Physiotherapists' conceptions of movement awareness- A phenomenographic study.

The phenomenon of movement awareness requires more attention to make it explicit in physiotherapy. The aim of this study was to explore the variation in physiotherapists' conceptions of movement quality, focusing on movement awareness. The informants were 15 physiotherapists from a variety of physiotherapy fields. We collected data through two group interviews and used the phenomenographic method to analyze them. Four themes emerged from the data: 1) Being in contact with one's own moving body; 2) Increased awareness of movement experiences; 3) Interrelationship between physiotherapist and patient; and 4) Better understanding of movement awareness. These themes varied by four descriptive categories of the movement awareness phenomenon: (I) Hesitation regarding own movement experiences; (II) Momentary contact with own movement experiences; (III) Presence in movement awareness and (IV) Better understanding of others' movement awareness. The physiotherapists' understanding of the movement awareness phenomenon widened through three critical aspects in the descriptive categories: Recognizing one's own movement awareness, Distinguishing one's own and others' movement awareness and New insights into implementing actions related to movement awareness in physiotherapy. These results can expand the understanding of the phenomenon of movement awareness among physiotherapists, although further research is needed.

Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial.

BACKGROUND: Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA. OBJECTIVE: To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE). STUDY DESIGN: A prospective, assessor-blinded, and block-randomized controlled trial. METHODS: Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health. RESULTS: At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included. CONCLUSIONS: BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.

Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis.

OBJECTIVE: Hip osteoarthritis may cause compensational movement strategies that require extra physical and mental effort. Such aberrant functioning can be captured in movement quality evaluation. The objective of this study was to explore whether movement quality, evaluated as a multiperspective phenomenon, is reflected in commonly used and recommended functional measures in this group of patients. METHODS: A cross-sectional study design was used. Baseline included 80 female and 21 male participants with hip osteoarthritis. Movement quality was evaluated by the Body Awareness Rating Scale-Movement Quality and Experience (BARS-MQE), part one, including 12 movement items. Correlation analyses (Pearson and Spearman) were performed to explore associations between BARS-MQE (sum score and single item scores), and scores on measures of physical capacity (Chair test, Stairs test, 6 minutes walking test; 6MWT), self-reported activity level (UCLA), function (HOOS subscales), pain during walking (NRS), self-efficacy (ASES) and health (EQ-5D-5L). Based on previous evidence, we hypothesized moderate associations between BARS-MQE and these measures. RESULTS: BARS-MQE's sum score showed moderate associations with Stairs test, 6MWT and UCLA (r = -0.425 to 0.304) and weak associations (r = 0.29 to 0.12) with ASES Pain and Symptoms, HOOS ADL, Chair test, NRS, HOOS Pain and Sports, and EQ-5D-5L. No association was found between BARS-MQE and HOOS Symptoms and Quality of life. Movement quality in item 12, walking, demonstrated moderate or weak association with all included measures. CONCLUSION: In this study of participants diagnosed with hip osteoarthritis, movement quality evaluated by BARS-MQE was moderately reflected in measures of physical capacity and activity, but weakly reflected in self-reported measures of health problems. With its particular dynamic procedure and inclusion of the whole moving person, movement quality evaluation by the BARS-MQE was shown to provide supplementary information on functioning, scarcely captured by the commonly used and recommended measures.

A vocabulary describing health-terms of movement quality - a phenomenological study of movement communication.

Purpose: The aim of the study was to develop a vocabulary targeting communication of health-terms of movement quality, establishing professional knowledge of a movement terminology usefull within rehabilitation.Methods: A phenomenological study design was chosen, inviting movement experts working in rehabilitation to describe movement observations when a change into more functional, health related ways of moving appeared in the rehabilitation processes. 15 physiotherapy experts were recruited, five from the field of neurology, primary health care and psychiatry. The informants had between 12-38 years of clinical practice, treating patients of all ages with a wide specter of diagnoses. Data collection followed a qualitative study design, of individual, in-depth interviews, based on a semi-structured interview guide. The interviews were taped, transcribed and sent to the informants for validation. Data analysis followed recommendation of Giorgi, modified by Malterud. Ethical considerations were followed.Results: Data revealed a vocabulary, clustered in five themes, Biomechanical, Physiological, Psycho-socio-cultural, Existential and Overarching perspective, 16 underlying categories and 122 descriptive health-terms of movement quality.Conclusion: The study demonstrated a multi-perspective movement vocabulary of 122 health characteristic terms, developed to facilitate movement communication within the broad field of rehabilitation. The result calls for further research concerning a movement vocabulary.Implications for RehabilitationThe phenomenon of movement quality has a potential for promoting rehabilitation-specific skills.A vocabulary describing health-terms of movement quality is useful within the overall rehabilitation field providing enhanced and specific health directed communication.A movement specific health-terminology will have impact on implications and facilitating a person-centered and goal directed rehabilitation.Rehabilitation professionals will have a multi-perspective, movement specific and structured terminology to communicate direct and concretely with patients, the multi-professional team, in society, and with politicians.

