This paper applies a hybrid Heideggerian-ethnomethodological approach to physiotherapy practice. Unlike previous studies written by and for practitioners, this paper uses my personal experience receiving physical therapy as its point of departure. By combining Heidegger’s [Being and time (trans: Stambaugh J). State University of New York Press, New York 1996] notion of the ‘ontological difference’ with Garfinkel’s (Studies in ethnomethodology, Prentice-Hall, Englewood Cliffs 1967) concept of ‘accountability,’ I argue that in physical therapy practice, both client and practitioner actively shape (...) the body into a coherent object for medical intervention. I begin by introducing three key phenomenological concepts, the life-world, the ontological difference, and Heidegger’s critique of subjectivity. I then empirically substantiate these concepts by reviewing classic and recent studies in ethnomethodology. I conclude with my own experience of physical therapy, and demonstrate how both client and practitioner actively constitute the body as a medical and therapeutic object. This is cause for both disability studies and physiotherapy to reconsider some of their core concepts, ‘medicalization’ and ‘client-specific measurement,’ respectively. (shrink)

Background: In the university context, assessing students’ attitude, knowledge and opinions when applying an innovative methodological approach to teach professional ethics becomes fundamental to know if the used approach is enough motivating for students. Research objective: To assess the effect of a blended-learning model, based on professional ethics and related to clinical practices, on physiotherapy students’ attitude, knowledge and opinions towards learning professional ethics. Research design and participants: A simple-blind clinical trial was performed (NLM identifier NCT03241693) (control group, n (...) = 64; experimental group, n = 65). Both groups followed clinical practices for 8 months. Control group performed a public exposition of a clinical case about professional ethics. By contrast, an 8-month blended-learning programme regarding professional ethics was worked out for experimental group. An online syllabus and online activities were elaborated, while face-to-face active participation techniques were performed to discuss ethical issues. Students’ attitudes, knowledge and opinions towards learning professional ethics were assessed. Ethical considerations: The study was approved by the University Ethic Committee of Human Research and followed the ethical principles according to the Declaration of Helsinki. Findings: After the programme, attitudes and knowledge towards learning professional ethics of experimental group students significantly improved, while no differences were observed in control group. Moreover, opinions reported an adequate extension of themes and temporization, importance of clinical practices and interest of topics. Case study method and role playing were considered as the most helpful techniques. Conclusion: The blended-learning programme proposed, based on professional ethics and related to clinical practices, improves physiotherapy students’ attitudes, knowledge and opinions towards learning professional ethics. (shrink)

It may be unethical to deny children with cystic fibrosis access to ethically approved clinical trials from which they might benefitDespite advances in nutritional management, aggressive antibiotic usage, and physiotherapy, cystic fibrosis remains a life limiting illness with high morbidity that imposes considerable burdens on children and families.1 Although survival to 40 years is predicted for children born in 1990s, the median age of death in 2003 was 24.2 years.The pathophysiological features of CF are produced by a defective gene (...) on chromosome 7, resulting in the defective production of a protein that regulates cellular ion transport. Defective ion transport is thought to lead to increased mucus viscosity, with poor airway clearance, recurrent bacterial infection, lung damage, and death.Gene therapy, the insertion of a normally functioning gene into deficient host cells using a suitable vector, is a potential treatment or cure for diseases produced by single gene defects—for example, CF. Gene therapy does, however, have potential or actual risks, leading many to suggest that evidence of efficacy in adults should be demonstrated before trials are conducted in children. Many serious diseases in adults such as CF have their onset in childhood. If early treatment provides greater hopes of benefit, children may be more appropriate targets for GT in CF than adults. It may be unethical to deny them access to properly constructed, ethically approved clinical trials from which they might benefit.Since research in children should be scientifically valid, in the child’s best interests, and the subject of valid consent, this article will consider these parameters in relation to trials of GT in children with CF. Because of the importance of consumer participation in the design of research we present the results of a questionnaire about GT trials delivered …. (shrink)

Background of the study: Physiotherapists in Nigeria renewed their practicing license annually through the regulatory body and are provided with the professional code of ethics which stipulate the appropriate conduct, behaviour to guild and regulate the practice of their profession however, the level of knowledge, attitude and application of the ethical guidelines by Nigerian physiotherapists need to be investigated. Aim of Study: This study assessed the knowledge, attitude and perception of Nigerian physiotherapists in relation to the ethics of their professional (...) practice. Methodology: The cross-sectional study recruited 117 licenced Physiotherapists working in various health institutions in Nigeria. They were recruited for the study during the 2018 annual scientific conference of clinical and academic physiotherapists in Nigeria. Data on demographic, work experience, knowledge, attitude and perception of ethics of professional practise were obtained using a self-administered questionnaire. Data were summarized using a descriptive statistics of percentage and frequency distribution. Results: All the participants 117 (100%) had copies of code of ethics and oath of professional practise. 74.6% of participants had good knowledge of code of professional ethics while 25.39% had poor knowledge. Only 40.8% (48) of the respondents demonstrated good attitudes toward code of professional ethics. Similarly, only 43.4% (51) of the respondents demonstrated good attitude towards oath of professional practise. 57.0 % of the respondents have heard about ethical misconduct among colleagues while only 13.60% have been involved in ethical misconduct with respect to colleagues or patients. Greater proportion of the respondents (78.2%) considered ethics in physiotherapy as very important while 43.4% supported the introduction of physiotherapy ethics as a course to physiotherapy students in year three of their undergraduate training. Conclusion: Majority of Nigerian physiotherapists have good knowledge of professional code of ethics and oath of professional practise, however, their attitudes towards periodic updating their knowledge on code of ethics and professional oath remain poor. Clinical implication and recommendation: Ethical matter are very important to the practise of physiotherapy, however the poor attitudes of physiotherapy toward updating their knowledge on ethical matters calls for the need for the regulatory body and the professional association to organise seminars and workshops on ethics in physiotherapy and introduce pre-renewal test on ethics before annual licence renewal. (shrink)

