Healthcare professionals' experiences of interdisciplinary collaboration in pain centres - A qualitative study.

OBJECTIVES: The complexity of chronic pain requires interdisciplinary collaboration. Although this is recognisable in the framework for pain centres, few studies have investigated how interdisciplinary collaboration in pain centres is experienced by healthcare professionals, including the facilitators and barriers to interdisciplinary collaboration. The aim of the current study was therefore to investigate experiences of interdisciplinary collaboration in the treatment of patients with chronic pain among healthcare professionals in tertiary care pain centres. METHODS: Eleven healthcare professionals, representing different healthcare disciplines from the four regional pain centres in Norway, participated in semi-structured individual interviews. The data were analysed thematically. RESULTS: The results were categorised into three themes 'The best approach for chronic pain treatment', 'Collegial collaboration', and 'Challenges with interdisciplinary teamwork'. The informants valued the interdisciplinary work at the pain centre. They perceived it as the best approach for their patients and appreciated the support the collegial collaboration gave them as professionals. Although working together was rewarding and provided new insights, the informants also experienced the interdisciplinary teamwork as challenging, e.g., when the different professions disagreed on recommendations for further treatment or did not manage to work together as a team. CONCLUSION: The informants found the interdisciplinary collaboration at the pain centre to provide the best treatment approach for their patients. It should be acknowledged that interdisciplinary teamwork can be challenging, and efforts should be put into establishing a good climate for collaboration and gaining knowledge about each profession's unique character and how they contribute to pain centre treatments.

Interprofessional collaboration for children with physical disabilities: a scoping review.

Interprofessional collaboration is vital in the context of service delivery for children with physical disabilities. Despite the established importance of interprofessional collaboration and an increasing focus on research on this topic, there is no overview of the research. A scoping review was conducted to explore current knowledge on interprofessional collaboration for children with physical disabilities from the point of view of the actors involved. The steps of this review included identifying a research question, developing a protocol, identifying relevant research, selecting studies, summarizing and analyzing the data, and reporting and discussing the results. Through databases and studies from hand-searches, 4,688 records were screened. A total of 29 studies were included. We found that four themes: communication, knowledge, roles, and culture in interprofessional collaboration illustrate current knowledge on the topic. Interprofessional collaboration for children with physical disabilities is shown to be composed of these four themes, depending on the actors involved. Interprofessional collaboration is affected by how these four themes appear; they mainly act as barriers and, to a lesser extent, as facilitators for interprofessional collaboration. Whether and how the themes appear as facilitators need further exploration to support innovation of interprofessional collaboration.

Torture survivors' experiences of receiving surgical treatment indicating re- traumatization.

Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.

Critical physiotherapy: a ten-year retrospective.

Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy's historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the "posts". In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.

Health Care and Social Work Students' Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study.

BACKGROUND: Virtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students' experiences with such a learning activity. OBJECTIVE: The aim of this study was to explore occupational therapy, social education, nursing, and social work students' experiences with virtual reality simulation as a learning activity in an interdisciplinary subject. METHODS: The data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke. RESULTS: The analysis revealed 3 overall themes for students' experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students' experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students' learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity. CONCLUSIONS: Virtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services.

Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization.

RATIONALE: The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE: Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS: A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS: Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS: This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.

"Learning is about being active, but the digital is not really active": physiotherapy teachers' attitudes toward and experiences with digital education.

BACKGROUND: Digital education is expected to transform higher education teaching and learning. Despite high expectations, higher education teachers have been slow to implement active digital learning. OBJECTIVE: The aim of this study was to investigate physiotherapy teachers' attitudes toward and experiences with digital education and what the teachers' considered prerequisites to a digital transformation of teaching and learning in physiotherapy. METHODS: Qualitative in-depth interviews were conducted with 12 teachers in physiotherapy education. The interviews were analyzed using inductive thematic analysis. FINDINGS: The findings illuminate teachers' attitudes toward and experiences with digital education and their views on prerequisites to a digital transformation of teaching and learning in physiotherapy education, presented as four themes: 1) skepticism toward digital education; 2) digital technology as a tool to support the established teaching practice; 3) longing for teacher collaboration; and 4) calling for time to plan and learn, and significant academic leadership. CONCLUSION: This study shows how physiotherapy teachers are skeptical about digital education, primarily viewing it as a threat to established teaching practices. Taken together, the findings demonstrate a potential for digital transformation in physiotherapy education, which can be released by informing the current teaching practices with evidence from research showing how use of digital technology can improve teaching and learning in physiotherapy education.

Fighting the waves; Covid-19 family life interference in a neurodevelopmental disorder-caregiver population.