Basic Body Awareness Therapy in patients suffering from fibromyalgia: A randomized clinical trial.

Introduction: The aim of this study is to assess whether Basic Body Awareness Therapy (BBAT) improves musculoskeletal pain, movement quality, psychological function, and quality of life. Methods: The effects of BBAT in addition to treatment as usual (TAU) were studied in a randomized controlled trial. Forty-one patients were randomly assigned to a control group (n = 21) and an intervention group (n = 20). Both groups received TAU including pharmacological therapy. The intervention group took part in 10 BBAT sessions. Outcome variables were measured regarding pain, movement quality, psychological function, and quality of life. Outcome measures were assessed before intervention, in posttest, and in follow-ups at 12 and 24 weeks. Results: The BBAT group showed significant improvement in 'pain' at posttest (p = 0.037) and in 'movement quality' from baseline to 24 weeks (p = 0.000). Intragroup analysis showed significant improvements in the SF-36 body pain subscale at 12 and 24 weeks (p = 0.001, p = 0.014), Hospital Anxiety Depression scale in anxiety subscale at 12 weeks (p = 0.019), State-Trait Anxiety Inventory anxiety questionnaire at 12 and 24 weeks (p = 0.012, p = 0.002), and STAI state at 12 and 24 weeks (p = 0.042, p = 0.004). Conclusion: This study showed that BBAT might be an effective intervention in patients suffering from fibromyalgia in relation to pain, movement quality, and anxiety.

Patient education and basic body awareness therapy in hip osteoarthritis - a qualitative study of patients' movement learning experiences.

BACKGROUND: Osteoarthritis (OA) is associated with pain, dysfunction and reduced quality of life. Patient education (PE) followed by 12 weekly sessions of Basic Body Awareness Therapy (BBAT) was offered to patients with hip OA, aiming to strengthen their ability to move and act functionally in daily life. AIM: To explore how patients described their experiences and outcome from participating in PE and BBAT. METHOD: Individual, semi-structured interviews with five patients, aged 52-78 years, were performed after PE and BBAT at four and ten months. Interview data were analyzed by systematic text condensation. RESULTS: Three main themes emerged. "Becoming motivated and involved" reflected experiences of encouragement and support from information given and communication with group members. In "Movement awareness learning" patients described becoming aware of and improving functional movement, alleviating symptoms and increasing daily functioning. "Movement and disease in a long-term perspective" reflected patients experience of increased self-awareness and taking better care of themselves at 10 months after baseline. Practicing basic movement principles, they felt empowered to handle daily life challenges in more functional and energy-economical ways. CONCLUSION: PE followed by BBAT in groups may be beneficial to patients with hip OA, and provide lasting benefits regarding daily life function. Implications for Rehabilitation Insight into disease process and relationship to functional movement gained through patient education may empower patients with hip osteoarthritis in management of daily life Movement awareness and exploration of movement quality using principles from Basic Body Awareness Therapy was found to support patients in finding resources for functional movement, implemented in daily actions Movement strategies characterized by adjustment rather than force was experienced by the patients to support their general functioning, despite of prevailing hip pain Implementing group therapeutic factors (Yalom) in physiotherapy was found to strengthen patients' motivation and belief in functional improvement.

Patients suffering from rheumatic disease describing own experiences from participating in Basic Body Awareness Group Therapy: A qualitative pilot study.

BACKGROUND: Rheumatic diseases have physical and psychological impact on patients' movement and function. Basic Body Awareness Therapy focuses on promoting more functional movement quality in daily life. The purpose of this study was to describe patient experiences from participating in Basic Body Awareness Group Therapy for inpatients with rheumatic disease. METHODS: A phenomenological design included data collection in two focus group interviews with seven patients. Giorgi's four-step phenomenological method was used for data analysis. RESULTS: Four main themes emerged: (1) "Movement exploration-being guided in movement" described informants' exploration of bodily signals and movement habits; (2) "Movement awareness training in a relational perspective" informants described experiences from being in a group setting; (3) "Movement awareness-integration and insight" described informants' reflections on movement experiences; and (4) "Integrating and practicing new movement habits" informants described how they used their movement experiences in daily life. CONCLUSIONS: The study described perspectives in movement learning experienced by patients. The results support the view that contact with the body can help patients exploring and cultivating their own resources for a more functional movement quality. Descriptions of relational movement learning aspects can contribute to our understanding of physiotherapy group design.

