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BACKGROUND: Reflection is promoted in health professional education as a way to learn in and on practice. 'Being reflective' is considered important to 'good' and 'expert' physiotherapy practice, yet there is limited research on reflective practices of experienced physiotherapists. For Aristotle, a good person reasons and acts in ways to promote human flourishing. Physiotherapists' perspectives on the place of reflection in good practice has the potential to advance professional understandings of how it may be enacted. Such knowledge may inform health professions education, regulatory guidelines, professional practices, and patient interactions. PURPOSE: The purpose of this research was to examine experienced musculoskeletal (MSK) practitioners' perceptions of reflection in the practice of a 'good' physiotherapist. METHODS: A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of the qualities and practices that constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on ways of 'being reflective', which emerged as a major theme in the original study. FINDINGS: Six themes were identified related to 'being reflective' in a 'good' physiotherapist: 1) learning from experience; 2) integrating multiple perspectives; 3) navigating indeterminate zones; 4) developing embodied knowledge; 5) questioning assumptions; and 6) cultivating wisdom. CONCLUSIONS: Findings support the notion that 'good' physiotherapy involves a disposition toward making wise judgments through reflection. This practice-based knowledge can inform educational initiatives that nurture practices that foster attention to reflective processes that inform phronesis in professional life. Through reflexivity on what the profession takes for granted, physiotherapists may be better prepared when navigating the indeterminate zones of practice.
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SYNOPSIS: Despite the importance of communication in person-focused care, biomedical knowledge and technical skill development are often prioritized in physical therapy education. As clinicians and educators, we contend that mindfulness and reflection nurture effective communication approaches and support physical therapists in navigating the complexity and uncertainty that comprise most clinical interactions. We suggest that clinicians be mindful of the self, the patient, and the context when interacting with patients. Although being mindful cultivates awareness and curiosity, being reflective is an active practice that can be used while deliberating about the right thing to do or say in a particular situation. In this Viewpoint, we offer clinicians and educators suggestions for engaging in mindful and reflective practices. Through the contemplative practices of mindfulness and reflection, clinicians can better cultivate their communication expertise and good practice. J Orthop Sports Phys Ther 2023;53(10):579-584. Epub: 8 September 2023. doi:10.2519/jospt.2023.11917.
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Communication , Physicians , Humans , Physical TherapistsABSTRACT
Purpose: Canadian physiotherapists who participated in the Physio Moves Canada (PMC) project of 2017 identified the state of training programmes as a threat facing professional growth of the discipline. One purpose of the project was to identify priority areas for physiotherapist training programmes as identified by academics and clinicians across Canada. Method: The PMC project included a series of interviews and focus groups conducted across clinical sites in every Canadian province and in Yukon Territory. Data were interpreted using descriptive thematic analysis; identified sub-themes were returned to participants for reflection. Results: Overall, 116 physiotherapists and 1 physiotherapy assistant participated in 10 focus groups and 26 semi-structured interviews. Results are presented using the curriculum guidelines of the time for organization. Here we describe two themes: Physiotherapy Professional Interactions, further defined by interpersonal and interprofessional competencies, and Context of Practice further defined by advocacy, leadership, community awareness, and business competencies. Conclusions: Participants appear to express a desire for programmes to train reflexive and adaptable primary health care practitioners with strong foundational knowledge and clinical expertise, complemented by interpersonal and interprofessional skills to empower physiotherapists to effectively care and advocate for patients, to lead health care teams, and to share ideas to inspire change towards a future of physiotherapy practice.
Objectifs : les physiothérapeutes canadiens qui ont participé au projet Physio Moves Canada (PMC) de 2017 ont déterminé que l'état actuel des programmes de formation était une menace à la croissance professionnelle de la discipline au Canada. L'un des objectifs de ce projet consistait à établir quels étaient les secteurs prioritaires dans les programmes de formation en physiothérapie d'après le corps professoral et les cliniciens du Canada. Méthodologie : le projet PMC incluait une série d'entrevues et de groupes de travail réalisée dans des établissements cliniques de chaque province du Canada et du Territoire du Yukon. Les chercheurs ont interprété les données au moyen d'une analyse thématique descriptive et transmis les sous-thèmes dégagés aux participants afin qu'ils y réfléchissent. Résultats : dans l'ensemble, 116 physiothérapeutes et un assistant-physiothérapeute ont participé à dix groupes de travail et 26 entrevues semi-structurées. Les résultats sont présentés au moyen des directives de programme de l'équipe en matière d'organisation. Les chercheurs décrivent deux thèmes : les interactions professionnelles en physiothérapie, mieux définies par les compétences interpersonnelles et interprofessionnelles, et le contexte de pratique, mieux défini par les revendications, le leadership, la sensibilité communautaire et les compétences commerciales. Conclusions : les participants semblent exprimer le souhait que les programmes forment des dispensateurs de soins de première ligne réflexifs et souples ayant des connaissances fondamentales et des compétences cliniques solides, complétées par des compétences interpersonnelles et interprofessionnelles pour habiliter les physiothérapeutes à soigner et défendre leurs patients avec efficacité, diriger des équipes soignantes et transmettre des idées pour inspirer le changement vers l'avenir de la physiothérapie.
