Debbie Wilson, MCSP, MSc

Rehabilitation- Challenges and Opportunities, free paper

CSP Conference 2013

Questions..

The study An iterative/hermeneutic phenomenological study

Six parents who were living the experience of parenting a child with long term physiotherapy needs

One hour interviews, and used the Colaizzi approach to analysis.

Correspondence with the parents for comments on both the verbatim transcripts and the formulation of meanings were vital to this process.

Further rigour applied through reflection and expert opinion on interpretation.

The phenomenon1) The relevance of relationships and roles

2) The relevance of learning physiotherapy; its meaningand context

3) Doing physiotherapy; enabling and influencing, practicalities, barriers and tangible things

Major theme one

The relevance of relationships and roles.....

Emergent theme 121b (2m1)

“And it’s not a case of oh we’re going to do this now. You’re constantly looking and just observing what your child is doing”

4c(5f7)

“You feel out of your comfort zone I think as a parent.”

Emergent theme 2 27b (5f7);

“I mean I think we saw her as a problem and I think she probably equally viewed us as a problem. And our relationship was really bad, which then impacted on (child)”.

Emergent theme 626a (2m1);

“what I’m being told that’s the best you can do really. Don’t force it, work with them, which is fine. But you’ve still got an element of you know, I’m not a physio.”

Emergent theme 84d (1f2);

“I thought oh my god am I going too high am I going to pull a muscle with him or something, you know. But as time went on eventually you just do it with your eyes closed pretty much. “

Emergent theme 1110(3f3);

“So it was actually really helpful to have someone who was like, no, you know, you just have to keep working on things and help him, etc., essentially.”

Emergent theme 1212a(4f6);

“I don’t want her disability ever to hold her back. I’d like her to try everything and if it doesn’t work, okay let’s go and have a look at something else.”

Emergent theme 1542(1f2);

“I roll (child) onto his side and I’m actually the one that’s holding his arm to stop him hurting himself and doing cycle kicks with his legs and he’s quite relaxed ‘cos he knows that mum knows how to do that”

Question..

Major theme 2

The relevance of learning physiotherapy; its meaning and context ...

Emergent theme 35 (3f3);

“He couldn’t go up and down stairs, you know, teaching him how to go up and down stairs, how to do things. She had a fun way of making everything so he didn’t know he was working, he was just having fun.”

Emergent theme 41(5f7);

“I think in the beginning with the physio I don’t think we took as much interest in it as we do now. Because I think we were still really struggling with the diagnosis ...maybe they had this all wrong and so he didn’t actually really need this physio, so what a waste of time.”

Emergent theme 54a(1f2);

“always smiling whilst you’re doing physio, he loves it, its play to him, it’s not you know working. So that was the start of it and yeah ...he was a different child.”

Emerent theme 738a (4f6);

“ (child) loves going to it and I think if it had been just full of exercises that, you know, someone was there and she was just doing this, this and this, I think we’d have struggled to keep going”

Emergent theme 96(4f6);

“I keep thinking that her feet are still turning out... You know I don’t know whether or not she needs the Piedro shoes still, I don’t know. Do you know what I mean? I don’t know.”

Emergent theme 1026a(2m1);

“what I’m being told that’s the best you can do really. Don’t force it, work with them, which is fine. But you’ve still got an element of you know, I’m not a physio.”

1041a(1f2);

“..the more I’ve worked with him the more confident I guess I became and I’m you know, obviously (child)became more confident with me.”

Emergent theme 1356(3f3);

“(friend) was gutted because this was a little girl the same age as her daughter who she saw in clinic, same diagnosis, and mother wouldn’t do anything, never bothered. It’s awful, it’s really shocking”

Question..

Major theme 3

Doing physiotherapy; enabling and influencing, practicalities, barriers and tangible things

Emergent theme 1414(1f2);

“where I just had no oomph to do it and the guilt you feel when you do that is just unreal.”

11a(5f7);

“it’s a struggle. Because we’ve got the other children you know, it’s not just (child)that we can devote our time to”

Emergent theme 1649(3f3); environments

“in the first instance I would say that in the hospital environment is, it’s more formal it’s like being in school, it’s like ..you’ve got to learn how to do it. Here is how you do it. This is actually quite serious...”

Question..

recommendations Physiotherapists try to balance and negotiate hands on

therapy and education.

Physiotherapy services allow for flexibility in service delivery, including the need for enhanced support at different points in the rehabilitation pathway.

Physiotherapists need to understand their teacher role and to be a good teacher requires a nurturing and mutually respective relationship.

Further evaluation of the timing and impact of home programme delivery may be valuable.

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