Arja Piirainen

Chronic pain affects the whole person – a phenomenological study

Abstract Purpose: The aim of this qualitative study was to explore participants’ perspectives on the effects of chronic pain on the psychophysical unity. Methods: Thirty-four chronic pain outpatients were interviewed, and the transcribed interviews were analysed with Giorgi’s four-phase phenomenological method. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the pain duration was more than 5 years, and most had degenerative spinal pain. Results: The results of this whole research project indicated that the phenomenon chronic pain consisted of four essential themes: Pain affects the whole person, invisibility, negativity, and dominance of pain. This study concentrates only on one theme “Chronic pain affects the whole person”, in which were found eight subthemes in the interviews. The strongest argument made by the participants was not the physical pain itself but the psychosocial consequences, such as distress, loneliness, lost identity, and low quality of life which were their main problems. Conclusions: In multidisciplinary holistic rehabilitation, it is essential to take care of the patient’s psychological distress. A potential source of psychosocial symptoms may be the subjective responses to experience of chronic pain due to the subjective meanings of pain. Implications for Rehabilitation About chronic pain Pain is an experience, not only an aversive sensation. Intensity of pain describes only the sensation, not the experience of pain. In chronic pain, the main complaint may be not the physical pain, but the distress. In rehabilitation, the patient needs to be taken as a whole person. Multidisciplinary rehabilitation, including patient counselling should be the fundamental part of treatment. In rehabilitation, the individual meaning of chronic pain needs to be disclosed.

Reflection on Work Culture: The key to success

This paper reports on a development project carried out in a large hospital aiming to develop the expertise of the participating physiotherapists, and to discover cultural factors that promote and hinder change in organisations. The reflective and participatory educational intervention employed an action research framework and developed individual expertise and work orientation among the participants, but more extensive development of work in the physiotherapy unit was found difficult. Change and the spreading of change were obstructed by a host of factors associated with the professional and organisational cultures and hierarchical structures of a large hospital.

Although unseen, chronic pain is real—A phenomenological study

Abstract Background Research has emphasised the essential role of psychosocial risk factors in chronic pain. In practice, pain is usually verified by identifying its physical cause. In patients without any distinct pathology, pain is easily defined as imaginary pain. The aim of this qualitative study was to explore the invisibility of chronic pain, from the patients’ perspective. Methods Thirty-four participants with chronic pain were interviewed. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the duration of pain was more than five years, and most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi’s four-phase phenomenological method. Results The participants’ chronic pain was not necessarily believed by health care providers because of no identified pathology. The usual statements made by health care providers and family members indicated speculation, underrating, and denial of pain. The participants reported experience of feeling that they had been rejected by the health care and social security system, and this feeling had contributed to additional unnecessary mental health problems for the participants. As a result from the interviews, subthemes such as “Being disbelieved”, “Adolescents’ pain is also disbelieved”, “Denying pain”, “Underrating symptoms”, “The pain is in your head”, “Second-class citizen”, “Lazy pain patient”, and “False beliefs demand passivity” were identified. Conclusions In health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice. Implications The Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric.

Reliability and validity study of the Finnish version of the Chronic Pain Acceptance Questionnaire (CPAQ)

Purpose: Acceptance has been discovered to be successful in improving quality of life when adjusting to chronic pain. Instead of avoiding and controlling the pain, the goal is to confront the pain and to live a value directed life. Thus far, there has not been an instrument in Finnish to assess the acceptance of chronic pain. This study aimed at translating the Chronic Pain Acceptance Questionnaire-(CPAQ)-into Finnish and assessing its reliability and validity. Method: Eighty-one persons with different types of chronic pain responded to the CPAQ, the Beck Depression Inventory (BDI), RAND-36 and questions of sociodemographic and pain-related variables. Results: The responders’ ages varied from 16 to 83 years (mean = 48.5 years) and 63% of them were women. For 55% of the participants, the pain had lasted more than 4 years and 63% from the sample had chronic pain in the low back or lower extremities. In test-retest analysis, the interclass correlation coefficient (ICC ) values were good, 0.81–0.87. Internal consistency was very good (α = 0.86). There was no floor-ceiling effect in the Finnish version of CPAQ. Correlation was found between both subscales of the CPAQ and every domain of the RAND-36 (r = 0.23; 0.68) and the BDI (r = −0.24; −0.62). Education, age, pain avoidance, social support and pain intensity correlated with either one of the subscales or total CPAQ. CPAQ revealed no association between fear of pain and pain duration. Conclusions: In conclusion, the Finnish version of the CPAQ is a reliable and valid method for measuring chronic pain acceptance. Implications for Rehabilitation Chronic Pain Acceptance Questionnaire There has not been an instrument in Finnish to assess the acceptance of chronic pain. The Finnish version of the Chronic Pain Acceptance Questionnaire (CPAQ) is a reliable and valid method for measuring chronic pain acceptance. In physiotherapy, CPAQ can be a useful instrument collecting background information of the chronic pain patient and assessing when to consult a psychologist. In addition in long therapies assessing the enhanced acceptance can be monitored with CPAQ.

Students’ Experiences of Reflective Writing as a Tool for Learning in Physiotherapy Education

The purpose of this study was to examine physiotherapy students’ experiences of reflective writing. The students (n = 32) were asked to video record their practical activities at school and at workplaces, and to write reflective journals on their experiences. The research data about students’ experiences of reflective writing were collected by interviewing the students. The data were analyzed phenomenographically. The findings revealed four qualitatively different experiences of reflective writing: 1) writing as a useless task; 2) writing as a tool for deepening understanding; 3) writing as a tool for self-reflection; and 4) writing as a tool for professional development. These categories differed from each other in six themes of variation: function of writing, focus of reflection, contribution to professional learning, emotions, main attribute of writing, and importance for learning. The various experiences raise pedagogical challenges and suggest the need for support especially to those students who do not see the value of writing in their studies. For most students, however, the combination of video recording and reflective writing proved to be a valuable and effective learning tool. It is recommended that reflective writing be used more systematically and frequently in the physiotherapy education.