There are currently no instruments available to measure ethical sensitivity in the therapeutic sciences. This study therefore aimed to develop and implement a measure of ethical sensitivity that would be applicable to four therapeutic professions, namely audiology, occupational therapy, physiotherapy, and speech-language pathology. The study followed a two-phase, sequential exploratory mixed-methods design. Phase One, the qualitative development phase, employed six stages and focused on developing an instrument based on a systematic review: an analysis of professional ethical codes, focus group (...) discussions, in-depth interviews, a review of public complaints websites, and an expert panel review. The development phase culminated in the Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences (MIEST), a pen-and-paper measure for studying ethical sensitivity in the therapeutic sciences.Phase Two, the quantitative stage, focused on implementing the MIEST in two different stages. A total of 100 participants completed the instrument. MIEST scores were found to be comparable for all four professions, which confirmed the multidisciplinary usability of the instrument. Participants tended to base decisions on the ethical principle of beneficence. The MIEST is effective to assess and describe the ethical sensitivity of professionals in the four specified therapeutic sciences. The constructed vignettes also make the MIEST appropriate for use in problem-based learning programs. (shrink)

While robot-assisted arm and hand training after stroke allows for intensive task-oriented practice, it has provided only limited additional benefit over dose-matched physiotherapy up to now. These rehabilitation devices are possibly too supportive during the exercises. Neurophysiological signals might be one way of avoiding slacking and providing robotic support only when the brain is particularly responsive to peripheral input. We tested the feasibility of three-dimensional robotic assistance for reach-to-grasp movements with a multi-joint exoskeleton during motor imagery-related desynchronization of sensorimotor (...) oscillations in the β-band only. We also registered task-related network changes of cortical functional connectivity by electroencephalography via the imaginary part of the coherence function. Healthy subjects and stroke survivors showed similar patterns – but different aptitudes – of controlling the robotic movement. All participants in this pilot study with nine healthy subjects and two stroke patients achieved their maximum performance during the early stages of the task. Robotic control was significantly higher and less variable when proprioceptive feedback was provided in addition to visual feedback, i.e. when the orthosis was actually attached to the subject’s arm during the task. A distributed cortical network of task-related coherent activity in the θ-band showed significant differences between healthy subjects and stroke patients as well as between early and late periods of the task. Brain-robot interfaces may successfully link three-dimensional robotic training to the participants’ efforts and allow for task-oriented practice of activities of daily living with a physiologically controlled multi-joint exoskeleton. Changes of cortical physiology during the task might also help to make subject-specific adjustments of task difficulty and guide adjunct interventions to facilitate motor learning for functional restoration. (shrink)

BackgroundEven though virtual reality is more and more considered for its power of distraction in different medical contexts, the optimal conditions for its use still have to be determined in order to design interfaces adapted to therapeutic support in oncology.ObjectiveThe objective of this study was to examine the benefits of VR using two immersion methods and comparing them with each other in a population of women with breast cancer who have undergone breast surgery, during scar massage sessions.MethodsIn a physiotherapy (...) center, each patient participated in four experimental conditions in a random order: two sessions used virtual immersion, one session proposed musical listening and the fourth one was a standard session care. The impact of the level of patient involvement in the virtual world was apprehended through the evaluation of the feeling of presence; the estimation of elapsed time of the physiotherapy sessions and particular attention was paid to the evaluation of patient emotional state.ResultsOur study showed an increase in positive emotions and a decrease in anxiety regardless which support methods were offered. Participatory VR created a feeling of more intense spatial presence.ConclusionOur results highlight the importance of the context in which VR should be offered. The presence of the practitioner and his interactions with the patient can provide a context just as favorable in reducing anxiety as the emotional regulation tools used. The use of technological tools should be favored when the practitioner is unavailable during the treatment phase or, even, in order to reduce the monotonous nature of repetitive therapeutic sessions. (shrink)

