Embodiment, tailoring, and trust are important for co‐construction of meaning in physiotherapy after stroke: A qualitative study

Abstract

Background and Purpose Physiotherapy, with an emphasis on high intensity, individually tailored, and person‐centered treatment, is an effective route for recovery after a stroke. No single approach, however, has been deemed paramount, and there is limited knowledge about the patient experience of assessment, goal‐setting, and treatment in physiotherapy. In this study, we seek to report patient experiences of I‐CoreDIST—a new physiotherapy intervention that targets recovery—and those of usual care. The purpose is to investigate how individuals with stroke experience the bodily and interactive course of physiotherapy during their recovery process. Methods A qualitative study, nested within a randomized controlled trial, consisting of in‐depth interviews with 19 stroke survivors who received either I‐CoreDIST or usual care. Data were analyzed using systematic text condensation, and this analysis was informed by enactive theory. Results Interaction with the physiotherapist, which was guided by perceived bodily changes, fluctuated between being, on the one hand, formal/explicit and, on the other, tacit/implicit. The experiences of participants in the intervention group and the usual care group differed predominantly with regards to the content of therapy sessions and the means of measuring progress; divergences in levels of satisfaction with the treatment were less pronounced. The perception of positive bodily changes, as well as the tailoring of difficulty and intensity, were common and essential features in generating meaning and motivation. An embodied approach seemed to facilitate sense‐making in therapy situations. In the interaction between the participants and their physiotherapists, trust and engagement were important but also multifaceted, involving both interpersonal skills and professional expertise. Conclusion The embodied nature of physiotherapy practice is a source for sense‐making and meaning‐construction for patients after a stroke. Trust in the physiotherapist, along with emotional support, is considered essential. Experiencing progress and individualizing approaches are decisive motivators.

Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial

“…Our results are in line with previous research in stroke rehabilitation where results of clinical trials often are neutral (53,54), meaning there is no statistical significant difference between groups at endpoint (55). We did encounter some well-known challenges in stroke (58). Following 12 weeks of 3-5 weekly physiotherapy sessions, both groups showed both statistically and clinically significant improvements in measures of postural control and balance, sustained low levels of physical activity, and variable improvements in gait speed and distance.…”

Co-design for stroke intervention development: Results of a scoping review

“…For example, tailoring data collection to meet the needs of individuals with stroke is necessary because individuals with stroke have different needs (e.g., being mindful of participants' function when assigning physical tasks) [54,129,130]. Also, if individualized and tailored approaches to stroke care are common in clinical practice (e.g., [137][138][139][140]), these approaches should be adopted for research and data collection [141]. Researchers will need to allocate sufficient time (e.g., meeting with individuals before data collection to understand how to engage them in data collection meaningfully) and resources (e.g., accessible written communication) to tailor data collection activities to meet the needs of individuals with stroke [26,43,65].…”

Current Trends in Balance Rehabilitation for Stroke Survivors: A Scoping Review of Experimental Studies

“…Stroke survivors face unique challenges in their recovery journey. By offering a range of therapeutic approaches, healthcare professionals can tailor treatment plans to meet the specific needs of individual patients, optimizing their chances of successful recovery [54][55][56].…”