Patient and caregiver perspectives on physiotherapy

Today, patients and clients have great impact on their choices of care and treatment provided within the healthcare system. For the caregivers and for physiotherapists as well, this means that we need to take into account patient and client wishes, perceptions and experiences in order to achieve optimal treatment results. In everyday practice, this might be easy by just talking and listening to the patients or the clients. In research, however, we need more systematic ways of approaching these questions. The way of doing this is by using a qualitative research design. Qualitative research seeks to understand a given research problem from the perspectives of the patient group it involves. This method provides the patient side of the treatment, i.e. behaviour, opinions, beliefs, wishes, emotions and relations but also socio-economic factors, such as roles in society, religion, ethnicity and gender issues (1). The tools used in qualitative research to capture these dimensions are participant observation, in-depth interviews and focus-group interviews. In social sciences, these methods are commonly used and have become even more so within medical research. In this issue of Advances in Physiotherapy, it is a great pleasure to present five papers dealing with qualitative methods. Sundling and co-workers describe patient with ALS and caregiver perception of non-invasive home ventilation. They analysed in-depth interviews with a qualitative content analysis, where three themes emerged; ‘‘getting to know the ventilator’’, ‘‘embracing the ventilator’’ and ‘‘being on the ventilator up to 24 h’’. The patients reported improved sleep and activity after adjusting to the ventilator and the caregivers perceived initial stress and interrupted sleep, but later on a deepened understanding of the benefits of the 24-h treatment. Rutberg & Öhrling also used qualitative content analysis to describe experiences of acupuncture among women with migraine. Two categories emerged: experiences during treatment and after treatment. The patient therapist relationship affected the experience and the results indicated a feeling of control over the migraine. Øien and co-workers also used in-depth interviews in combination with video-recordings to explore change and perception in Norwegian psychomotor physiotherapy treatment of patients with chronic neck and back pain. The process of self-perception was integrated in changing movement behaviour and a basis for reducing pain. Wallin and co-workers videotaped group-based exercise sessions in geriatric rehabilitation. They used another type of analysis discourse analysis and found four categories: ‘‘taciturn exercising’’, ‘‘submissive disagreeing’’, ‘‘resilient endeavouring’’ and ‘‘lay helping’’. The client’s contribution to the interaction with the physiotherapist is an important part of the rehabilitation process. Ståhle-Öberg and FjellmanWiklund used Grounded Theory, another qualitative method based on interviews, verbatim transcription and analysis of the text, to capture parents’ experience of pain in children with cerebral palsy and multiple disabilities. Assessing health-related quality of life (HRQL) with questionnaires is another way of exploring patient perceptions. In a study by Grahn Kronhed and co-workers, the effect of training on HRQL, pain and falls, was investigated among osteoporotic women. An exercise group was compared with a control group. The exercise group improved in six of the HRQL domains, assessed with SF-36, and in four domains, they scored better than the control group. Finally, Virta and co-workers with a quantitative approach present a follow-up study of a supervised exercise programme among patients with subacromial impingement. Of 97 patients participating in the programme, only 10 needed surgery. A strong recommendation from this study is that a supervised exercise programme should be the first treatment alternative for patients with impingement syndrome. Two book reviews are presented in this issue, one by Häkkinen on a book by Jewell, Guide to evidencebased physical therapy practice, and one by Björnsdottir on a book by Higgs, Smith, Webb, Skinner and Croker, Contexts of physiotherapy practice. As you may have noticed, we now publish 64 pages in each issue of Advances in Physiotherapy, compared with 48 pages in the previous years. Our intention is to expand the journal and we strive to publish papers from different fields of physiotherapy and related areas. I welcome you to submit your research contributions to our journal.