Higher education teachers’ descriptions of their own learning: a large-scale study of Finnish Universities of Applied Sciences

ABSTRACT In this large-scale study, higher education teachers’ descriptions of their own learning were examined with qualitative analysis involving application of principles of phenomenographic research. This study is unique: it is unusual to use large-scale data in qualitative studies. The data were collected through an e-mail survey sent to 5960 teachers at universities of applied sciences in Finland. The number of respondents was 1622. Four hierarchically structured categories of learning were found: individual learning, collegial learning, team learning and innovative partnership learning. The role of teachers in higher education demands innovative partnership learning: being active at the societal level with workplaces and international partners.

Patients’ conceptions of preoperative physiotherapy education before hip arthroplasty

Abstract In Finland, over 7500 hip arthroplasties are performed annually. While the mean age of the patients has increased, the length of hospital stay has decreased, and this presents challenges for patient education. The aim of this study was to explore patients’ conceptions of preoperative physiotherapy education. This qualitative study included 10 hip arthroplasty patients. Data were collected using individual interviews at home before collecting preoperative information, and at the hospital after the operation. The interviews were tape-recorded and analysed using the phenomenographic method. Four hierarchically constructed categories of preoperative physiotherapy education were identified: readiness for the operation, preparing for the rehabilitation, actor within the hospital service system and independent actor. These categories were analysed through the following themes: knowledge about hip arthroplasty, action skills, body understanding and trusting encounter. According to the patients’ conceptions, in preoperative physiotherapy education gaining knowledge is the key element, which should be combined with practical elements. This requires a trusting relationship between the patient and the physiotherapist. Two critical aspects can be identified: how the readiness for the operation could shift towards preparation for rehabilitation, and widening the perspective from preparing for rehabilitation to being the actor within the hospital service system.

Physiotherapy students’ conceptions of skill at the beginning of their Bachelor studies

Abstract Skills have recently received widespread attention in education policy documents and discussions. This article reports the results of research on Bachelor’s degree physiotherapy students’ conceptions of skill at the beginning of their studies. The aim of the present study was to examine how beginning students understand skill, and the focus was on conceptions of skill in general rather than on any particular skills. The participants of the study were 35 physiotherapy students. The data were gathered within the first two weeks of their university studies. Specifically, requested essays written by the students were analyzed using the phenomenographic approach. The data-driven analysis yielded four descriptive categories which reflect the students’ conceptions of skill: (1) Talents; (2) Skills requiring individual practice; (3) Skills requiring social practice; and (4) Competence requiring collaboration. The categories form a hierarchy. The differences between the categories are described along seven themes of variation. The themes were named: (1) Acquisition; (2) Emotions; (3) Motivation; (4) Reflection; (5) Evaluation; (6) Agency; and (7) Social Environment. This hierarchical system of categories sheds new light on students’ understanding of the skill. The findings can be used as a basis for planning physiotherapy curricula, especially for designing skills education and training, and for supporting students along their educational path, especially in offering opportunities for students to reflect on their skill conceptions. Ultimately, physiotherapy students’ awareness of different skill conceptions and developing their skills to advise and treat will benefit patients.

Revising the negative meaning of chronic pain – A phenomenological study

Objectives Chronic pain may disable the body, depress the mind and ruin the quality of life. The aim of this study was to use the participants’ personal experiences to explore the meaning of the experience of chronic pain and to find successful ways to manage chronic pain. Methods Thirty-four participants with chronic pain were interviewed. The transcribed interviews were analysed using Giorgi’s phenomenological method consisting of four phases: (1) reading the transcriptions several times, (2) discriminating meaning units, (3) collecting meaning units into groups and (4) the synthesis. Results The participants stated that the key to managing chronic pain was to reconsider the individual meaning of the experience of pain. As a result of the interviews, seven subthemes were found based on the ‘Negativity of chronic pain’, namely, ‘State of reflection’, ‘Reconsidering values’, ‘Acceptance of pain’, ‘Support network’, ‘Altered self’, ‘Joys in life’ and ‘Pain dissociation’. Conclusions Pain is an aversive sensation, which leads to the conclusion that the meaning of the experience is also negative, but it can be reversed. In clinical practice, the focus should be on revising the subjective meaning of pain in order to manage pain and to restore positivity in personal life.

The phenomenon of movement quality: a phenomenographic study of physiotherapy students’ movement experiences

Abstract Background: This study aimed to explore how students in a physiotherapy bachelor program acquire awareness of their own movement quality and form conceptions of movement quality. Methods: The study was designed as an elective course, implementing Basic Body Awareness Therapy principles. The participants were six PT students. Two data sets – students’ diaries and reflective group interviews – were collected, one a week before the course ended, and one on its completion. Phenomenographic research methodology was used to transcribe and analyze the data. Results: Three descriptive categories emerged reflecting the PT students’ conceptions of movement quality phenomenon as a widening process: I: Coming into contact with movement experiences, II: Variety of movement qualities, and III: Movement quality as professional development. Within these, two critical aspects, Acceptance of own movement quality and Reflective reasoning based on own experiences of being in movement to gain quality, were identified, indicating aspects of pedagogical importance in deepening PT students’ understanding of the movement quality phenomenon. Conclusion: The three categories reflect the PT students’ variety, widening views on movement quality. The findings elucidate movement awareness learning, by being in movement, indicating a direction for future research on students’ learning of movement quality conceptions within physiotherapy education.