, self and illness perception is constituted as a co-construction between a physiotherapist and a patient with complex symptoms, expanding the use of a standard physiotherapy test. Methods: This qualitative study is based on video-recordings and in-depth interviews of seven women with the complex health condition chronic pelvic pain. The video recordings consist of the patients performing the Standard Mensendieck test pre- and post-treatment with Norwegian psychomotor physiotherapy. The interviews are based on the patients` and the physiotherapists` conversations while watching and elaborating on these video recordings. Empirical data is analyzed within the theoretical perspectives of phenomenology and enactive theory, especially focusing on the concepts of embodiment and intersubjectivity. Results: Taking an embodied approach, considering the body as expressive, communicative, and vulnerable to the environment and context, the results show that through bodily expressions the patients experienced the test situation as demanding, thus providing information beyond what the test was intended to measure. Additionally, when administering a standardized test, the interaction between the therapist and the patient had an impact on the results. Sensitive attention towards the patients bodily expressive emotions as a vital part of the interaction, reinforced therapeutic alliance by ensuring the integrity and autonomy of the patient. Discussion: Mutual communication, gave new insights regarding the patients’ complex symptoms and reinforced their belief in themselves and their recovery processes. Applying the patient’s expertise on herself and her life together with the professional expertise may make health care an interdependent practice where sensemaking is a co-construction of meaning between the patient and the health personnel

Chronic pelvic pain sufferers’ experiences of Norwegian psychomotor physiotherapy: a qualitative study on an embodied approach to pain.

Purpose - Chronic pelvic pain (CPP) is a multifaceted condition, and many women live with CPP without receiving any explanation for their complex symptoms. A multimodal approach including physiotherapy is the recommended treatment. To increase the limited knowledge of what is beneficial in physiotherapy, this article aims to explore women’s experiences of Norwegian psychomotor physiotherapy (NPMP) as treatment for CPP. Method - This qualitative study is based on in-depth interviews with eight women undergoing CPP. The concept of embodiment underpins the entire research project, and the analysis of the participants’ experiences builds on a phenomenological approach. Results and conclusion - Three final themes embrace the participants’ experiences of change after NPMP treatment: experiencing their body in new ways, letting go of tension, and understanding their symptoms. Through treatment, the participants moved from keeping bodily sensations at a distance towards increased bodily self-awareness. They realised that their state of tension was linked to their emotional life and stress was revealed as a trigger of bodily reactions they related to their symptoms. Positive bodily sensations were essential for the participants to let signals from their body guide their actions in a change process

Enactive explorations of children's sensory-motor play and therapeutic handling in physical therapy

Introduction: In pediatric physical therapy, there is an ongoing debate about the use of therapeutic handling and its potential effects on motor learning. In this study, we build on enactive theoretical perspectives to explore the role of therapeutic handling in connection to children's sensory-motor play, engagement, and performance during a single physical therapy session. Material and methods: This is a qualitative study based on video observations of therapy sessions and interviews with 15 physical therapists (PTs) each treating two different children aged 0–3. The authors utilized a framework of co-reviewing, discussing, and reflecting on the sessions. Themes were identified and used to describe the ways by which PTs’ therapeutic handling unfolds, with connections to theories on sensory-motor play and learning, along with enactive perspectives on embodiment, experience, mutual incorporation, and sense-of-agency. Results: The characteristics and purposes of therapeutic handling are presented in two main themes: (1) position and support, and (2) directing movement. We found that position and support promoted sensory-motor improvement when the PTs’ handling aligned with the child's play interests and engagements. As part of play, the children used new and additional support surfaces to self-initiate better posture and movement solutions and reach play goals. The PTs’ ways of directing movements varied. To awaken curiosity and induce a child's self-driven motor exploration the PT needs to be subtle, flexible, and precise in the directing of movement. This entails responsiveness to the child's signals and bodily know-how in the placing of hands and direction of pressure to enable the child to actively participate in and eventually self-drive movement. Discussion: Therapeutic handling that is mutually incorporated between PT and child can enrich the child's playing-to-learn-to-move process by providing novelty and facilitating the child's sense-of-agency in the self-initiated exploration and refinement of movement possibilities. In the PTs’ effort to merge therapeutic handling with children's play, the momentum of interaction can open new therapeutic windows of movement experience and learning opportunities

