50 research outputs found
Curing the blood and balancing life: Understanding, impact and health seeking behaviour following stroke in Central Aceh, Indonesia
Get PDFThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Previous studies have highlighted the importance of understanding the subjective illness experience. Stroke, as the second highest cause of death and highest cause of adult morbidity internationally, is no exception. However, the research to date has significant gaps. Lay understandings of stroke in low and middle income countries remain poorly understood, and very few studies have explored the links between experience and the context in which they occur. These gaps in knowledge have resulted in insufficient attention being paid to the relevance of local contexts in the implementation of international and regional recommendations for stroke.
The study presented in this thesis explores the experience of stroke in Central Aceh, Indonesia. It drew on phenomenology and ethnography and used a range of qualitative methods. People with stroke and their carers were involved in the examination of stroke understandings, its causation and mechanism, the impact of stroke on their lives, and actions taken to remediate the symptoms. This information was complemented with an in-depth study of healers, within the context of the health systems through which they operate. Further information on current social, religious and cultural practices was gathered through participant observation.
The study revealed that lay understandings occurred within a range of explanatory models. Also highlighted was the complex relationship between the understanding of the condition, the impact on the family, and the health seeking behaviour. All were influenced by the specific context and an attempt to regain a homeostatic balance in life; within the person, with others, and with the supernatural.
The results of this study demand critical interrogation of the international guidelines both for stroke and for policies to promote access to health personnel at the primary care leve
The complexities of 'otherness': reflections on embodiment of a young White British woman engaged in cross-generation research involving older people in Indonesia
Get PDFThis article has been made available through the Brunel Open Access Publishing Fund.If interviews are to be considered embodied experiences, than the potential influence of the embodied researcher must be explored. A focus on specific attributes such as age or ethnicity belies the complex and negotiated space that both researcher and participant inhabit simultaneously. Drawing on empirical research with stroke survivors in an ethnically mixed area of Indonesia, this paper highlights the importance of considering embodiment as a specific methodological concern. Three specific interactions are described and analysed, illustrating the active nature of the embodied researcher in narrative production and development. The intersectionality of embodied features is evident, alongside their fluctuating influence in time and place. These interactions draw attention to the need to consider the researcher within the interview process and the subsequent analysis and presentation of narrative findings. The paper concludes with a reinforcement of the importance of ongoing and meaningful reflexivity in research, a need to consider the researcher as the other participant, and specifically a call to engage with and present the dynamic nature of embodiment
Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements
Get PDFOBJECTIVE: To explore the clinical judgements of therapists in prescribing the intensity of hand strengthening exercise in rheumatoid arthritis (RA). METHODS: Phase I: Eleven therapists knowledgeable in treating patients with RA subjectively identified seven clinical cues. These were incorporated into 54 hypothetical patient case scenarios. PHASE II: Therapists with ≥2 years post-registration experience and current or recent experience in treating patients with RA were asked to assess 69 case scenarios in total (54 + 15 repeats) and judge what intensity of hand strengthening exercise they would prescribe using the OMNI-Resistance Exercise Scale of perceived exertion. Using responses to the repeated cases, the Cochran-Weiss-Shanteau index of expertise was used to identify therapists who prescribed more consistently. Multiple regression was used to determine which clinical cues were most strongly associated with the intensity of exercise prescribed. A sub-group analysis explored differences between consistent and inconsistent prescribers. RESULTS: Fifty-three therapists took part. Thirty completed all 69 case scenarios. Across all therapists, the three most important clinical cues associated with lower intensity of exercise prescribed were (1) Patient's reported pain intensity whilst practising the exercise (β = -1.150, p < 0.001), (2) Disease activity (β = -0.425, p < 0.001) and (3) average hand pain over the last week (β = -0.353 p < 0.001). Twelve therapists were categorised as consistent prescribers. This group relied on fewer clinical cues (three vs. seven) when judging what intensity of exercise to prescribe. CONCLUSION: This study provides insights into how therapists prescribe hand exercises. Intensity of hand strengthening exercise was influenced by three key clinical cues, including pain intensity and disease activity
Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study
Get PDFThis is the post-print version of the final paper published in Physiotherapy. The published article is
available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections,
structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been
made to this work since it was submitted for publication. Copyright @ 2013 Elsevier B.V.Objectives - To explore demographic differences in awarded marks of the final clinical placement in a physiotherapy undergraduate programme.
Design - Retrospective analysis of clinical placement assessment marks.
Setting - A London university offering clinical placements throughout South East England.
Participants - 333 physiotherapy students entering physiotherapy training between 2005 to 2009.
