Boge-Olsnes Cathrine Maria, Risør Mette Bech, Øberg Gunn Kristin
Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Front Psychol. 2023 Aug 3;14:1166496. doi: 10.3389/fpsyg.2023.1166496. eCollection 2023.
There has been an increased use of standardized measurements in health care meant to provide objective information to enhance the quality and effectivity of care. Patient performance tests are based on standardized predefined criteria with a limited focus. When facing multifaceted health conditions, information expanding the predefined criteria in a standardized test may be required to understand the patient's complex symptoms. Relying on test information based on measurements according to functional biology, one risks missing information communicated by the sensitive and expressive body of the individual patient. The aim of this article is to investigate how body, self and illness perception is constituted as a co-construction between a physiotherapist and a patient with complex symptoms, expanding the use of a standard physiotherapy test.
This qualitative study is based on video-recordings and in-depth interviews of seven women with the complex health condition chronic pelvic pain. The video recordings consist of the patients performing the Standard Mensendieck test pre- and post-treatment with Norwegian psychomotor physiotherapy. The interviews are based on the patients and the physiotherapists conversations while watching and elaborating on these video recordings. Empirical data is analyzed within the theoretical perspectives of phenomenology and enactive theory, especially focusing on the concepts of embodiment and intersubjectivity.
Taking an embodied approach, considering the body as expressive, communicative, and vulnerable to the environment and context, the results show that through bodily expressions the patients experienced the test situation as demanding, thus providing information beyond what the test was intended to measure. Additionally, when administering a standardized test, the interaction between the therapist and the patient had an impact on the results. Sensitive attention towards the patients bodily expressive emotions as a vital part of the interaction, reinforced therapeutic alliance by ensuring the integrity and autonomy of the patient.
Mutual communication, gave new insights regarding the patients' complex symptoms and reinforced their belief in themselves and their recovery processes. Applying the patient's expertise on herself and her life together with the professional expertise may make health care an interdependent practice where sensemaking is a co-construction of meaning between the patient and the health personnel.
在医疗保健中，标准化测量的使用日益增加，旨在提供客观信息以提高护理质量和有效性。患者表现测试基于标准化的预定义标准，重点有限。当面对多方面的健康状况时，可能需要在标准化测试中扩展预定义标准的信息，以了解患者的复杂症状。仅依赖基于功能生物学测量的测试信息，可能会遗漏个体患者敏感且具表现力的身体所传达的信息。本文旨在探讨身体、自我和疾病认知如何在物理治疗师与有复杂症状的患者之间共同构建，从而扩展标准物理治疗测试的应用。
这项定性研究基于对七名患有慢性盆腔疼痛这一复杂健康状况的女性的视频记录和深入访谈。视频记录包括患者在接受挪威心理运动物理治疗前后进行标准门森迪克测试的情况。访谈基于患者和物理治疗师在观看和详细讨论这些视频记录时的对话。实证数据在现象学和生成理论的理论视角内进行分析，尤其关注体现和主体间性的概念。
采用体现方法，将身体视为有表现力、能交流且易受环境和情境影响的，结果表明患者通过身体表达体验到测试情境具有挑战性，从而提供了超出测试预期测量范围的信息。此外，在进行标准化测试时，治疗师与患者之间的互动会对结果产生影响。对患者身体表达情绪的敏感关注作为互动的重要部分，通过确保患者的完整性和自主性加强了治疗联盟。
相互交流为了解患者的复杂症状提供了新见解，并增强了他们对自身及康复过程的信心。将患者对自身及其生活的专业知识与专业人员的专业知识相结合，可能会使医疗保健成为一种相互依存的实践，其中意义建构是患者与医护人员之间意义的共同构建。