INTRODUCTION: The current COVID-19 pandemic interferes with family lives across the world, particularly families of children with neurodevelopmental disorders (NDDs) are at a greater risk for being negatively impacted by the pandemic. Together with representatives from this caregiver population the aim was to explore the interference associated with normal family life caused by the COVID-19 pandemic. METHOD: This is a descriptive study using a cross-sectional design. Following a strategic network sampling strategy, a user-developed national survey was completed by a larger sample (N = 1,186) of parents and informal caregivers of children with NDDs. The survey utilized a combination of both closed and open-ended questions, and a logistic regression analysis was carried out to assess the association between family characteristics, characteristics of the child, and COVID-19 related family life interference. Before carrying out the regression an inductive content analysis of the open-ended question on `How has the isolation affected the family´ was carried out to construct the outcome variable. RESULTS: The initial analysis indicated that the COVID-19 pandemic induced a shift in everyday family life and a lack of guidance and support related to managing the challenges they were facing. Caregivers who reported that COVID-19 had significantly interfered with their family life, were more likely to report having anxious children, and to have experienced an increased number of conflicts at home. The logistic regression showed that both anxious children and increased conflicts considerably increased the risk for reporting family life interference compared to those that reported no increased conflicts or anxious children. DISCUSSION: Considering how the COVID-19 related increased conflicts at home and anxious children threaten the family life of the NDD caregiver population, as an external source of family stress, which might lead to negative impact on their mental and physical well-being, the need for further research in collaboration with user representatives is apparent. Our study suggests that more information should be provided to healthcare providers, social professionals, peers, people with NDDs, and caregivers of people with NDDs about the potential threats that a stressful life event such as the current pandemic can pose to their mental and physical health and their family life.

Recovering from chronic fatigue syndrome as an intra-active process.

In this article, we draw on the narrative of a woman who has recovered from chronic fatigue syndrome (CFS) to explore the process of recovering from a debilitating illness. Inspired by Julia Kristeva's notion of the body as a complex biocultural fact and by Karen Barad's posthuman theory (also termed agential realism), we adopt an intra-active approach to the woman's recovery process, revealing the role played by human as well as nonhuman entities. In so doing, we move beyond "dualistic," often polarized debates in the medical literature (and mainstream media) regarding the causes of CFS: debates in which "biological/physiological" factors tend to be set against "mental/cognitive/psychological" ones. We argue for a medical perspective in which the intra-action of human and nonhuman agents is recognized as contributing to an individual's recovery process.

Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: protocol for a multistage qualitative study.

INTRODUCTION: Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. METHODS AND ANALYSIS: This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. ETHICS AND DISSEMINATION: The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.

Boundary work: the Mensendieck system and physiotherapy education in Norway.

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work, however, has emphasized the fluidity and collaborative nature of professionalization projects, and placed more emphasis on inter-professional negotiations and disciplinary coexistence. In this paper, we draw on this work to analyze the harmonization of the independent Mensendieck System of medical gymnastics in Norway, and the emerging state-sponsored physiotherapy system. Our contention is that over the course of the middle decades of the 20th century, advocates of the Mensendieck System and providers of orthodox, biomedically informed physiotherapy, came together and found a way to work collaboratively in a shared space without compromising their distinctive professional identities. We argue that this approach both points to ways we might revisit traditional conflict-based analyses of the history of physiotherapy, while also suggesting new ways of imagining how the profession might change in the years to come.

Digital learning designs in physiotherapy education: a systematic review and meta-analysis.

BACKGROUND: Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education. METHODS: The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses. RESULTS: Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching. CONCLUSIONS: The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students' learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.

"I enjoy the treadmill very much": Moving beyond traditional understandings of self-efficacy in anti-obesity interventions.

The last decade has seen increased focus on self-efficacy approaches in anti-obesity interventions. Self-efficacy approaches stemming from Bandura's social cognitive theory involve enhancing the patient's self-efficacy to ensure behavior change through exercise and dietary changes as well as weight-loss control. Inspired by Barad's theory of agential realism, this study explores self-efficacy by acknowledging that also non-human entities have agency. Drawing on one adolescent's experiences of testing herself while running on a treadmill, we put Barad's concept of "intra-acting" into play. Acknowledging the treadmill's agency as well as the agency of the program itself enables us to see the becoming nature of self-efficacy. As such, reading Bandura's concept of self-efficacy through Barad helps us discover more clearly the contingent and fluid process of self-efficacy, a process of becoming that needs to account for both human and non-human actors. Regarding how adolescents' anti-obesity programs can be designed and implemented to enhance self-efficacy, we argue that physiotherapists must understand the intra-active processes involved in such programs.

Learning with technology in physiotherapy education: design, implementation and evaluation of a flipped classroom teaching approach.