A systematic synthesis of qualitative studies on parents’ experiences of participating in early intervention programs with their infant born preterm

Early intervention programs involving both the parent and the infant born preterm have demonstrated positive effects on developmental outcomes for the children. However, studies have also shown that parental engagement and adherence when implementing intervention programs can be challenging. The aim of this review was to provide a comprehensive description and new insights into key messages gleaned from the parent reports on participating in early intervention with their infant born preterm; knowledge vital to facilitate implementation of early interventions into clinical practice when using a model of direct parent involvement. Early intervention is broadly defined as a multi-interdisciplinary field provided to children from birth to five years of age to foster child health, wellbeing, development, adapting parenting and family function. For this systematic synthesis we define early intervention as programs with specific activities completed with the infant during the first year after birth. We assembled qualitative interview studies on parents’ experiences with participation in early intervention and applied Malterud’s qualitative systematic meta-synthesis to synthesize and translate the original findings across studies. In the analysis we applied enactive concepts of embodiment, autonomy, participatory sensemaking, and agency. 10 qualitative studies were identified and included. The systematic synthesis reveals how parents’ successful and meaningful participation in early intervention programs were facilitated by their “active embodied doing.” The “embodied doing” appeared as the basis for the parents’ sense-making processes, development of confidence, and the ability for parents to see new possibilities for actions within themselves, with and in the child. In that respect, a perception of mutuality in the interaction between parent, infant and interventionist was central. Consequently, an important consideration when implementing early intervention into clinical practice is to promote embodied parent–infant interactions as well as trust between the parent and the interventionist

Two-year motor outcomes associated with the dose of NICU based physical therapy: The Noppi RCT

Background - Interventions involving both the parent and the preterm infant have demonstrated lasting effects on cognitive outcomes, but motor effects are less salient. It remains unclear when to commence early intervention and if dosages have impact on motor outcomes. Aims - To examine the effect on motor performance at 24-months corrected age following a parent-administered intervention performed with infants born preterm in the NICU. Intervention dosing and longitudinal motor performance were also analyzed. Study design - Single-blinded randomized multicenter clinical trial. Subjects - 153 infants born, gestational age ≤ 32 weeks at birth, were randomized into intervention or control group. Outcome measures - Infant Motor Performance Screening Test, Test of Infant Motor Performance, Peabody Developmental Motor Scales-2. Results - No significant difference was found between the intervention and the control group assessed with the PDMS-2 at 24-months CA. However, a significant positive association was found between dosing and the Gross Motor and Total Motor PDMS-2 scores. Analysis of longitudinal motor performance showed a decreasing motor performance between 6- and 24-months corrected age in both groups. Conclusions - There was no difference in motor performance between groups at 24-months corrected age. However, increased intervention dosage was positively associated with improved motor outcome

Hvordan ivaretas samspillsveiledning til foreldre i norske nyfødtintensivenheter?

