Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study

Abstract

Background: Group-based physiotherapy is effective for individuals with MS; nevertheless individualization within groups is questioned and little is known regarding individuals´experiences with individualization in small groups. Objective: We aimed to explore the short-and long-term experiences of individuals with MS participating in a 6-week, group-based, individualized physiotherapy-intervention. Methods: Within a randomized controlled trial (RCT), 25 in-depth interviews with a strategic sample of 13 people (9 women; age 25-79 years old; European Disability Status Scale (EDSS) 1-6.5) were conducted at weeks 7 and 30 using systematic text condensation, with dynamic systems theory and phenomenology as analytical frameworks. Results: The main categories were: 1) movement control, orientation and insights: Bodily improvements were associated with targeted exercises, specific adjustments by the physiotherapist, emotional engagement and re-access to activities; and 2) the individual within the group: Equal distributions of one-to-one interactions and attention were important for experiencing success. Less attention and improvements turned attention toward own disability. Physical changes felt particularly emotional short term, implying that individuals' feelings of ownership and control of body and movement, new views of themselves and changed affordances in daily life were involved. Conclusion: Equally distributed attention and engagement, targeted exercises and hands-on adjustments resulting in visible and perceived bodily changes were experienced as key factors of individualization in small groups.

Phenomenological physiotherapy: extending the concept of bodily intentionality

“…To compensate for the limitations of the dominant quantitative approach to physiotherapy research, there is a growing interest in enquiries based on qualitative methods . Here, academic publications on physiotherapy tend to either refer to phenomenology and its theoretical constructions (Nicholls 2017; Shaw and Connelly 2013; Øberg, Normann, and Gallagher 2015) or to engage in some form of ‘phenomenological’ empirical research (Arntzen et al . 2021; Blixt, Solbrække, and Bjorbækmo 2021; Meide et al 2018; Skjaerven, Kristoffersen, and Gard 2008; Smythe, Larmer, and McNair 2012).…”

“…Even earlier, cognitive scientists and philosophers started exploring the possibilities of how phenomenological or, more generally, human-perspective based investigations can integrate factors commonly studied by empirical science from a third-person detached perspective (eg, Gallagher 2003; Merleau-Ponty 1963; Merleau-Ponty 2012; Varela, Thompson, and Rosch 2016; for an overview, see Gallagher and Zahavi 2020, 34–50; Zahavi 2019a, 103–140). Similarly, several physiotherapy theorists have recently recognised that a phenomenological theorisation of bodily relationships with the world cannot be reduced exclusively to first-person reflective experience as such relationships always involve actual physical events and subpersonal processes (Arntzen et al . 2021, 1081; Normann 2020, 773–774; Øberg, Normann, and Gallagher 2015, 244–245).…”

“…Merleau-Ponty’s thoughts on living organisms were more recently taken up and elaborated on by embodied cognition theorists and enactivists. Those authors link them to contemporary scientific research on neural pathology, morphogenesis or morphodynamics, and to other theoretical frameworks such as dynamic systems theory (Gallagher 2005; Thompson 2007; Varela, Thompson, and Rosch 2016; in the context of physiotherapy, Arntzen et al . 2021; Normann 2020).…”

“…Merleau-Ponty 2012, 145–146; 1963, 168–169; in the context of physiotherapy, cf. Natvik et al 2019; Arntzen et al . 2021; Normann 2020).…”

“…de Haan 2020; Gallagher 2018; Slatman and van de Ven 2021; Zahavi and Martiny 2019; Zahavi and Loidolt 2021). Some recent physiotherapy research also contributes to our understanding of structural changes of intentionality, even if it does not specifically focus on this concept (Arntzen et al . 2021; Normann 2020).…”