N. Waiserberg1,2, P. Feder-Bubis3
1Tel Aviv University, Sackler Faculty of Medicine, Physical Therapy, Tel Aviv, Israel, 2Ben Gurion University of the Negev, Department of Health Policy and Management, Beer Sheva, Israel, 3Ben Gurion University of the Negev, Department of Health Policy and Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Beer Sheva, Israel
Background: Israeli Special Education Law specifies physiotherapy (PT) services for children with motor disabilities are provided within education settings. Thus, despite its recognition as a health profession, most pediatric PT practice occurs in educational, not medical settings. This poses questions about the nature of the professional practice provided to these.
Purpose: To identify and describe school-based physiotherapy (SBPT) for children with motor disabilities as perceived by the physiotherapist, the child, parents, educational personnel, and physicians who refer the child for therapy.
Methods: We conducted a qualitative study that included eight focus-groups with children with motor disabilities and parents of children with motor disabilities (n=38; aged 4.5-21 years) at special education schools, and 25 in-depth interviews with physiotherapists, educational personnel, pediatric orthopedics and neurologists. The focus groups and interviews were transcribed and a thematically analyzed. Study trustworthiness was ensured using the constant comparison method, peer debriefing, reflexivity and audit.
Results: Participants perceived PT as basic to the children's life and essential to their functioning. Their perceptions of SBPT were categorized in four main themes:
Something different: Physiotherapy within educational settings is perceived as distinct from that provided in medical ones. Participants described different practices, activities and symbolic structures that underscore the differences between SBPT and clinical PT. Physiotherapists are not always at ease in educational settings as in medical ones.
An holistic point of view, broad practice: SBPT is compatible with current theoretical models (e.g. the International Classification of Functioning, Disability and Health - ICF) that emphasize individuals' participation in their own environment. In educational settings, the child's natural environment, the PT intervention aims at all ICF components, the practice is broad, and takes place within and outside the treatment room, having a direct and indirect impact on the child.
Strangeness: Participants described a two-way estrangement between physiotherapy and the educational setting – the educational setting does not know what to expect of the physiotherapists, who, in turn, do not always know what their role is in that setting.
Interconnection: Participants perceived the SBPTst as a coordinator of care and a mediator between the medical and educational systems, the child/parent and doctors and educators, and sometimes even between the child and her/his parents.
Something different: Physiotherapy within educational settings is perceived as distinct from that provided in medical ones. Participants described different practices, activities and symbolic structures that underscore the differences between SBPT and clinical PT. Physiotherapists are not always at ease in educational settings as in medical ones.
An holistic point of view, broad practice: SBPT is compatible with current theoretical models (e.g. the International Classification of Functioning, Disability and Health - ICF) that emphasize individuals' participation in their own environment. In educational settings, the child's natural environment, the PT intervention aims at all ICF components, the practice is broad, and takes place within and outside the treatment room, having a direct and indirect impact on the child.
Strangeness: Participants described a two-way estrangement between physiotherapy and the educational setting – the educational setting does not know what to expect of the physiotherapists, who, in turn, do not always know what their role is in that setting.
Interconnection: Participants perceived the SBPTst as a coordinator of care and a mediator between the medical and educational systems, the child/parent and doctors and educators, and sometimes even between the child and her/his parents.
Conclusions: Part of pediatric PT is provided in educational settings, encompassing many potential opportunities for holistic treatment in the child's environment. It expands the boundaries of the profession; however, the estrangement and ambiguity may push professionals to limit themselves to narrower, familiar professional practices. It is then that the children do not benefit in full from what SBPT can offer.
Implications: In the last few decades, physiotherapists moved from their professional comfort zone – body function and structure – to areas to that traditionally did not relate to physiotherapy, such as participation, personal factors, and environmental factors. These areas could justify having physiotherapy in educational settings, but the lack of professional confidence is particularly apparent when the profession is practiced in an unfamiliar field. SBPT should be explicitly taught.
Funding acknowledgements: The research was funded by a grant of the Israel National Institute For Health Policy Research
Keywords:
School based physiotherapy
Perception
Qualitative study
School based physiotherapy
Perception
Qualitative study
Topics:
Paediatrics
Paediatrics: cerebral palsy
Professional issues
Paediatrics
Paediatrics: cerebral palsy
Professional issues
Did this work require ethics approval? Yes
Institution: Ben-Gurion University of the Negev
Committee: the Human Subjects Research Committee
Ethics number: 1701-1
All authors, affiliations and abstracts have been published as submitted.