Subacromial impingement syndrome is a common condition in clinical practice, characterized by shoulder pain and functional limitations. This study aims to compare the effectiveness of virtual reality-based therapy (VR) and traditional therapy in improving functional outcomes, while also analyzing correlations between key assessment tools: the Disabilities of the Arm, Shoulder, and Hand Score (DASH), the Simple Shoulder Test (SST), and the Constant-Murley Score (CMS). Patients were divided into two groups (VR therapy vs. traditional therapy), and their progress was assessed using (...) these tools. The results revealed significant improvements in functional scores for both groups, with the VR group demonstrating slightly superior outcomes. VR has not only revolutionized individual patient care but also provided scalable solutions in physiotherapy clinics, aligning with modern healthcare management principles. A correlation analysis indicated strong positive relationships between DASH, SST, and CMS scores, highlighting their consistency in evaluating shoulder function. Additionally, significant negative correlations were observed between functional scores and pain ratings, emphasizing the critical role of pain management in treatment success. These findings suggest that VR therapy is an effective complement to traditional methods, providing enhanced engagement and measurable improvements in shoulder function. The study underscores the importance of integrating innovative approaches like VR into rehabilitation strategies, paving the way for personalized and multidimensional care in subacromial impingement syndrome. This study highlights how VR-based interventions align with international trends in digital health innovation, particularly in East European rehabilitation centers that have successfully integrated VR-based therapies. (shrink)

Many countries, including Australia, have established a national scheme that supports the recognition of a single ethical review for multi-centre research conducted in publicly funded health services. However, local site-specific governance review processes remain decentralised and highly variable. This short report describes the ethics and governance processes required for a negligible risk national survey of physiotherapy-led airway clearance services in Australia. We detail inconsistencies in research governance document preparation and submission (platforms, processes, forms and signatories) and report the time (...) cost and likely impact of these inconsistencies on health services research outcomes. Processes and strategies that facilitated success in this project are identified and summarised as helpful hints to other researchers looking to embark on negligible risk research in public health facilities. (shrink)

Background During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under severe pressure. During this time, bachelor’s degree programs in nursing, physiotherapy and occupational therapy were disrupted, and students in their second year were displaced. Students experienced the continuous reorganisation of their traineeship as healthcare facilities adapted to a climate of uncertainty. Purpose The aim of this study was to investigate the degree of moral distress and (...) the ethical issues most often encountered by physiotherapy, nursing and occupational therapy students enrolled in a traineeship during the first wave of the COVID-19 pandemic in southern Switzerland. Participants and research context The sample consisted of 102 participants, and the response rate was 81.6%. Research design Based on a pragmatic approach, a mixed-method with a convergent design was adopted. Data were collected between 30 April 2020 and 14 May 2020, via a survey administered to all occupational therapy, physiotherapy and nursing students in their fourth semester. Ethical considerations Given that no vulnerable persons were involved, the Ethics Committee of Southern Switzerland waived authorisation. However, all measures were put into place to protect participants by guaranteeing their anonymity and confidentiality. Results and discussion The data analysis showed that the main source for moral distress was ‘poor teamwork’ and that the moral issues encountered most often by students were related to the appropriateness of care and working conditions, with a clear reference to students’ own safety and that of their loved ones; the other concerns reported included the loss of learning opportunities and the perceived lack of technical knowledge and skills. Conclusions This survey offers a faithful overview of physiotherapy, nursing and occupational therapy students’ experience during the first pandemic wave. This study also identifies some key recommendations for healthcare professions’ education. (shrink)

:A common goal of ethics education is to equip students who later become health practitioners to not only know about the ethical principles guiding their practice, but to also autonomously recognize when and how these principles might apply and assist these future practitioners in providing care for patients and families. This article aims to contribute to discussions about ethics education pedagogy and teaching, by presenting and evaluating the use of the visual arts as an educational approach designed to facilitate students’ (...) moral imagination and independent critical thinking about ethics in clinical practice. We describe a sequence of ethics education strategies over a 3 year Doctor of Physiotherapy program, focusing on the final year professional ethics assessment task, which involved the use of visual arts to stimulate the exploration of ethics in healthcare. The data were analyzed using both thematic and content analysis. Two key themes centered on emotional responses and lateral thinking. The use of artwork appeared to facilitate imaginative, emotional, and conceptual thinking about ethics and clinical experience. This study provides some evidence to support the effectiveness of the use of the visual arts in promoting students’ recognition of ethical dimensions within their clinical experience and reflection on their emerging professional identity. As one student noted, she left the museum “somewhat changed.”. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 (...) across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

