Getting in touch: Communication in physical therapy practice and the multiple functions of language

Abstract

In physical therapy, communication that actively involves the patient is seen as the foundation of patient-centered treatment. Research on communication in physical therapy highlights how patients' opportunity to actively participate is often limited by the therapists' focus on biomedical facts and clinical tasks. Few studies have explored aspects of communication in clinical practice that may promote patients' active participation. The aim of this study is to shed light on verbal and nonverbal communication used by physical therapists to get in touch with patients and how this physical and linguistic touching may contribute to encouraging patients' participation. The selected case is from a qualitative observational case study of the first encounter between a female physical therapist and a male patient with chronic neck pain. Drawing on theories about communication and the metafunctions of language, the findings highlight how the therapist's use of unfinished sentences, repetitions of the patient's own words, touch, gaze and accepting interruptions from the patient promotes the patient's participation. Demonstrations of the use of linguistic communication theory in this study may contribute to enhancing physical therapists' self-awareness around communication and how to get in touch with patients, which is a fundamental element in patient-centered treatment.

Legitimacy in clinical practice: How patients with chronic muscle pain position themselves in the physiotherapy encounter

“…Elliot Mishler 34 conceptualizes the encounter between patients and medical professionals as a struggle between the ‘voice of the life world’ and the ‘voice of medicine’, in which the first tends to be suppressed by the latter. To empower the patients and give them the opportunity to communicate their illness experiences and position themselves as subjects with specific needs and interests, we suggest, in line with Mishler and others, that the physiotherapists try to keep their questions open‐ended and listen to the patients' responses with minimal interruptions, and repeat the patients' own linguistic formulations 34–36 . This includes giving up control of a fixed interview format or method.…”

“…To empower the patients and give them the opportunity to communicate their illness experiences and position themselves as subjects with specific needs and interests, we suggest, in line with Mishler and others, that the physiotherapists try to keep their questions open-ended and listen to the patients' responses with minimal interruptions, and repeat the patients' own linguistic formulations. [34][35][36] This includes giving up control of a fixed interview format or method. We believe, however, that gaining new insight into own practice-the patients' positioning work and interactions with the therapists-in itself may lay the foundation for change and new ways of acting for the therapists.…”

The role and function of body communication in physiotherapy practice: A qualitative thematic synthesis

“…Patients said that these adjustments increased their awareness and understanding of their own body reactions and contributed to their knowledge of their problem. This form of "bodily dialogue" between patient and therapist was observed in multiple studies (Ahlsen & Nilsen, 2022;Bjorbaekmo & Mengshoel, 2016;Buhl & Pallesen, 2015;Ekerholt & Bergland, 2004.…”

“…Examples included maintaining eye contact, sitting quietly, and not interrupting the patient as they spoke (Ekerholt, 2011). Physiotherapists could also signal presence by changing their body communication in response to the patient's communication (Ahlsen & Nilsen, 2022). The authors provided an example of where the physiotherapist had started to move away from the patient, but the patient started talking.…”

“…Theme 3: Guiding physiotherapy intervention through bodily dialogue By attuning to patient body communication, physiotherapists were able to adjust their therapeutic approach. This helped patients understand more about their health and physical function (Ahlsen & Nilsen, 2022;Buhl & Pallesen, 2015;Ekerholt & Bergland, 2004Gyllensten et al, 1999;Øien et al, 2011;Roenn-Smidt et al, 2022;Thornquist, 1991). Ekerholt and Bergland (2004 observed that, during massage or when teaching exercises, the physiotherapist adjusted their touch as well as the difficulty of movements based on the response observed in the patient's breathing.…”