BACKGROUND: The purpose of the study was to describe the design, implementation and evaluation of a flipped classroom teaching approach in physiotherapy education. The flipped classroom is a blended learning approach in which students receive digital lectures as homework, while active learning activities are used in the classroom. Flipped classroom teaching enables a learning environment that aims to develop higher-order cognitive skills. METHODS: The study design was a historically controlled, prospective, cohort study. An eight week theoretical course on musculoskeletal disorders was redesigned, moving from a conventional approach to a flipped classroom model. Pre-class learning material consisted of about 12 h of video lectures and other digital learning resources that were split up over the duration of the course. In-class activities consisted of seven full-day seminars where students worked in groups in order to solve problem-based assignments. The assignments were designed to reflect authentic clinical problems and required critical thinking and reasoning. Outcomes were measured with course-grades and compared with historical controls of conventional teaching, using descriptive statistics. Self-perceived learning outcomes and students' experiences were also collected in a survey. RESULTS: Fifty-one students passed the course exam, two failed and one did not attend (n = 54). The share of students with Excellent, Very good and Good (ABC) performances increased by more than 10% relative to any previous year. In addition, Satisfactory, Sufficient and Failed performances (DEF) decreased by more than 10%. Almost two thirds of the students preferred the flipped classroom approach as compared with conventional teaching. Interaction with peers and educators, and flexibility, were the most positive factors that were reported by students. Long seminars, time-constraints and low motivation with respect to preparation and educators' roles were the most common complaints. CONCLUSIONS: A flipped classroom approach in physiotherapy education resulted in improved student performances in this professional programme, when compared with conventional teaching. Students responded positively to the collaborative learning environment, especially with respect to the associated autonomy and flexibility. There were indicators that all groups did not work optimally and that accountability to other group members did not always ensure pre-classroom preparations.

Recovering from provoked vestibulodynia: Experiences from encounters with somatocognitive therapy.

Although provoked vestibulodynia (PVD) represents a significant challenge for many young women in the Western world, little is known about how these women experience therapeutic efforts. The aim of this paper is to enhance our knowledge of the way that the therapeutic process is experienced by women with PVD undergoing somatocognitive therapy (SCT). The study enhances insight into this recently developed therapy through a detailed description of the physiotherapy approach. The empirical data are based on interviews with six women who participated in SCT. The empirical data analysis is guided by thematic analysis. Our findings demonstrate how the women experience SCT as a bodily process of wholeness. The process of wholeness relates to new experiences in the women's own bodies, awareness of muscular and mental tension and relaxation, breathing patterns, and perceptions focusing on pain. The findings are presented as three interrelated themes: 1) sensitizing the body as an interconnected unit; 2) incorporating the painful pubic region into the body; and 3) developing a new understanding of oneself. The women who participated in this study found that SCT contributed significantly to the process of their recovery from PVD.

Curing and caring competences in the skills training of physiotherapy students.

This article explores the significance of curing and caring competences in physiotherapy education, as well as how curing and caring competences intersect within the professional training of physiotherapy students. The empirical data include participant observations and interviews with students attending skills training in the first year of a bachelor's degree program in Norway. Curing and caring are conceptualized as gender-coded competences. That is, curing and caring are viewed as historical and cultural constructions of masculinities and femininities within the physiotherapy profession, as well as performative actions. The findings illuminate the complexity of curing and caring competences in the skills training of physiotherapy students. Curing and caring are both binary and intertwined competences; however, whereas binary competences are mostly concerned with contextual frames, intertwined competences are mostly concerned with performative aspects. The findings also point to how female and male students attend to curing and caring competences in similar ways; thus, the possibilities of transcending traditional gender norms turn out to be significant in this context. The findings suggest that, although curing somehow remains hegemonic to caring, the future generation of physiotherapists seemingly will be able to use their skills for both caring and curing.

Sportiness and masculinities among female and male physiotherapy students.

This article explores the gendered importance of sportiness in terms of students' judgments of themselves and their classmates as suitable physiotherapy students. The article is based on observations and qualitative interviews with students attending clinical skills training classes in the first year of a bachelor's degree program in physiotherapy in Norway. The analysis focuses on sportiness as a display of masculinity and is inspired by Connell's concept of multiple masculinities. The findings demonstrate sportiness as a shared common value among students. However, it was also found that there are two main typologies: (1) hyper-sportiness; and (2) ordinary sportiness. Male students judged as possessing hyper-sportiness are acknowledged as particularly suitable physiotherapy students and assume a hegemonic position in the student milieu. Female students who adapt hyper-sportiness have the potential to assume a hegemonic position, but tend not to do so. Female students with an ordinary level of sportiness have no particular problems in being identified as suitable physiotherapy students, whereas male students do encounter such problems. The article demonstrates how physiotherapy students' sportiness is more complex than previously known, particularly concerning differences in how female and male students are acknowledged in terms of perceived suitability as physiotherapy students. Additionally, this work shows a continuity of historical lines with respect to how sportiness is embedded in gender within the physiotherapy profession.