Dans le contexte actuel de longs délais d’attente pour accéder aux services de réadaptation, la grande majorité des établissements utilisent la priorisation des demandes de référence pour aider à gérer les listes d’attente. Les pratiques de priorisation varient grandement d’un milieu à l’autre et il y a peu de consensus sur la meilleure façon de prioriser les demandes de référence. Cet article décrit les processus de priorisation de services en physiothérapie au Québec et leurs implications potentielles en termes d’équité dans (...) l’accès aux services. Il s’agit d’une analyse secondaire d’une enquête menée en 2015 auprès des cliniques externes en physiothérapie (n=98 ; la proportion de participation était de 99 %) dans les hôpitaux publics du Québec. Dans de nombreux milieux, les personnes ayant une condition orthopédique aigüe étaient priorisées, tandis que les conditions chroniques recevaient une priorité moindre. Nous avons comptabilisé 72 combinaisons différentes de critères de priorisation utilisées dans les cliniques externes de physiothérapie. Nous avons également observé une variabilité dans le type de personnel impliqué dans le processus de priorisation, le nombre de niveaux de priorité utilisés pour classer les demandes de référence et la source d’information utilisée pour établir la priorisation. Ces résultats mettent en lumière des enjeux potentiels concernant l’équité dans l’accès aux services de physiothérapie : la priorisation des personnes atteintes de conditions aigües au détriment de celles atteintes de conditions chroniques, l’absence de consensus sur un processus de priorisation équitable et la nécessité d’évaluer adéquatement les besoins de traitement des patients. De futures recherches et interventions sur les critères et les processus de priorisation sont nécessaires pour assurer un accès équitable aux services de physiothérapie, en particulier dans le secteur public. (shrink)

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians (...) to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations. (shrink)

This paper presents a qualitative study investigating the application of physiotherapists’ professional ethics in practice with respect to touch, intimacy, and corporeality during therapy, based on the experiences of elderly patients. As the relationship in a physiotherapy session is multidimensional, the study considered three levels: physical contact, verbal contact, and the conditions in which the therapy took place. The aim of this study was to find out what values are of importance to older people during a physiotherapy session, (...) with emphasis on the categories of touch, corporeality, and intimacy. The studied group consisted of sixteen male and female physiotherapy patients aged between sixty-six and ninety-two years. The study was conducted according to the grounded theory methodology. The research material consisted of transcriptions of free targeted interviews, which were subjected to a process of coding and analysis. As a result of data analyses, three superior categories have been identified—safety, anxiety, interpersonal relationship—and three a priori categories stemming from the characteristic features of the study area—touch, corporeality, and intimacy. The a priori categories did not appear independently in statements made by the respondents, but instead seemed to be components of superior categories. The most important values indicated by the respondents concerned the interpersonal relationship with their physiotherapist and the feeling of safety and care. In terms of touch, corporeality, and intimacy, the respondents indicated, among others, the importance of predictability, a sense of security, privacy, and acceptance of the body. (shrink)

BackgroundLittle is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational (...) or vocational variables?MethodsAn observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: (A) Physiotherapist and patient interaction (19 items), (B) Physiotherapist and other health professionals including other physiotherapists (10 items), (C) Physiotherapists and the system (5 items) and (D) Professional and economic ethical situations (12 items).ResultsThe two most frequently experienced ethical issues were ‘Scarce resources and time affecting quality of physiotherapy treatment’ and ‘Physiotherapy not accessible to all people in society who need it’. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of ‘Physiotherapists and the system’ were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts.ConclusionThis study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists’ ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice. (shrink)

At present, in the UK, live lobe donation of the lung is generally considered in the context of patients with cystic fibrosis (CF) which is a life-threatening, inherited disease.1 However, if this technique is successfully developed it may be applicable to other patients with end stage lung disease. Cystic fibrosis is a disease where the major morbidity and mortality is due to pulmonary infection and respiratory failure.2 In l938 70% of patients born with CF died within one year of birth, (...) but now the average survival has improved to 32 years.1 The improved survival has been due to improved medical care, but also, and in very large measure, to the devotion of the families who have carried out time-consuming daily treatments such as chest physiotherapy, nebuliser treatment, high calorie diets etc. To these patients and their families lung transplantation brought new hope.3 The first successful transplant for CF was performed in the UK in 1985 and we now have patients alive and well more than ten years after transplantation. However, sadly, nearly 50% of patients with CF die on the transplant waiting list because of a shortage of donor organs from brain stem dead donors. This is a tragedy for the individual patient, the families and those who care for them. Is there a way forward? Education of the public so that a relative of a brain dead individual will give permission for the organs to be used has been carried out for many years but only with a small increase in the number of available organs. “Required request” where doctors would be required, by law, to ask relatives of brain dead patients to consider transplantation and “assume consent” where consent to donation is assumed unless there is evidence to the contrary, do not have the …. (shrink)

The word “dignity” refers to a certain pre-eminence of the human being, granting it an irreplaceable value. It is universal and common to all people. To safeguard dignity, health professionals must have a correct understanding of its meaning and how it manifests through concrete actions in daily care. From this perspective, we sought to understand how health students perceive this concept and use it in patient care during clinical practice. This study aimed to unveil the concept of dignity from the (...) experiences of final-year health students at a Chilean university. Seventeen final-year university students from nursing, physiotherapy, medicine, obstetrics, and occupational therapy programs participated in the study. Data were collected through qualitative questionnaires, seventeen in-depth interviews, and a focus group conducted between March and November 2022. Grounded theory was used for data analysis. For the students, dignity is an inherent value to every human being throughout their life cycle, regardless of their health condition. The concept is developed through modelling by parents and university professors and enriched by experiences during clinical practice. It manifests through respect for individuality, privacy, and the value of the person, recognising the reciprocity between patient and caregiver. It is considered a fundamental ethical premise in both personal and professional fields. The study concludes that the dignity of the person is a central value for health students. For the educators of future professionals, promoting dignity should be an ethical responsibility that encompasses both theoretical teachings and practical experiences. (shrink)

