Group-based and individualized physiotherapy for persons with multiple sclerosis - A qualitative observational and interview study

Abstract

Physiotherapy is a complex professional practice, particularly in the care for persons with multiple sclerosis (MS). Group-based organization of interventions is a common treatment approach in MS rehabilitation, regardless of limited knowledge on the nature of essential elements of such professional practices. This dissertation presents and discusses how actions and interactions affect opportunities and challenges for achieving success within a group-based and individualized intervention for people with MS.

The empirical material is based on 30 hours qualitative video observations of examinations and exercise sessions, and 26 hours in-depth interviews with physiotherapists (PTs), collected during the conduction of a group-based and individualized exercise intervention for persons with MS. Twenty-five clinical encounters were included, consisting of all together 40 patients led by six different PTs. The data material were transcribed and analyzed using Malterud’s systematic text condensation method, and theoretically interpreted through the enactive framework.

The results reveal that hands-on facilitation and individual adaptations provided movement changes and improvements that built the patients’ and PTs’ expectations and insights. Individualization in the exercise sessions depended on advanced ongoing evaluations and clinical reasoning, which could be challenged if patients’ functional levels differed largely. The patients’ individual improvements affected the group atmosphere positively, and were strengthened when the PTs encouraged the patients to share their experiences.

The results imply that bodily experiences and thought processes are closely connected, and require PTs who combine theoretical knowledge with practical skills and adapted interactional strategies. Although challenging, the group organization seems to provide opportunities for increased meaning-making, as the patients hold unique experiences that can lead to new insights through mutual interactions. These results contradict the prevailing view of group organization in physiotherapy, and propose that it seems possible to embed the benefits of individualization in group settings.