Bakgrunn: Nasjonale retningslinjer anbefaler at foreldre til prematurt fødte barn tilbys kunnskapsbasert samspillsveiledning mens barnet er innlagt på sykehus. Forskning viser at foreldreveiledningsprogrammet «Mother-Infant Transaction Program» (MITP-m) kan fremme vedvarende god utvikling og tilpasning i familier med prematurt fødte barn. Hensikt: Denne studien undersøker i hvilken grad programmets antatte kjerneelementer er implementert i norske nyfødtposter, og hvorvidt denne kunnskapen påvirker foreldres mestringstro i foreldrerollen like etter utskrivelse fra sykehuset. Metode: Totalt 150 foreldre fra åtte ulike nyfødtintensivenheter i Norge besvarte et elektronisk spørreskjema to uker etter at de ble utskrevet fra sykehuset. Spørreskjemaet besto av egenutviklede spørsmål om MITP-m samt to validerte spørreskjemaer. Vi har analysert dataene deskriptivt og gjennom regresjonsanalyser. Resultat: Foreldrene fortalte at de kk mye generell veiledning og opplæring. Samspillstemaer, slik som veiledning om tilstandsregulering og barns sosiale natur, syntes i mindre grad å være ivaretatt. Foreldre som bekreftet mye samspillskunnskap etter utskrivelsen, kk god oppfølging av de faste kontaktsykepleierne og den behandlende legen. Foreldrene var mye til stede på avdelingen, og de hadde betydelig støtte i sitt eget sosiale nettverk. Det sosiale nettverket er spesielt viktig for opplevd mestringstro i foreldrerollen etter utskrivelsen. Konklusjon: Foreldrene rapporterer om god oppfølging i nyfødtintensivavdelingene. De følte seg godt ivaretatt av dedikerte kontaktsykepleiere og behandlende leger. Det fremkommer ikke av resultatene om dette var relatert til ulike veiledningsprogrammer. Foreldreveiledning med søkelys på barnets tilstandsregulering og sosiale kapasitet og behov bør trolig styrkes

The World Social Situation: Development Challenges at the Outset of a New Century

World social development has arrived at a critical turning point. Economically advanced nations have made significant progress toward meeting the basic needs of their populations; however, the majority of developing countries have not. Problems of rapid population growth, failing economies, famine, environmental devastation, majority-minority group conflicts, increasing militarization, among others, are pushing many developing nations toward the brink of social chaos. This paper focuses on worldwide development trends for the 40-year period 1970-2009. Particular attention is given to the disparities in development that exist between the world’s “rich” and “poor” countries as well as the global forces that sustain these disparities. The paper also discusses more recent positive trends occurring within the world’s “socially least developed countries” (SLDCs), especially those located in Africa and Asia, in reducing poverty and in promoting improved quality of life for increasing numbers of their populations

Study protocol: an early intervention program to improve motor outcome in preterm infants: a randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences

Background Knowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy. Methods/Design A pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age. Discussion The paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention

Attention and adjusted actions in physiotherapists treatment of preterm born infants

The purpose was to explore the importance of individual and contextual actions in conjunction with movements made and achieved by infants born preterm during physiotherapy sessions. Material and methods: The sample consists of (a) 16 infants born preterm with birth weights Theoretical perspectives were Physiotherapy in connection, Phenomenology of the body, Infants body in interaction and Attention. Direct observation and video recording of treatment sessions, supplemented by interviewing the physiotherapists were performed during the infants first year after term age. The whole material consisted of 59 videos, 59 interviews and the researchers own post-situational notes. The analyses were phenomenological-hermeneutical and informed by Philosophy, Developmental Psychology and Micro sociology. The sessions were thematically arranged and contents of meaning were held together with each other and with the theories. The results indicates that physiotherapists sensitive presence and adapted dynamic actions (sounds, eye contact, facial expressions and handling) are significant for enhancing preterm infants attention, the quality of motions and the infants active participation during treatment sessions. Conclusion: The enhancement of preterm infants` movements seems to depend on the physiotherapists ability to gain and keep infants' attention and to make individualized adjustments towards the individual infants` distinctive character and utterances

Physical Therapy with Newborns and Infants: Applying Concepts of Phenomenology and Synactive Theory to Guide Interventions

Physical therapy involving newborns and young infants is a specialized area of practice reserved for therapists who have advanced training and the competence to help newborns, young infants and their families meet their goals. Beginning at birth, infants apply a significant amount of effort to actively participate in and shape their world. Infants make their intentions and requests for support known through their behaviors during social and physical therapy encounters. The therapeutic encounter viewed from the infant’s perspective has received limited attention in the physical therapy literature. The purpose of this article is to discuss concepts related to phenomenology and synactive theory that are relevant to physical therapy with newborns and young infants during the first few months of life after birth