Frailty is a major concern for healthy ageing, reflecting declining functional capacity and increased vulnerability. Beyond clinical implications, frailty raises questions about how health systems recognise vulnerability, allocate responsibilities, and ensure equitable care. These challenges align with the Sustainable Development Goals (SDGs). Health system readiness refers to the capacity of health systems to adapt policies, infrastructure, and operational processes to integrate frailty care into routine service delivery. In low- and middle-income contexts, frailty remains insufficiently embedded within health system frameworks, limiting (...) coordinated responses. This study examines how readiness for frailty care is understood and enacted by frontline healthcare professionals. Using a qualitative design, five focus group discussions were conducted (March–July 2024) across healthcare settings in Indonesia and Malaysia. Nineteen participants, representing nursing, medicine, physiotherapy, and pharmacy, were purposively recruited. Data were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis supported by NVivo. Analytical rigour was enhanced through investigator triangulation, team-based coding, and member checking. Four interrelated themes reveal systemic gaps. Frailty remains largely invisible in policy and clinical frameworks; professional roles are fragmented and weakly coordinated; care responsibilities are displaced to families and communities; and structural resource constraints limit implementation. These findings indicate uneven readiness. Strengthening readiness requires alignment across governance, service delivery, and workforce capacity to address inequities in the distribution of care responsibilities. Frailty thus emerges as a critical lens for evaluating health system governance in ageing societies. (shrink)

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples’ health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non‐Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non‐Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest (...) educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal‐led curriculum. Of relevance to this is educator training in how to decentre non‐Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well‐designed professional development. (shrink)

The training of healthcare professionals goes beyond technical skills, requiring the development of humanistic competencies to balance the technical and the human aspects. Bioethics, essential in health programs, addresses juridical-moral conflicts arising from the interaction between social values and science. The inclusion of bioethics in curricula is crucial to prepare healthcare professionals for contemporary ethical dilemmas. This study aims to highlight the perception of bioethical and professional deontology knowledge among Health Degree students, providing a critical foundation to strengthen ethical education (...) and address emerging ethical challenges in their professional practice. A total of 150 students in physiotherapy, nursing, and psychology at the European University of Valencia were evaluated through an Ad-Hoc survey. The scale measured bioethical knowledge with 19 Likert-scale items. Internal consistency was adequate (α = 0.872). Statistical analysis revealed significant differences in bioethical knowledge among the studied degrees (p<0.05). First-year students scored higher on “The end justifies the means” and “I know the principle of beneficence. ” First and third-year students valued equality in patient treatment. In applied ethics, fourth-year students stood out. (shrink)

The training of healthcare professionals goes beyond technical skills, requiring the development of humanistic competencies to balance the technical and the human aspects. Bioethics, essential in health programs, addresses juridical-moral conflicts arising from the interaction between social values and science. The inclusion of bioethics in curricula is crucial to prepare healthcare professionals for contemporary ethical dilemmas. This study aims to highlight the perception of bioethical and professional deontology knowledge among Health Degree students, providing a critical foundation to strengthen ethical education (...) and address emerging ethical challenges in their professional practice. A total of 150 students in physiotherapy, nursing, and psychology at the European University of Valencia were evaluated through an Ad-Hoc survey. The scale measured bioethical knowledge with 19 Likert-scale items. Internal consistency was adequate (α = 0.872). Statistical analysis revealed significant differences in bioethical knowledge among the studied degrees (p. (shrink)

