A PHENOMENOLOGICAL AND CRITICAL EXAMINATION OF KNOWLEDGE EXPRESSED AND EXCHANGED IN PHYSIOTHERAPY WITH CHILDREN

Bjorbækmo W.S.¹, Robinson H.S.¹, Engebretsen E.¹

¹University of Oslo / Institute of Health and Society, Department of Health Sciences, Oslo, Norway

Background: The integration of different types of knowledge within the practice of physiotherapy is urgent in view of the current emphasis on the involvement of clients themselves. There is broad consensus to see even young children as competent individuals with opinions, feelings and knowledge about the situation in which they find themselves.
However, the growing fields of 'knowledge translation' and 'evidence-based practice' tend to dominate research in physiotherapy. These fields largely have a 'top-down' approach to how research findings should be transferred and integrated into practice.
As a result, there has been little research into how different types of knowledge are expressed, exchanged and negotiated in clinical encounters with children. This study is an attempt to address this lacuna.

Purpose: To examine how knowledge is expressed, shared and exchanged in the practice of primary health care physiotherapy with children whose medical diagnosis suggests the need for long-term follow-up.

Methods: The empirical material was generated as part of the first author’s doctoral research. It derives from close observations of seven children between six and 11 years of age during regular weekly therapy sessions with five physiotherapists. Post-session written notes, along with the first author’s comments and questions, constitute the database. In the phenomenological analysis we aimed to be open to the uniqueness and meaning of knowledge expressed and exchanged. The complementing analytical moves of bracketing and reduction, and the process of phenomenological writing involved systematic analysis of meaning structures embedded in the various situations. Writing anecdotes involved reflecting on experiences and attempting to recreate the actual events using language geared to the experiential or lived sensibility of the lifeworld. This process inevitably represents a transcended form of the actual experience.

Results: By presenting three anecdotes we show how the children take initiative and display playful knowledge both of their body, moving capacity and of the equipment and tasks introduced in therapy. The physiotherapists tend to emphasize physiological knowledge relating to the body, its functions and the ‘dangers’ of pathological movement patterns. The interactions between physiotherapists and children illustrate a lack of give-and-take; both parties seem to have their own agenda, and the exchanges between them become detached and vague. They appear caught in a kind of stagnant co-existence where their connection and contact are at a standstill and there is little exchange of knowledge between them.

Conclusion(s): No joint venture is established between the child and the physiotherapist and the exchange and translation of knowledge between them takes place as if between ‘healer’ and ‘sufferer’. Physiotherapists are called upon to view children as possessing knowledge relevant to their own therapy, and to recognize children’s ‘playful and ambivalent’ forms of participating as meaningful contribution in their own therapy.

Implications: The findings reveal the significance of integrating different knowledge perspectives in order for therapy to develop along qualitative and creative lines. By integrating different knowledge perspectives physiotherapists will be able to support children´s active and knowledge creative participation in their own therapy.

Topic: Professional issues

Ethics approval: The study is approved by the regional committee for medical research ethics (REK-S) and, the Norwegian Social Science Data Services.

All authors, affiliations and abstracts have been published as submitted.