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Purpose: Canadian physiotherapists who participated in the Physio Moves Canada (PMC) project of 2017 identified the current state of training programmes as a threat facing professional growth of the discipline in Canada. One purpose of this project was to identify key priority areas for physiotherapist training programmes as identified by academics and clinicians across Canada. Method: The PMC project included a series of interviews and focus groups conducted across clinical sites in every Canadian province and in the Yukon Territory. Data were interpreted using descriptive thematic analysis; identified sub-themes were returned to participants for reflection. Results: Overall, 116 physiotherapists and 1 physiotherapy assistant participated in 10 focus groups and 26 semi-structured interviews. Participants identified critical appraisal of continuing professional development options, knowledge translation, cultural fluency, professionalism, pharmaceutical knowledge, and clinical reasoning as priorities. For clinical practice specifically, participants identified practical knowledge, scope of practice, exercise prescription, health promotion, care of complex patients, and digital technologies as the priorities. Conclusion: Training priorities identified by participants may be useful to physiotherapy educators in preparing graduates to be adaptable and flexible primary health care providers for the future needs of a diverse population.
Objectifs : les physiothérapeutes canadiens qui ont participé au projet Physio Moves Canada (PMC) de 2017 ont déterminé que l'état actuel des programmes de formation était une menace à la croissance professionnelle de la discipline au Canada. L'un des objectifs de ce projet consistait à établir quels étaient les secteurs prioritaires dans les programmes de formation en physiothérapie d'après le corps professoral et les cliniciens du Canada. Méthodologie : le projet PMC incluait une série d'entrevues et de groupes de travail réalisée dans des établissements cliniques de chaque province du Canada et du Territoire du Yukon. Les chercheurs ont interprété les données au moyen d'une analyse thématique descriptive et transmis les sous-thèmes dégagés aux participants afin qu'ils y réfléchissent. Résultats : Dans l'ensemble, 116 physiothérapeutes et un assistant-physiothérapeute ont participé à dix groupes de travail et 26 entrevues semi-structurées. Les participants ont établi que l'évaluation critique des possibilités de perfectionnement professionnel continu, l'application des connaissances, la maîtrise culturelle, le professionnalisme, les connaissances pharmaceutiques et le raisonnement clinique étaient des priorités. En pratique clinique plus précisément, ils ont ciblé les priorités suivantes : les connaissances pratiques, la portée de pratique, la prescription d'exercices, la promotion de la santé, les soins des patients ayant des besoins complexes et les technologiques informatiques. Conclusion : les priorités de formation qu'ont établies les participants peuvent être utiles pour les formateurs en physiothérapie qui préparent les diplômés à devenir des dispensateurs de soins primaires polyvalents et flexibles afin de répondre aux futurs besoins d'une population diversifiée.
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INTRODUCTION: Qualities of a physiotherapist may influence the therapeutic alliance and physiotherapy outcomes. Understanding what qualities constitute a 'good' physiotherapist has yet to be systematically reviewed notwithstanding potentially profound implications for the future practice of physiotherapy. PURPOSE: The primary purpose of this review was to critically examine how physiotherapists and their patients describe the qualities of a 'good' musculoskeletal physiotherapist as depicted in peer-reviewed literature. The secondary aim was to synthesize qualities represented in the literature, and to compare patient and physiotherapist perspectives. METHODS: An integrative review methodology was used to undertake a comprehensive literature search, quality appraisal of studies, and thematic analysis of findings. An electronic search of CINAHL, EMBASE, Nursing and Allied Health, PsycINFO, PubMed, and Scopus databases was conducted within a time range from database inception to June 14, 2019. RESULTS: Twenty-seven studies met the inclusion criteria. Six qualities of a 'good' musculoskeletal physiotherapist were identified as: responsive, ethical, communicative, caring, competent, and collaborative. CONCLUSIONS: The qualities of a 'good' physiotherapist identified in the review emphasize the human interaction between physiotherapists and patients and point to the centrality of balancing technical competence with a relational way of being.