Many physiotherapists are reluctant to treat a client with bone metastases, as treatment indications are not clearly defined. The paradigmatic case presented here, and a review of the literature, allow us to highlight some ethical and clinical issues in physiotherapy care at the end of life, particularly for patients with bone metastases. The objective of this article is not to create an ethical decision making model but rather to serve as additional guidance to existing decision models in rehabilitation. This (...) guidance is based on principlism and is specific to the oncology clients in palliative care. The proposed principles, without being exhaustive, are beneficence, non-maleficence, respect for autonomy and justice. With a review of clinical indications and precautions, the article also helps to clarify both the theoretical and the evidence-based risks. These principles provide avenues for reflection to guide the management of these patients. The physiotherapist will then be able to conduct a critical analysis, in collaboration with the interdisciplinary team, whose goal is to respect the client’s right to appropriate care at the right time and that is based on clinical need. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Note on Being Ability–different, Atypically–bodied... Criptastic?Emily HutcheonIn being prompted to write about my experiences with disability [alternatively written: (dis)ability, dis/ability, “disability,” disAbility], I am confronted with more questions than I have answers. Am I to reflect on that small window of time, one so small that I don’t actually remember it, when I did not know that I was different? My mom [End Page 196] has recounted vivid (...) moments where I seem to come to this realization—for example, at the age of three, when I see my twin sister and friends scrambling on a playground and I process that I am unable to join them. Realization of my differentness (my different body, my different way of moving, my different abilities) continued into my youth and adulthood (Can’t skate—check. Can’t ride a two–wheeled bike—check. Usually walk behind others, destined to be the last in a group—check. Was the smart kid in class, aka smartass–in–training—check).Eventually, I realized that my differentness was not contained to my body or my abilities. Were my mind, my self, and my relationships different as well? I seemed to empathize when others didn’t or couldn’t. I saw that certain things were just wrong, and was confused when others didn’t share my concern. I seemed to see, feel, and experience things that others did not. For instance, I had two invasive operations before the age of eleven, a handful of minor procedures and countless physiotherapy sessions. Some memories of these times are horrific. Some I cherish, including the genuine care of the health care staff. Some are hilarious, like being doped–up before invasive surgery at the age of ten and calling my favorite surgeon “So cute!!” But always, there was physical pain, pain, pain. At times, I was completely dependent on others to help me to the bathroom, the shower, to move around, and to recover. I received such tender and exquisite care from my mom during these times. The dependency, which I had no choice but to experience, the dependency that is feared by almost everyone I know (“If I am ever a burden to my family, shoot me”) is something that my mom and I constantly joke about (“Em, I will take care of you now, only if you change my diapers when I’m old, kay?”). I have come to learn that this dependency, along with those other shades of vulnerability, are an inevitable consequence of being human, and to deny this is to relinquish our capacity to connect with others.I had, and continue to have, relationships with strangers, friends and family, which are, in my best estimation, atypical. I am the recipient of staring, laughing, pointing, sympathy, disgust, empathy, tender care, curiosity, hostility, resentment, and ambivalence. While in the gym, complete strangers approach me to say, with all the kindness, enthusiasm, and obliviousness in the world: “Glad to see you out and about. Good for you!” For some, I am to be protected; for others, I am to be tiptoed around; and for others, I am to be congratulated for “overcoming my circumstance” and for being oh–so–valuable to society because of my smarts and productivity.It is a rare few who accept what Cerebral Palsy and epilepsy offer to my life and to their own, with all of their accompanying complexities, possibilities, and contradictions.It is ironic that the excellent health care and services I have received, which have probably changed my life for the better, are only made possible because of the “disability” label, which I have come to heartily dislike. I have always felt ill–at–ease with this word and concept. In my mind, it just does not describe me or others around me. Perhaps more accurately, the definitions and associations that stubbornly accompany the term (e.g., the disabled person as asexual, passive and in need of protection, the disabled person as the conquering hero) would never accurately describe me. Undoubtedly, the term is negative in its connotations. And, of course, the concept of disability relies on certain notions of “normal.” By most accounts in... (shrink)

Background Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. Research Question What factors contribute to Moral distress among physiotherapists and how do they cope? Objectives To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. Research Design A 2017–2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing (...) a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. Participants and Context Israeli physiotherapists from various occupational settings recruited via professional networks. Ethical Considerations The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. Findings Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. Discussion Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. Conclusions Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies. (shrink)

This study clarifies the need for a renewed account of the body in physiotherapy to fill sizable gaps between physiotherapeutical theory and practice. Physiotherapists are trained to approach bodily functioning from an objectivist perspective; however, their therapeutic interactions with patients are not limited to the provision of natural-scientific explanations. Physiotherapists’ practice corresponds well to theorisation of the body as the bearer of original bodily intentionality, as outlined by Merleau-Ponty and elaborated upon by enactivists. We clarify how physiotherapeutical practice corroborates (...) Merleau-Ponty’s critical arguments against objectivist interpretations of the body; particularly, his analyses demonstrate that norms of optimal corporeal functioning are highly individual and variable in time and thus do not directly depend on generic physiological structures. In practice, objectively measurable physical deviations rarely correspond to specific subjective difficulties and, similarly, patients’ reflective insights into their own motor deficiencies do not necessarily produce meaningful motor improvements. Physiotherapeutical procedures can be understood neither as mechanical manipulations of patients’ machine-like bodies by experts nor as a process of such manipulation by way of instructing patients’ explicit conscious awareness. Rather, physiotherapeutical practice and theory can benefit from the philosophical interpretation of motor disorders as modifications of bodily intentionality. Consequently, motor performances addressed in physiotherapy are interpreted as relational features of a living organism coupled with its environment, and motor disorders are approached as failures to optimally manage the motor requirements of a given situation owing to a relative loss of the capacity to structure one’s relation with their environment through motor action. Building on this, we argue that the process of physiotherapy is most effective when understood as a bodily interaction to guide patients towards discovering better ways of grasping a situation as meaningful through bodily postures and movements. (shrink)

