Ulla Talvitie

The meanings older people give to their rehabilitation experience

Promoting older peoples ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older peoples autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.

Physiotherapy under discussion: A discourse analytic study of physiotherapy students’ clinical education

Clinical education is asserted to be an important period in professional education, being an environment where deep conceptual understanding can develop. The aim of this study was to analyse the interaction between clinical educators and students during supervision discussion sessions in physiotherapy students clinical education. The focus was on examining the meanings related to physiotherapy practice and the construction of these meanings by means of discussion. By analysing 10 videotaped supervision discussion sessions and by using qualitative discourse analysis, three interpretative repertoires related to physiotherapy practice were identified: Treatment-skill, theory-based and experience repertoires. The results indicated that even if the comprehension of physiotherapy practice could be constructed in joint understanding between the clinical educator and student, clinical educators seemed to play an important role in revising students’ comprehension by conducting the discussions. Although the physiotherapy practice seemed to be discussed quite uncritically and unreflectively, this study highlighted the discussion sessions in clinical education as an arena for critical analysis of physiotherapy practice and thereby assisting in bridging the gap between theory and practice in the physiotherapy profession. Considering the small number of analysed sessions and the methodological limitations no generalizations could be made and more observational research from this area is evidently needed.

Interaction between clients and physiotherapists in group exercise classes in geriatric rehabilitation

The aim of this paper is to explore how older people construct their interaction in group exercise classes in geriatric rehabilitation and what is their contribution to the interaction. Discourse analysis was employed and data, consisting of seven videotaped group-based exercise sessions, were collected from 52 older people (aged 66–93 years) and nine rehabilitation professionals in seven rehabilitation centres. Four discourse categories were found. In “taciturn exercising”, older people remained verbally silent but physically active. In “submissive disagreeing”, older people opposed the professionals’ agenda by displaying reluctant consent to proposals. In “resilient endeavouring”, older adults persisted on their course of action, regardless of the disapproval of the professionals. In “lay helping”, older people initiated spontaneous encouragement, but also gave verbal and physical assistance to their peers. Older peoples meaningful contribution to interaction, whilst it may challenge the institutional flow of activities, can constitute an integral part of the re-ablement process of rehabilitation.

Client’s role and participation in stroke physiotherapy encounters: an observational study

Abstract Client participation is a basic principle in rehabilitation encounters. Coping at home after stroke requires self-confidence and autonomy, which can be enhanced by active collaboration and knowledge sharing. Earlier studies show, however, that clients are not always offered the role of an active participant in physiotherapy practice. A contradiction remains between official rhetoric and clinical practice. The purpose of this study was to investigate the interaction between the client and the physiotherapist in stroke rehabilitation sessions. Eight video-recorded treatment sessions were observed after an educational intervention that focused on client participation. Discourse analysis was used to examine the client’s involvement in the sessions. Four discourses were identified: taking on expert talk, inviting the client to participate in self-guided planning, neglecting emotional talk and supporting reflection. The client’s active participation manifested as responding to instructions, making plans, solving problems, expressing feelings, and evaluating personal performance and progress. The physiotherapists preferred the hands-off approach and invited the client to take an active role. However, they found it difficult to deal with the client’s expressions of fear and uncertainty. More attention should be paid to the client’s emotional expressions to enhance the client’s self-efficacy and self-management skills after stroke.