Considering the Role of Physical Therapists Within the Treatment and Rehabilitation of Individuals With Eating Disorders: An International Survey of Expert Clinicians.

PURPOSE: Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research. METHODS: An international cross-sectional survey design was undertaken with experienced physical therapists within the field of EDs. Physical therapist responses were analysed with descriptive statistics and thematic analysis as appropriate. RESULTS: Twenty-eight international physical therapists participated. On average, participants had 6.9 years (95% confidence interval: 3.1-10.7, n = 27) of clinical experience working in ED settings and devoted approximately 39.3% (95% confidence interval: 23.8-54.8, n = 27) of their time to treating individuals with EDs. Participants reported that physical therapy interventions have a diverse range of benefits on the physical, mental and disease-specific factors (e.g. binges) in people with EDs. The key role of physical therapists includes improving body awareness, especially during physical activity combined with psycho-education about healthy doses of physical activity. Physical therapists were able to identify a range of barriers and facilitators to physical activity in people with EDs. DISCUSSION: This paper provides a first step towards understanding the role and value of physical therapists working with individuals with EDs. Copyright © 2015 John Wiley & Sons, Ltd.

A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa.

PURPOSE: The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. METHOD: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. RESULTS: Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. CONCLUSIONS: The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.

A systematic review on physical therapy interventions for patients with binge eating disorder.

PURPOSE: Since a distorted body experience and a sedentary lifestyle are central in the course of binge eating disorder (BED), physical therapy might be an interesting add-on treatment. The aim of this study was to systematically review randomised controlled trials (RCTs) evaluating physical therapy on binge eating and physical and mental health in BED patients. METHOD: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Library were searched from their inception until 15 August 2012 for relevant RCTs comparing physical therapy with a placebo condition, control intervention or standard care. RESULTS: Three RCTs involving 211 female community patients (age range: 25-63 years) met all selection criteria. Review data demonstrate that aerobic and yoga exercises reduce the number of binges and the body mass index (BMI) of BED patients. Aerobic exercise also reduces depressive symptoms. Only combining cognitive behavioural therapy (CBT) with aerobic exercise and not CBT alone reduces BMI. Combining aerobic exercise with CBT is more effective in reducing depressive symptoms than CBT alone. CONCLUSIONS: The limited number of available studies and the heterogeneity of the interventions limit overall conclusions and highlight the need for further research. IMPLICATIONS FOR REHABILITATION: Because of severe co-morbid psychiatric and physical conditions, binge eating disorder is one of the most difficult psychiatric conditions to treat. Both yoga and aerobic exercise have shown promise in reducing binge eating pathology and weight. Combining aerobic exercise with cognitive behavioural therapy seems more effective in reducing depressive symptoms than cognitive behavioural therapy alone.

How can movement quality be promoted in clinical practice? A phenomenological study of physical therapist experts.

BACKGROUND: In recent years, physical therapists have paid greater attention to body awareness. Clinicians have witnessed the benefits of supporting their patients' learning of movement awareness through the promotion of their movement quality. OBJECTIVE: The aim of this study was to investigate how physical therapist experts promote movement quality in their usual clinical settings. DESIGN: A phenomenological research design that included a sampling strategy was devised. Using specific criteria, 6 lead physical therapists nominated a group of physical therapist experts from the fields of neurology, primary health care, and mental health. Fifteen informants, 5 from each field, agreed to participate. METHODS: In-depth interviews were conducted with a semistructured interview guide. The informants were invited to simply describe what they had experienced to be successful therapeutic processes for promoting movement quality. Each interview was audiotaped and transcribed. The data analysis was based on a multistep model. RESULTS: Three main themes emerged from the data. First, the physical therapists' embodied presence and movement awareness served as a precondition and an orientation for practice. Embodied presence is a bodily felt sense, a form of personal knowing that evokes understanding and fosters meaning. Second, creating a platform for promoting movement quality revealed implementation of psychological attitudes. Third, action strategies for promoting movement quality suggested a movement awareness learning cycle and components for clinical use. CONCLUSIONS: This study demonstrated specific attitudes and skills used by physical therapist experts to promote movement quality in their clinical practice. These results may serve as a therapeutic framework for promoting movement quality in clinical physical therapy, although further research is needed.