This contribution focuses on a physiotherapy consultation in which the first author of the contribution is the patient and the second author is the physiotherapist. It features analysis of video excerpts in which (1) the physiotherapist instructs the patient how to do an exercise and (2) the patient turns the physiotherapist's instructions into a course of action while (3) the physiotherapist monitors, assesses, guides, and corrects the patient's instructed actions by deploying touch. The investigation draws on video-recordings and transcriptions (...) of the physiotherapist’s and the patient’s interaction during the exercise instructions, the authors’ experience of touching/being touched during these instructions, and their shared understandings as discussed during data-sessions devoted to select video-clips of exercise instructions. In a learning process, the instructor’s instructional corrections are critical: they provide learners with relevant specifications and explanations as to how instructed actions and/or remedial actions are to be accomplished. Whereas monitoring and touching the patient allows the physiotherapist to feel, assess, correct, and guide the patient’s instructed actions, being touched permits the patient to feel how the physiotherapist’s touch resonates beyond locally circumscribed body contact and adapt her movements accordingly. Our contribution thus reveals touching/being touched configurations that establish joint attention and action on extended sensoriality as forming constitutive parts of a dynamic sensorimotor process of inter- and intrabodily resonance, which is challenging to investigate. (shrink)

[In Czech] This article aims to explain how Merleau-Ponty’s phenomenological account of embodiment contributes to the theory and practice of physiotherapy. The mechanistic conception of the body, to which physiotherapy usually refers, assumes a universal model of its functioning and interprets its relationship to the environment causally. In fact, however, it does not allow a satisfactory explanation of the efficiency of the therapeutic methods used in practice. In contrast, Merleau-Ponty’s concept of motor intentionality points to the fact that (...) the body “understands” the practical meaning of a situation. Bodily understanding is then manifested in particular by the ability to adequately differentiate, adapt or vary motor and postural responses to environmental challenges. This change in the conception of embodiment also has important implications for understanding the therapist-patient relationship and the intervention itself. Physiotherapists should draw more on the fact that they are themselves a body and, on this basis, guide the patient’s bodily intentionality towards a more developed understanding of the practical meaning of situations. (shrink)

This paper addresses the ontological status of the body in the context of bodily practices in body-oriented disciplines, such as sport training, dance, and physiotherapy. Following Descartes’, Huss...

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or (...) other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals. (shrink)

BackgroundPatients have the right to equal, respectful treatment. Nowadays, one third of patient complaints concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to analyze the ethical competence of practicing physiotherapists.MethodA self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation Tool) based (...) on an analysis of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health services or private practice responded to the questionnaire.ResultsBased on the results, most of the physiotherapists evaluated themselves highly ethically competent in all areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was evaluated as highest, while character strength, including the strength to support ethical processes and speak on behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the international or national ethical codes of conduct.ConclusionsThis was the first attempt to assess all aspects of ethical competence empirically in a clinical environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’ viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient. (shrink)

Background: Physical exercises can affect executive function both acutely and chronically, with different mechanisms for each moment. Currently, only a few reviews have elaborated on the premise that different types of exercises have different mechanisms for improving executive function. Therefore, the primary purpose of our systematic review was to analyze the effects of acute and chronic exercises on executive function in children and adolescents.Objective: We identified acute and chronic exercise studies and randomized controlled trials of executive function in children and (...) adolescents that reported overall effect, heterogeneity, and publication bias of acute and chronic exercises on executive function.Methods: We searched for RCTs of exercise interventions in children and adolescents from databases including PubMed, Web of Science, Scopus, The Cochrane Library, CNKI, and Wanfang, from January 1 2009 to December 31 2019. We performed methodological quality evaluations on the included literature using the Physiotherapy Evidence Database Scale and graded evidence with a meta-analysis using Stata 12.0 software.Results: In total, 36 RCTs were included ; the overall results of the meta-analysis indicated that acute exercises significantly improved working memory = −0.72; 95% confidence interval −0.89 to −0.56; p < 0.001), inhibitory control, and cognitive flexibility, whereas chronic exercises significantly improved working memory, inhibitory control, and cognitive flexibility.Conclusion: Acute and chronic exercises can effectively improve the executive function of children and adolescents. The effects on inhibitory control and cognitive flexibility are considered as small effect sizes, while the effects on working memory are considered as moderate effect size. Limited by the quantity and quality of the included studies, the above conclusions need to be verified with more high-quality studies. (shrink)

This article is dealing with the professionalization intention of a physiotherapy trainer through an innovative plan called «Training group on the analysis of rehabilitation practicing». This innovative plan has been created by the management team of a physiotherapy training institute, in South of France, in response to the 2015 reforms about the studies leading to the state-registered diploma of physiotherapist. Thanks to the studies of both the genesis and goal of that plan, plus the observation of its application (...) by a trainer, this study is trying to give a few answers to the following question: How role-playing and the collective analysis the TGARP has implemented can help physiotherapy students develop their professionalization and reflexivity during their full-time education? (shrink)

