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Physiotherapists’ clinical reasoning about patients with non-specific low back pain, as described by the International Classification of Functioning, Disability and Health
Jönköping University, School of Health and Welfare, HHJ. Quality improvements, innovations and leadership in health care and social work. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.ORCID iD: 0000-0001-9363-7323
Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.ORCID iD: 0000-0003-3817-4981
2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 23-24, p. 2217-2228Article in journal (Refereed) Published
Abstract [en]

Purpose: To explore and describe what physiotherapists experience they need to know about patients with non-specific low back pain (NSLBP) to make decisions about intervention.

Method: Four focus groups containing a total of 21 physiotherapists were carried out in Sweden. Interviews were transcribed and qualitative content analysis performed. The manifest content was coded and categorised, and a theme emerged. Extracted symptoms and signs were linked to ICF codes.

Result: Physiotherapists’ clinical reasoning represented a broad view on low back pain (LBP) including codes from all ICF components. The participants argued for individualisation of intervention to a specific patient’s problems. A theme of case complexity emerged, involving three levels: easy case, characterised by impairment in body function with close relation to specific body structures; complex case, characterised by impairments in body function, particular mental functions, activity limitations and participation restrictions, particular management of activity level and very complex case, characterised by impairments in body function, activity limitations and participation restrictions, and contextual factors, with help-seeking behaviour as a particular feature.

Conclusion: The physiotherapists’ clinical reasoning reflected a broad view on patients with NSLBP, with variations related to case complexity. The use of ICF codes contributed to understanding that the physiotherapists applied a broad perspective on NSLBP as a health condition as well as to knowledge about how physiotherapists’ understand patients with NSLBP.

Physiotherapists’ use of the ICF in clinical practice might facilitate identification and assessment of specific patient’s back pain problem as they occur in daily life and therefore be helpful in rehabilitation planning. Findings might also have an educational value.

Place, publisher, year, edition, pages
Informa Healthcare, 2011. Vol. 33, no 23-24, p. 2217-2228
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-16995DOI: 10.3109/09638288.2011.563819ISI: 000296499500008PubMedID: 21446858OAI: oai:DiVA.org:hj-16995DiVA, id: diva2:472694
Available from: 2012-01-04 Created: 2012-01-04 Last updated: 2024-01-04Bibliographically approved
In thesis
1. Utrymme för deltagande: Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård
Open this publication in new window or tab >>Utrymme för deltagande: Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Hälso- och sjukvårdsmöten som föranleds av medicinskt ospecifika symptom innebär utmaningar för både patient och vårdprofessionell. Samtidigt erbjuder det ospecifika ett mer flexibelt utrymme för patienters aktiva deltagande i beslutsprocesser än vad som är fallet vid specifika hälsoproblem med ett begränsat antal vedertagna behandlingsalternativ. Syftet med forskningsprojektet var att undersöka utmaningar relaterade till utrymmet för patienters deltagande i beslutsprocesser avseende intervention. Avhandlingen baseras på fyra artiklar som undersöker erfarna sjukgymnasters föreställningar om, och interagerande i möten med patienter med ospecifika ländryggsbesvär.

Forskningsprojektet genomfördes med explorativ empirisk ansats kombinerat med fokuserad etnografi. Det betyder att forskningen grundas på erfarenhetsbaserad kunskap som samlas in i naturligt förekommande verksamhet. Data samlades in via fokusgrupper med sjukgymnaster, samt via deltagande observationer av det första mötet mellan sjukgymnast och patient. Samtliga sammankomster videofilmades och transkriberades, och analyserades med fokus på beslutsprocesser avseende intervention.

Forskningsprojektet resulterade i tre mönster: i) kontrasten mellan sjukgymnasternas förställningar om helhetsperspektiv i förhållande till det biomedicinska intresse som de utövade, ii) omvandlingen av patienternas resursorientering till biomedicinskt hälsoproblem, samt iii) överensstämmelse mellan sjukgymnasternas inställning till, och deras hantering av andra aktörer. Resultatet tyder på att sjukgymnasterna resonerade om element från flera systemnivåer men fattade beslut på sin egen systemnivå, det vill säga utifrån professionell metodik och teori. Det innebär att utrymmet för patienters aktiva deltagande i beslutsprocesser avseende intervention inte togs tillvara i den omfattning som var möjlig. Genom att vårdprofessionella utvecklar kommunikativa och interaktiva förmågor kan patienters resurser bättre tas tillvara i intervention, vilket indirekt kan leda till ökad nöjdhet och bättre funktionsförmåga.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences, 2013. p. 119
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 42
Series
Studies from the Swedish Institute for Disability Research, ISSN 1650-1128 ; 47
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-20912 (URN)978-91-85835-41-6 (ISBN)
Public defence
2013-04-29, Forum Humanum, Barnarpsgatan 39, 553 18, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-04 Created: 2013-04-04 Last updated: 2024-01-04Bibliographically approved

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Josephson, IréneBülow, PiaHedberg, Berith

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