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Physical Therapists , Humans , Physical Therapy Modalities , CommunicationABSTRACT
BACKGROUND: Being 'responsive' is named as an element of ethic of care theories, yet how it is enacted is not clearly described in health professional practice. Being 'responsive' is implied within patient-centered approaches and promoted as important to health care practices, including physiotherapy. However, ways of being a responsive practitioner have not been explicitly examined. Practitioners' perspectives about how a 'good' physiotherapist enacts responsiveness have potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, and patient interactions. PURPOSE: The purpose of this research was to explore experienced musculoskeletal (MSK) practitioners' perceptions of 'responsiveness' in the practice of a 'good' physiotherapist. METHODS: A secondary analysis of data arising from a hermeneutic phenomenological study into physiotherapists' perceptions of what constitutes a 'good' physiotherapist was undertaken. The secondary analysis focused on 'responsiveness,' which emerged as a major theme in the original study. FINDINGS: Six themes were identified related to 'Being responsive' in a 'good' physiotherapist: Being person-centered, Being attentive, Being open, Being a listener, Being validating, and Being positive. CONCLUSIONS: As a relational way of practicing, being responsive may facilitate person-centered approaches including a relational understanding of autonomy, inviting dialogue, and sharing power and decision-making with patients. Pivotal to the practice of a 'good' physiotherapist, being responsive in the ways underscored by participants suggests researchers, educators, and practitioners consider relational ways of practicing as a balance to the technical aspects of physiotherapy.
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Physical Therapists , Humans , Qualitative Research , Physical Therapy Modalities , Attitude of Health PersonnelABSTRACT
BACKGROUND: Practitioners' perspectives of what constitutes a 'good' physiotherapist have not been explicitly examined despite their potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions. PURPOSE: The purpose of this research was to examine physiotherapists' perceptions of what constitutes a 'good' physiotherapist. The context of the study was musculoskeletal practice (MSK). METHODS: A hermeneutic phenomenological investigation was undertaken. Semi-structured interviews were conducted with twelve experienced MSK physiotherapists to examine their perceptions of what constitutes a 'good' physiotherapist. FINDINGS: Seven themes were identified. Good physiotherapists were depicted as: 1) oriented to care; 2) integrating knowledge sources; 3) competent; 4) responsive; 5) reflective; 6) communicative; and 7) reasoning. To deepen the understanding of these themes, we discuss the findings in relation to Joan Tronto's ethic of care theory. CONCLUSIONS: Physiotherapists' perceptions of what constitutes a 'good' physiotherapist highlight practices that may underpin an ethic of care including the pivotal role of person-centered and relational dimensions of practice. The findings call into question the profession's emphasis on a technical rationalist approach to education and clinical practice and invites conversation about future directions that balance technical competence with relational dimensions of practice.
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Study Design Systematic review. Background When assessed in isolation, balance and neurocognitive testing may not be sufficiently responsive to capture changes that occur with concussion. Normal daily activities require simultaneous cognitive and physical demands. Therefore, a dual-task assessment paradigm should be considered to identify performance deficits. Objectives To evaluate the literature and to identify dual-task testing protocols associated with changes in gait after concussion. Methods A systematic review of articles of individuals with concussion who underwent dual-task testing with a combination of motor and cognitive tasks was conducted. The AMED, CINAHL, Embase, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science databases and gray literature were searched from inception to January 29, 2017. Title and abstract, full-text, and quality review and data abstraction were performed by 2 independent reviewers. Results Twenty-four articles met the inclusion criteria. Eleven articles reported decreased gait velocity and increased medial-lateral displacement for individuals with concussion during dual-task conditions. Overall, included articles were of poor to moderate methodological quality. Fifteen articles used the same participants and data sets, creating a threat to validity and limiting the ability to make conclusions. Conclusion A deterioration in gait performance during dual-task testing is present among people with concussion. Specific recommendations for the use of a dual-task protocol to assess individuals with suspected concussion injury in a clinical setting have yet to be determined. J Orthop Sports Phys Ther 2018;48(2):87-103. Epub 7 Nov 2017. doi:10.2519/jospt.2018.7432.
