Supervision in pediatric physiotherapy: an ambiguous distinction between treatment and supervision. A qualitative explorative study using observations and interviews

Abstract

Supervision of non-professionals has become an integrated part of current practice in pediatric physiotherapy in primary health care. Limited knowledge exists regarding the content, organization and achievements of such practice. In this doctoral project, we explored supervision in the field of physiotherapy services for preschool children with CP who have personal aides responsible for the daily follow-up under the supervision of a physiotherapist (PT). We aimed to identify features that are characteristic for the supervision as a clinical practice. The study had a qualitative explorative design, and we collected data via video-recorded observations of supervision sessions, observations and video-recorded sequences of aides’ work day and individual interviews with PTs and aides. We related the study to enactive theory, an embodied approach to cognition and sense-making building on insights from dynamic system theory, cognitive science and the phenomenology of the body. The data was analyzed using a qualitative content analysis. Paper I demonstrated that PTs perceive supervision as a complex process due to the many contingencies that occur. The PTs transformed their professional jargon into everyday language to enhance the aides’ understanding. Paper II showed that PTs use three supervision approaches, each of which gave rise to different forms of knowing. In paper III, we demonstrated that knowledge gained from the supervision sessions were not directly transferred to the preschool settings; aides transformed insights rather than applied them directly. The papers demonstrated that supervision in pediatric physiotherapy comprises temporal and transformative processes of knowing that extend beyond the mere linguistic. PTs need to address both the child and the aide in a combination of dyadic and triadic interactions. The aide’s work is also characterized by temporal and transformative processes, emphasizing that the application of knowledge is not a mere transfer of knowledge within and between contexts.