Embodied Knowledge - the Phenomenon of Subjective Health Complaints reflected upon by Norwegian Psychomotor Physiotherapy specialists.

BACKGROUND: Many patients report subjective health complaints (SHCs) during primary health care consultations. OBJECTIVE: To elucidate Norwegian Psychomotor Physiotherapy (NPMP) specialists' clinical experiences in treatment of patients suffering from SHCs. METHODS: Twelve NPMP specialists were interviewed. The transcripts were qualitatively analyzed using systematic text condensation. RESULTS: "Embodied knowledge" seemed to be an unfamiliar concept to those suffering from SHCs. The NPMP specialists regarded increased body awareness to be a vital element in the process of recovery from SHCs. Differences between NPMP specialists' professional view and that of some medical doctors were reported. Three categories emerged from the material: 1) "The process of establishing a joint understanding of subjective health complaints"; 2) "The process of increasing the patients' embodied awareness"; and 3) "The challenge of sharing embodied knowledge in inter-professional communication." CONCLUSION: The NPMP specialists emphasized the importance of increasing patients' consciousness of their embodied knowledge. They searched to adjust their therapeutic approaches, depending on the individual patient's specific problems and degree of emotional and/or bodily strain. The NPMP specialists experienced the importance of creating a shared understanding of the meaning embedded in SHCs between patients, NPMP specialists, and medical doctors.

Learning and knowing bodies: Norwegian psychomotor physiotherapists' reflections on embodied knowledge.

BACKGROUND: The lived experience is irreducible, and can give access to pre-reflective and implicit, embodied knowledge. There is a lack of research concerning how specialists in Norwegian Psychomotor physiotherapy (NPMP) utilize their patients' embodied knowledge. AIM: The aim of this study was to explore if the NPMP therapists experience the phenomenon "listening to the body" as a useful source of personal knowledge and motivation in the patient's process of' recovery, and if there could be too much "listening to the body"? DESIGN AND METHODS: A qualitative study based on empirical data from the interviews with 12 specialists in NPMP. The research data were analyzed using systematic text condensation as analyzing method. RESULTS: Four themes emerged: (1) "The negative imperative of the body"; (2) "The embodied traumatic experiences"; (3) "The process of creating meaning"; and (4) "The embodied person emerges-who am I and what choice do I have?" The results revealed the importance of becoming aware of embodied experiences, which might represent different aspects of the patients' lives. CONCLUSION: Embodied knowledge can support the physiotherapists in their clinical practice. The learning and knowing body represents resources of empowerment for the patients.

The effect of psychomotor physical therapy on health-related quality of life, pain, coping, self-esteem, and social support.

BACKGROUND: Norwegian psychomotor physiotherapy (NPMP) is commonly applied for patients with long-lasting pain and psychological symptoms. The approach is based on a bio-psychosocial model of health and might have benefits to physical, psychological, and physical domains of health-related quality of life (HRQOL). No previous randomized controlled clinical trials have been performed to examine the effectiveness of NPMP as individual treatment. The aim was therefore to assess the effect of a 6-month intervention of NPMP on HRQOL and on pain, coping, social support, and self-esteem. METHODS: The study was a pragmatic randomized controlled trial comparing an intervention group with a control group. Participants were recruited from 36 physiotherapists specialized in NPMP, working in private practice. The intervention group received NPMP once weekly for 6 months, whereas the control group received no intervention. Measurements were performed at baseline and after 6 months. A total of 105 participants were included. HRQOL was measured by the 36-item Short Form Health Survey, SF-36. To examine the effect of the intervention, independent sample t tests were performed with the "difference in mean values," delta (=∆, posttest result - baseline result). RESULTS: Significant differences between the two groups were observed in six of the eight SF-36 domains: Physical Functioning, Bodily Pain, General Health, Mental Health, Social Functioning, and Vitality. Effect size ranged from 0.9 for Vitality to 0.3 for Role Physical and Role Emotional. Furthermore, there was a significant difference between groups regarding pain and self-esteem in favour of the intervention group. The Cohen's d effect sizes of the different dimensions of HRQOL ranged from 0.3 to 0.9 with a median of 0.6. CONCLUSION: The results of this study demonstrate that 6-month intervention of NPMP increased HRQOL and self-esteem as well as reduced pain.

