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Lahelle A.1, Normann B.1,2
1UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromsø, Norway, 2Nordland Hospital Trust, Bodø, Norway
Background: Reduced balance and core stability are common impairments in persons with multiple sclerosis (MS). GroupCoreSIT is a new individualized intensive group based exercise intervention targeting core stability and balance, where all the participants are assessed individually prior to the intervention. Assessment is fundamental for professional activity in physiotherapy, and will affect the subsequent intervention planning and treatment of patients. The knowledge regarding assessment prior to group interventions is sparse.
Purpose: The purpose of this study is to gain new knowledge about how physiotherapy assessment of people with MS prior to a group based intervention is carried out in terms of professional practice, and the physiotherapists' reflections regarding vital aspects of the assessment. Such knowledge contributes to guide clinical decision making and strengthen evidence based practice in physiotherapy.
Methods: The study was grounded in a phenomenological hermeneutic research approach, based on 12 qualitative non-participatory video observations of assessments prior to the intervention and 13 following semi-structured theme based interviews with the physiotherapists. The material was analyzed using NVivo software, systematic text condensation, and enactive theory as theoretical perspective.
Results: Let`s get it started! - Many of the observed assessments had apparent elements of starting a new project where the physiotherapists prepared and motivated the patients for the subsequent weeks of exercise. Some of the physiotherapists emphasized verbal instructions and explanations, and others complemented words with handling and exploration of specific movements while requesting the patients perceptions of these movements. The physiotherapists goal was to form a belief that the intervention could improve the patients functional abilities.
Gaining insights: Mutual participation vs. in the head of the therapist When the physiotherapists invited the patients to join the clinical reasoning process, there were gained mutual and deeper insights in the movement problems in relation to ADL compared to the assessments where the physiotherapists did not invite the patients to join the clinical reasoning process.
Specific vs. general; Significant distinctions for intervention planning The assessment was a basis for planning exercises and adjustments prior to the intervention. Some of the therapists assessed the patients general activities and abilities for different exercises from the exercise bank, and tried out various postural sets. Other therapists did more specific assessments of body functions and structures, and explored the potential for improvement in core activation. Specific assessments resulted in opportunities to plan exercises targeting to improve the patients specific movement problems, while general assessments resulted in general and pragmatic intervention planning.
Conclusion(s): Co-construction of mutual engagement between the physiotherapist and the patient, involving expressions and perceptions through both body and verbal language, is essential to establish motivation for the intervention period. Systematic, individualized movement analyses is vital for planning of tailored exercises targeting to address the individuals movement problem.
Implications: Exhaustive assessment prior to group training is essential, and should emphasize identifying specific movement problems in relation to ADL as a foundation for individualized intervention planning.
Funding acknowledgements: The study was founded by Northern Norway Regional Health Authority
Topic: Neurology
Ethics approval: The studu was approved by the Norwegian Regional Committee for Medical Research Ethics.
All authors, affiliations and abstracts have been published as submitted.