Main outcome measures
Marks awarded following assessment using a clinical placement assessment form.
Results - The mean mark (SD) for age were standard entry 71 (7.4) vs. mature entry 72 (7.99) (ns); for gender male 72 (8.45) vs. female 71 (7.21) (ns); and ethnicity White British 72 (7.71) vs. ethnic minority 70 (7.01) (p = 0.023). No interaction effects were observed between the independent variables and only ethnicity demonstrated a statistically significant effect (mean difference (MD) 2.4% 95%CI 0.5 to 4.3, F = 5.24, p = 0.023).
This difference was maintained in most subcategories. Significant differences were observed for the interpersonal section (MD 2.21% 95%CI 0.14 to 4.28, F = 4.409, p = 0.03), the clinical reasoning section (MD 2.39% 95%CI 0.53 to 4.25, F = 6.37, p = 0.012) and the treatment section (MD 2.93 95%CI 1.10 to 4.83, F = 9.198, p = 0.003).
Conclusions - Physiotherapy students from minority ethnic backgrounds were awarded a significantly lower mark than their white majority peers in final clinical placements, although the difference was small. Potential reasons are considered, with the strongest recommendation being for further enquiry into the potential relationship between ethnicity and success in undergraduate physiotherapy education
Prescribing hand strengthening exercise for patients with rheumatoid arthritis; clinical cues influencing occupational therapists' and physiotherapists' judgements
Get PDFObjective
To explore the clinical judgements of therapists in prescribing the intensity of hand strengthening exercise in rheumatoid arthritis (RA).
Methods
Phase I: Eleven therapists knowledgeable in treating patients with RA subjectively identified seven clinical cues. These were incorporated into 54 hypothetical patient case scenarios. Phase II: Therapists with ≥2 years post-registration experience and current or recent experience in treating patients with RA were asked to assess 69 case scenarios in total (54 + 15 repeats) and judge what intensity of hand strengthening exercise they would prescribe using the OMNI-Resistance Exercise Scale of perceived exertion. Using responses to the repeated cases, the Cochran-Weiss-Shanteau index of expertise was used to identify therapists who prescribed more consistently. Multiple regression was used to determine which clinical cues were most strongly associated with the intensity of exercise prescribed. A sub-group analysis explored differences between consistent and inconsistent prescribers.
Results
Fifty-three therapists took part. Thirty completed all 69 case scenarios. Across all therapists, the three most important clinical cues associated with lower intensity of exercise prescribed were (1) Patient's reported pain intensity whilst practising the exercise (β = −1.150, p < 0.001), (2) Disease activity (β = −0.425, p < 0.001) and (3) average hand pain over the last week (β = −0.353 p < 0.001). Twelve therapists were categorised as consistent prescribers. This group relied on fewer clinical cues (three vs. seven) when judging what intensity of exercise to prescribe.
Conclusion
This study provides insights into how therapists prescribe hand exercises. Intensity of hand strengthening exercise was influenced by three key clinical cues, including pain intensity and disease activity
Factors affecting engagement in screening clinics ; exploring the experiences of patients with rare endocrine gene disorders
Get PDFThe aim was to explore the patient experience of those attending screening appointments for rare endocrine syndromes. Obtaining insights into the factors that potentially enhanced or detracted from attendance and engagement with the clinics could assist in developing strategies to promote patient engagement. A qualitative approach using semi-structured interviews was employed to understand individuals’ perceptions and experience of the screening clinics. Twelve interviews were conducted with patients (age 10-66 years, purposive sampling). Four main themes were identified: (1) Perception at a distance, (2) Seeing my future self (3) The body and person in clinic and (4) The patient or doctor, who knows best? These highlighted several areas which could be used to inform approaches to promote enhanced patient engagement: the importance of careful management of projections of self, balancing information overload and honesty, interpersonal relationships and humanisation of care and assisting with the early navigation for the non-expert individual
A racial inclusivity training resource for physiotherapy practice education : evaluation report 2022
Get PDFResearch within physiotherapy education in the UK has highlighted inequity in student attainment, including practice education, in relation to student ethnic background. Further research with students from minority ethnic backgrounds highlighted a number of concerns with belonging within the profession. On practice placement, this was illustrated through perceived differences with their educators, impact on assessment as well as racist encounters and micro-aggressions. For multiple reasons, students often felt unable to articulate these issues/experiences with their practice educators. A need was identified to support practice educators to further understand the student experience in order to enhance their ability to supervise without prejudice. Health Education England commissioned the development of an education package to begin to develop this support for practice educators. The training package was developed in 2022 by a group of four educationalists supported by a diverse co-creators team of experienced practice educators and current students with lived experience of racism within the profession
Perspectives on ageing, later life and ethniciy: Ageing research in ethnic minority contexts