Body awareness--a vital aspect in mentalization: experiences from concurrent and reciprocal therapies.

BACKGROUND: A psychomotor physiotherapist and a clinical psychologist had collaborated on patients consistently for several years, when their individual therapeutic approach had turned out to be insufficient. AIM: The aim of this study was to investigate the therapists' understanding of their patients and the therapeutic processes they had been involved in, and to develop concepts in order to understand the concurrent therapeutic processes. DESIGN AND METHOD: This qualitative study is based on a grounded theory approach. The two strategically chosen therapists participated in "mini focus-group" interviews, in data transcription and in the analyzing process. FINDINGS: Three empirical categories emerged from the therapists' experiences. The core category "Body awareness: a vital aspect in mentalization" was comprised of two main categories: (1) "The over-stretched children in the grown-up patients"; and (2) "The traumatized children in the grown-up patients". CONCLUSION: Reduced body awareness seemed to correspond with lacking or fragmented memories of their own life history. Body awareness was a vital aspect in the therapeutic processes. Future challenges seemed to become manageable for the patients once they had realized that the resources for coping with these demands were available within themselves.

Breathing: a sign of life and a unique area for reflection and action.

BACKGROUND AND PURPOSE: The aim of this study was to clarify patients' experiences of breathing during therapeutic processes in Norwegian psychomotor physical therapy (NPMP). SUBJECTS AND METHODS: A qualitative approach was used based on interviews with 9 women and 1 man aged between 41 and 65 years. The data were analyzed with the aid of grounded theory. RESULTS: Three categories were identified from the participants' experiences: (1) "Breathing: An Incomprehensible and Disparate Phenomenon," (2) "Breathing: Access to Meaning and Understanding," and (3) "Breathing: Enhancing Feelings of Mastery." Initially, breathing difficulties and bodily pains were described as physical reactions that seemed utterly incomprehensible to the participants. Communication, both verbal and nonverbal, between the patient and the physical therapist was described as vitally important, as was conscious attention to occurrences during the treatment sessions. The participants learned to recognize changes in their breathing patterns, and they became familiar with new bodily sensations. Consequently, they acquired new understanding of these sensations. The feeling and understanding of being an entity (ie, "body and soul") emerged during therapy. The participants increased their understanding of the interaction between breathing and internal and external influences on their well-being. Their feelings of mastery over their daily lives were enhanced. The therapeutic dialogues gave them the chance to explore, reflect, and become empowered. DISCUSSION AND CONCLUSION: In experiencing their own breathing, the participants were able to access and identify the muscular and emotional patterns that, linked to particular thoughts and beliefs, had become their characteristic styles of relating to themselves and the world.

The first encounter with Norwegian psychomotor physiotherapy: patients' experiences, a basis for knowledge.

AIMS: The intention of this study was to elucidate patients' experiences of the examination of the body given in Norwegian Psychomotor Physiotherapy. METHODS: A qualitative approach was used, based on interviews with nine women and one man aged between 41 and 65 years. The data were analysed with the aid of grounded theory, using the first two steps: open and axial coding. RESULTS: Three categories were identified from the patients' experiences. The first category "The Situation before Treatment", emerged from the subcategories "Prejudice concerning the prefix 'psycho"', "Difficulties in recognizing the body's information", and "The body is ambiguous". The second category, "Establishing the Relationship", emerged from the subcategories "Getting to know the therapist as an empathic person" and "Discovering professional skills". The third category, "Examination is Interaction", emerged from the subcategories "Dialogues--room for reflection", "Undress, the feeling of disclosure", and "Personal boundaries--good to be seen". These three categories emphasize the importance of cooperation between the physiotherapist and the patient in exploring the social and emotional context in order to understand the meaning of the body's symptoms. There must be no doubt about the skill and competence of the therapists, including their insight, personal responsibility, engagement, attentiveness, and awareness. CONCLUSIONS: Our material reflects the great impact the body examination had on the informants. Examination requires mutual interpretation. The patients' knowledge represents a significant potential for understanding of their own situation.