Reciprocity in Low Back Pain Care and Its Role in Power Dynamics: A Give-and-Take Approach

Mescouto, Karime; Tan, Meris; Setchell, Jenny

doi:10.1093/ptj/pzac145

Cited by 3 publications

(3 citation statements)

References 43 publications

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“…This biomedical scripted approach lends itself to paternalistic practice where the physiotherapist holds more power within the encounter, which is known to negatively impact the therapeutic alliance and patients’ engagement with physiotherapy ( Mescouto et al, 2022b ). It positions the clinician as the expert on the patient’s pain experience rather than a partnership of reciprocal and shared exploration.…”

Section: Resultsmentioning

confidence: 99%

Distress in the care of people with chronic low back pain: insights from an ethnographic study

Dillon,

Olson,

Plage

et al. 2023

Front. Sociol.

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IntroductionDistress is part of the experiences and care for people with chronic low back pain. However, distress is often pathologised and individualised; it is seen as a problem within the individual in pain and something to be downplayed, avoided, or fixed. To that end, we situate distress as a normal everyday relational experience circulating, affecting, moving in, through, and across bodies. Challenging practices that may amplify distress, we draw on the theorisation of affect as a relational assemblage to analyse physiotherapy clinical encounters in the care of people with chronic low back pain.MethodsAdopting a critical reflexive ethnographic approach, we analyse data from a qualitative project involving 15 ethnographic observations of patient-physiotherapist interactions and 6 collaborative dialogues between researchers and physiotherapists. We foreground conceptualisations of distress— and what they make (im)possible—to trace embodied assemblage formations and relationality when caring for people with chronic low back pain.ResultsOur findings indicate that conceptualisation matters to the clinical entanglement, particularly how distress is recognised and navigated. Our study highlights how distress is both a lived experience and an affective relation—that both the physiotherapist and people with chronic low back pain experience distress and can be affected by and affect each other within clinical encounters.DiscussionSituated at the intersection of health sociology, sociology of emotions, and physiotherapy, our study offers a worked example of applying an affective assemblage theoretical framework to understanding emotionally imbued clinical interactions. Viewing physiotherapy care through an affective assemblage lens allows for recognising that life, pain, and distress are emerging, always in flux. Such an approach recognises that clinicians and patients experience distress; they are affected by and affect each other. It demands a more humanistic approach to care and helps move towards reconnecting the inseparable in clinical practice—emotion and reason, body and mind, carer and cared for.

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Section: Resultsmentioning

confidence: 99%

Distress in the care of people with chronic low back pain: insights from an ethnographic study

Dillon,

Olson,

Plage

et al. 2023

Front. Sociol.

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“…Both data sets were produced as part of a wider project conducted between April 2019 and June 2021. 5,6,24,25 All 45 clinicians from the two study sites were invited to participate in the dialogues. A total of 29 clinicians provided written consent and participated in the dialogues (seven from Site 1 and 22 from Site 2), a response rate of 64.4%.…”

Section: Methodsmentioning

confidence: 99%

“…Both data sets were produced as part of a wider project conducted between April 2019 and June 2021. 5,6,24,25…”

Section: Methodsmentioning

confidence: 99%

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia

Mescouto

Olson

Costa

et al. 2023

J Health Serv Res Policy

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Objectives Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity – the ability to examine and challenge power relations, and broader social issues embedded in everyday life – can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. Methods Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia – a private physiotherapy clinic and a public multidisciplinary pain clinic. Results Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices – such as assisting patients to navigate health care systems, considering patients’ socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. Conclusions Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.

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Integrated manual therapies: IASP taskforce viewpoint

Draper-Rodi,

Newell,

Barbe

et al. 2024

PR9

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Introduction: Manual therapy refers to a range of hands-on interventions used by various clinical professionals, such as osteopaths, osteopathic physicians, chiropractors, massage therapists, physiotherapists, and physical therapists, to treat patients experiencing pain. Objectives: To present existing evidence of mechanisms and clinical effectiveness of manual therapy in pain. Methods: This Clinical Update focuses on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care. Current models of manual therapy and examples of integrative manual therapy are discussed. Results: The evolution of concepts in recent years are presented and current gaps in knowledge to guide future research highlighted. Mechanisms of manual therapy are discussed, including specific and contextual effects. Findings from research on animal and humans in manual therapy are presented including on inflammatory markers, fibrosis, and behaviours. There is low to moderate levels of evidence that the effect sizes for manual therapy range from small to large for pain and function in tension headache, cervicogenic headache, fibromyalgia, low back pain, neck pain, knee pain, and hip pain. Conclusion: Manual therapies appear to be effective for a variety of conditions with minimal safety concerns. There are opportunities for manual therapies to integrate new evidence in its educational, clinical, and research models. Manual therapies are also well-suited to fostering a person-centred approach to care, requiring the clinician to relinquish some of their power to the person consulting. Integrated manual therapies have recently demonstrated a fascinating evolution illustrating their adaptability and capacity to address contemporary societal challenges.

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Reciprocity in Low Back Pain Care and Its Role in Power Dynamics: A Give-and-Take Approach

Cited by 3 publications

References 43 publications

Distress in the care of people with chronic low back pain: insights from an ethnographic study

Distress in the care of people with chronic low back pain: insights from an ethnographic study

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia

Integrated manual therapies: IASP taskforce viewpoint

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