Get PDFThis special issue focuses broadly upon questions and themes relating to the current conceptualisations, representations and use of ‘ethnicity’ (and ethnic minority experiences) within the field of social gerontology. An important aim of this special issue is to explore and address the issue of ‘otherness’ within the predominant
existing frameworks for researching those who are ageing or considered aged, compounded by the particular constructions of their ethnicity and ethnic ‘difference’. The range of theoretical, methodological and empirical papers included in this collection provide some critical insights into particular facets of the current research
agendas, cultural understandings and empirical focus of ethnic minority ageing research. The main emphasis is on highlighting the ways in which ethnic cultural homogeneity and ‘otherness’ is often assumed in research involving older people from ethnic minority backgrounds, and how wider societal inequalities are concomitantly
(re)produced, within (and through) research itself – for example, based on narrowly defined research agendas and questions; the assumed age and/or ethnic differences of researchers vis-à -vis their older research participants; the workings of the formalised ethical procedures and frameworks; and the conceptual and theoretical frameworks employed in the formulation of research questions and interpretation of data. We examine and challenge here the simplistic categorisations and distinctions often made in gerontological research based around research participants’ ethnicity, age and ageing and assumed cultural differences. The papers presented in this collection reveal instead the actual complexity and fluidity of these concepts as well as the cultural dynamism and diversity of experiences within ethnic groups. Through an exploration of these issues, we address some of the gaps in existing knowledge and understandings as well as contribute to the newly emerging discussions surrounding the use of particular notions of ethnicity and ethnic minority ageing as these are being employed within the field of ageing studies.This special issue is one of the outcomes from the Economic and Social Research Council (ESRC) seminar series on ‘Ageing, Race and Ethnicity’ (project reference ES/J021547/1),held in the UK during 2012-2014. Open access for this editorial has been provided through the University of Nottingham open access funds
From dictatorship to a reluctant democracy: Stroke therapists talking about self-management
Get PDFThis article is made available through the Brunel Open Access Publishing Fund.Purpose: Self-management is being increasingly promoted within chronic conditions including
stroke. Concerns have been raised regarding professional ownership of some programmes,
yet little is known of the professional’s experience. This paper aims to present the views of
trained therapists about the utility of a specific self-management approach in stroke
rehabilitation. Method: Eleven stroke therapists trained in the self-management approach
participated in semi-structured interviews. These were audio recorded, transcribed verbatim
and analysed thematically. Results: Two overriding themes emerged. The first was the sense
that in normal practice therapists act as ‘‘benign dictators’’, committed to help their patients,
but most comfortable when they, the professional, are in control. Following the adoption of
the self-management approach therapists challenged themselves to empower stroke
survivors to take control of their own recovery. However, therapists had to confront many
internal and external challenges in this transition of power resulting in the promotion of a
somewhat ‘‘reluctant democracy’’. Conclusions: This study illustrates that stroke therapists
desire a more participatory approach to rehabilitation. However, obstacles challenged the
successful delivery of this goal. If self-management is an appropriate model to develop in
post stroke pathways, then serious consideration must be given to how and if these
obstacles can be overcome
Flipping the ICF: Exploring the Interplay of Theory and the Lived Experience to Reconsider Physical Activity in Community-Dwelling People With Multiple Sclerosis
Get PDFPeople with multiple sclerosis (MS) report lower physical activity levels and are at a risk of becoming sedentary. As such, they are at an increased risk of developing secondary health conditions associated with inactivity. This is of major public health concern. Attempts to improve the physical activity levels in people with MS remain a challenge for health professionals. One key reason might be the lack of understanding about the meanings people with MS ascribe to exercise and physical activity. This paper draws on the key findings of a three-phased interconnected mixed methods sequential explanatory study to examine the meanings of exercise and physical activity from the perspectives of people with MS and health professionals. Phase 1 used a four-round Delphi questionnaire to scope and determine the consensus of priorities for exercise and physical activity and the reasons why people with MS (N = 101) engaged in these activities. Phase 2 used face-to-face semistructured interviews of people with MS (N = 16) to explore the meanings ascribed to exercise and physical activity. Phase 3 explored the perceptions of physiotherapists (N = 14) about exercise and physical activity using three focus groups. Using the International Classification of Functioning, Disability, and Health as a theoretical framework to underpin this study, the authors discuss the key factors, for example, emphasis on the contextual factors, that drive decision making around exercise and physical activity participation in people with MS and explore the clinical implications to health professionals