This contribution aims to understand the process of renormalisation operated at the level of internship tutors by the management team in a French physiotherapy training institute, faced with the implementation of a reform of the studies. The study is based on the concepts of corporate social responsibility (CSR) and leadership and on a three-year interview survey with the management. The results highlight the issues encountered in the first year and the training dynamics implemented in the third year. The discussion (...) debates the evolution of CSR and the concomitant leadership it develops. (shrink)

Rehabilitation and palliative care are increasingly playing a major role in medicine, surgery, nursing, physiotherapy and related professions. We believe that the same value should still characterize observation and palpation. Accordingly, the gains in the Medical Humanities from the analysis of themes related to the touching/touched experience are documented here and the features of two outstanding works (Borges’s Tlön, Uqbar, Orbis Tertius and Derrida’s Le Toucher) are called into question. We will try to explore the meaning of the senses (...) as well as the sensibilia as natural kinds of clinical phenomenology, thereupon the intelligibility and the supremacy of corporeality, contact, touching and haptic perception are stressed. (shrink)

IntroductionAt present, in the UK, live lobe donation of the lung is generally considered in the context of patients with cystic fibrosis which is a life-threatening, inherited disease.1 However, if this technique is successfully developed it may be applicable to other patients with end stage lung disease. Cystic fibrosis is a disease where the major morbidity and mortality is due to pulmonary infection and respiratory failure.2 In l938 70% of patients born with CF died within one year of birth, but (...) now the average survival has improved to 32 years.1 The improved survival has been due to improved medical care, but also, and in very large measure, to the devotion of the families who have carried out time-consuming daily treatments such as chest physiotherapy, nebuliser treatment, high calorie diets etc. To these patients and their families lung transplantation brought new hope.3 The first successful transplant for CF was performed in the UK in 1985 and we now have patients alive and well more than ten years after transplantation. However, sadly, nearly 50% of patients with CF die on the transplant waiting list because of a shortage of donor organs from brain stem dead donors. This is a tragedy for the individual patient, the families and those who care for them. Is there a way forward?Can the number of organs available for transplantation be increased?Education of the public so that a relative of a brain dead individual will give permission for the organs to be used has been carried out for many years but only with a small increase in the number of available organs. “Required request” where doctors would be required, by law, to ask relatives of brain dead patients to consider transplantation and “assume consent” where consent to donation is assumed unless there is evidence to the contrary, do not have the …. (shrink)

This article examines how functional neurological disorder (FND), historically called hysteria, is currently enacted in biomedical treatment discourse. Drawing on Annemarie Mol's concept of enactment, it explores how different therapeutic approaches produce divergent versions of the disorder across symptom clusters. Through a close reading of eleven narrative reviews published between 2016 and 2025, I analyse how targeted therapies for functional motor symptoms and functional seizures are justified, how they relate to diagnostic logic, and how they are shaped by historical assumptions. (...) While both symptom clusters are diagnosed through rule-in criteria based on physical signs—rather than psychological aetiology—their treatment diverges substantially. Functional motor symptoms are increasingly addressed through FND-specific physiotherapy, grounded in neuroimaging studies and aimed at retraining automatic movement. Functional seizures, by contrast, are treated through adapted psychological therapies, particularly CBT-based interventions targeting emotion, stress, and behaviour. This divergence, I argue, enacts a therapeutic split that implicitly reflects a historical mind-body dualism. The disorder is neurologically diagnosed in both cases, yet treated physically in only one. Rarely problematised in the literature, this discrepancy has consequences for patients and FND's coherence as a diagnosis. This finding highlights a structural inconsistency in current clinical reasoning and raises questions about how FND might be managed without perpetuating outdated assumptions about emotion and the nature of somatic symptoms. (shrink)

Game-based approaches are emerging in many fields, such as education, social sciences, marketing and government. Most studies debate its role in consolidating learning, guided by both internal and external rewards. These approaches are also being applied in rehabilitation, where patients must undergo a re-learning process of motor gestures after an injury to a body structure. In physiotherapy, much importance is given to analytical-functional movement aspects, but less to the recovery of the complete experience, including motivation, perception, and emotional experience (...) of the patient during the process. The aim of this narrative review is to investigate the role of subjective experience in the application of gamification in physiotherapy, considering the added value it provides to recovery by involving neural structures, not just motor functions. By analyzing the most investigated aspects in using gamification in rehabilitation, we will outline the primary methods of investigation into the engagement and emotions involved in the process. Through a selection of scientific articles found on main databases, we identified articles investigating the patient’s experience. The analysis of these articles was based on aspects related to the recovery of movement, the technology used, as well as the methods of investigation and collection of qualitative data regarding the emotions and perceptions of patients during the gamification experience. The results are divided into two primary topics. Overall, this review supports the idea that gamification could represent a rehabilitation approach integrating physiotherapy, more suitable for the final stages of recovery, such as returning to work or sports. (shrink)