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Utrymme för deltagande: Beslutsprocesser i möten mellan patienter med ospecifika ländryggsbesvär och sjukgymnaster i primärvård
Jönköping University, School of Health Science, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health Science, HHJ, Dep. of Behavioural Science and Social Work.
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. , 119 p.
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: urn:nbn:se:hj:diva-20912ISBN: 978-91-85835-41-6 (print)OAI: oai:DiVA.org:hj-20912DiVA: diva2:614384
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: 2015-12-21Bibliographically approved
List of papers
1. Physiotherapists’ clinical reasoning about patients with non-specific low back pain, as described by the International Classification of Functioning, Disability and Health
Open this publication in new window or tab >>Physiotherapists’ clinical reasoning about patients with non-specific low back pain, as described by the International Classification of Functioning, Disability and Health
2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 23-24, 2217-2228 p.Article 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
National Category
Other Health Sciences
Identifiers
urn:nbn:se:hj:diva-16995 (URN)10.3109/09638288.2011.563819 (DOI)000296499500008 ()21446858 (PubMedID)
Available from: 2012-01-04 Created: 2012-01-04 Last updated: 2015-06-02Bibliographically approved
2. Problem-solving in physiotherapy - physiotherapists' talk about encounters with patients with non-specific low back pain
Open this publication in new window or tab >>Problem-solving in physiotherapy - physiotherapists' talk about encounters with patients with non-specific low back pain
2013 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 8, 668-677 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate how physiotherapists talk about the choice of intervention for patients with NSLBP, particularly how professionals manage clinical encounters that may be experienced as challenging.

Method: Discourse analysis was performed of four focus groups’ talk. Twenty-one experienced physiotherapists working in primary health care in southern Sweden participated.

Results: Four focal themes appeared: Responsibility for health and health-related problems; Normalization – what counts as a normal back pain problem in relation to living an ordinary life; Change process – how to lead one’s life; and Individualization of the intervention in relation to the individual patient but also from the physiotherapists’ point of view. The themes shape an over-arching pattern of Problem-solving – which concerned both the professional task and the back pain problem, and was related to varying case complexity. This may have implications for the intervention the individual patient will be offered and on outcome.

Conclusions: Physiotherapists’ attitudes and approaches seem to entail components of professional and personal values which may influence patients’ access to health care, with a risk for unequal assessment and intervention as a consequence. We argue that enhanced physiotherapist-patient collaboration, including patient-led problem-investigation, is a prerequisite for improved outcome in terms of patient satisfaction, and for physiotherapy development. Future investigations of patients’ roles in specific face-to-face encounters are needed.

Place, publisher, year, edition, pages
United Kingdom: Informa Healthcare, 2013
Keyword
clinical reasoning, discourse analysis, low back pain, physiotherapy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-19945 (URN)10.3109/09638288.2012.705221 (DOI)000316211800005 ()22897738 (PubMedID)
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2015-06-02Bibliographically approved
3. In what ways do physiotherapists utilize patient resources in intervention?: A qualitative analysis of the interaction in the context of non-specific low back pain
Open this publication in new window or tab >>In what ways do physiotherapists utilize patient resources in intervention?: A qualitative analysis of the interaction in the context of non-specific low back pain
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-20909 (URN)
Available from: 2013-04-04 Created: 2013-04-04 Last updated: 2013-04-04Bibliographically approved
4. ’Not physically present actors’ in encounters between physiotherapists in primary care and patients with nonspecific low back pain
Open this publication in new window or tab >>’Not physically present actors’ in encounters between physiotherapists in primary care and patients with nonspecific low back pain
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-20911 (URN)
Available from: 2013-04-04 Created: 2013-04-04 Last updated: 2013-04-04Bibliographically approved

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