Approaches to Physiotherapy Interventions Focusing on Client-Centredness

Abstract: The aim of physiotherapy is to promote health and well-being, and to facilitate increased activity and participation of individuals with diseases and injuries. The profession is influenced by different health paradigms which have emerged from different knowledge traditions. The biomedical paradigm of health adopts a dualistic view of mankind in which the normal is regarded as the standard, and the aim is to cure or correct impairments. The biopsychosocial paradigm of health takes a holistic view of mankind, and describes health as the dynamic interaction between the components of body function/structure and activity/participation on the one hand, and environmental and personal factors on the other. By applying a client-centred approach the physiotherapist can, by various interventions, increase the client’s activity and participation. This can be achieved by the physiotherapist’s understanding of the client’s disease and the way in which the client experiences his/her illness. Another prerequisite is that the physiotherapist develops a client-centred therapeutic alliance with the client. The overall purpose of the work presented in this thesis was to study the phenomenon of physiotherapy interventions focusing on client-centredness. A qualitative method in the tradition of phenomenography was used to identify various ways of experiencing, conceiving and understanding this phenomenon in a second-order perspective. Physiotherapists and clients were carefully selected and interviewed with semi-structured interviews, and strategically selected scientific articles were examined. The selection strategy was employed to ensure maximum variation. The results presented in Papers I, III and IV show that physiotherapists use three different approaches in interventions: the physiotherapist-centred approach, the physiotherapist-led approach, and the client-centred approach. These approaches demonstrate critical variations in health paradigms that influence the conceptions of health, physiotherapy knowledge, intervention focus, the role of the physiotherapist, goal-setting and aspects of motor learning. The different approaches are general theories not associated with individual physiotherapists. Paper II describes how women recovering from breast cancer experience physical activity recommended by physiotherapists in four different ways: Compliance with instructions and need for support, Struggle to get back to normal and fear of negative side-effects, A wish to stay normal and not allow limitations, and Getting control of the situation with new strategies. The descriptive categories exhibit critical variations in how these clients experience the limitations resulting from their illness and the treatment and how these, in turn, affect their control over the situation. Physiotherapists’ understanding of their clients’ experience of physical activity is beneficial in clinical practice in order to develop empowerment and client-centredness. Different approaches are required at different times depending on how clients are dealing with their limitations and the way in which they experience control. The design of the approach is dependent on the therapeutic alliance between the physiotherapist and the client. The results presented in this thesis contribute to strengthening the theoretical frameworks behind different physiotherapeutic interventions, and can thus increase awareness and reflection on the choice of intervention.