Infusing Rehabilitation with Critical Research and Scholarship: A Call to Action

Setchell, Jenny; Nicholls, David A.; Wilson, Nicky; Gibson, Barbara E.

doi:10.3138/ptc.70.4.gee

Cited by 18 publications

(7 citation statements)

References 13 publications

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“…This ‘voluntary giving up’ can be interpreted as passivity, or conformity to ‘how things are’, but also shows the power of dominant norms and expectations to direct behaviour. This power acts on and through health professionals – doctors (Lupton, 2012), nurses (Einboden et al, 2013) and physiotherapists (Setchell, Nicholls et al, 2018) tend to act as implicitly expected. Power, therefore, orients physiotherapist-patient interactions, with an unequal distribution of power favouring healthcare professionals and treating patients’ bodies as objects of the clinical gaze.…”

Section: Methodology and Methodsmentioning

confidence: 99%

“…These studies used postructuralist sociological conceptualisations to unpack the power relationships in physiotherapy and to challenge the pervasive biomedical approach to the body. They produced helpful insights that enabled physiotherapists to differently conceptualise their work (Setchell et al, 2018a). To further explore this interplay between biomedical norms and multidimensional approaches, and to apply it to the context of LBP, the aims of this study were: (1) to explore how biological and human aspects of care are enacted in the clinical management of people with LBP in a physiotherapy setting, (2) to investigate how power plays out in this enactment.…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis

et al. 2022

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Despite recommendations to incorporate physical and psychosocial factors when providing care for people with back pain, research suggests that physiotherapists continue to focus on biological aspects. This study investigated how interpersonal and institutional norms influence this continued enactment of the biological aspects of management. We used theoretically-driven analysis, drawing from Foucauldian notions of power, to analyse 28 ethnographic observations of consultations and seven group discussions with physiotherapists. Analysis suggested that physiotherapy training established expectations of what a physiotherapist ‘should’ focus on, and institutional circumstances strongly drew the attention of physiotherapists towards biological aspects. Resistance to these forces was possible when, for example, physiotherapists reflected upon their practice, used silences and pauses during consultations, and actively collaborated with patients. These circumstances facilitated use of non-biomedical management approaches. Findings may assist physiotherapists to rework the enduring normative focus on biomedical aspects of care when providing care for patients with back pain.

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Section: Methodology and Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis

et al. 2022

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“…In line with the growing body of work in critical physiotherapy, we believe that the principal benefit of the critical study of physiotherapy lies in exposing otherwise unnoticed and unreflected problems that pervade its theories and practices (Setchell, Nicholls, Wilson & Gibson, 2018). In the present case, it is the exposure of an underlying, but as yet unseen act of violence at the heart of physiotherapy theory and practice because of its grounding in ontology and epistemology.…”

Section: Toward An Otherwise Physiotherapymentioning

confidence: 67%

The fundamental violence of physiotherapy: Emmanuel Levinas’s critique of ontology and its implications for physiotherapy theory and practice

Marić¹,

Nicholls²

2019

OPJ

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The fundamental role of ontology, epistemology, and ethics is widely recognised across the healthcare professions. Yet what is less known in physiotherapy is how ontology and epistemology potentially undermine the ethical intentions of our theories and practices. In this article, we draw on the work of 20th-century philosopher Emmanuel Levinas to highlight this problem. Particularly Levinas’s ethical critique of ontology and the associated notion of thematisation enable us to highlight a violence that takes place in the philosophical foundations of physiotherapy. Using the overarching aims of physiotherapy, the theory and practice of diagnosis, and the notion and enforcing of professional identities as examples, we additionally show how this violence consequently pervades physiotherapy theory and practice. By exploring a range of critical and practical implications, we finally show how an application of Levinas’s critique of ontology additionally opens toward an otherwise physiotherapy grounded in a renewed understanding of self, other, and their relation. With this, we hope to highlight the core value and critical need for a deeper engagement with the work of Levinas in relation to all aspects of physiotherapy, and particularly its understanding and implementation of ethics that is so fundamental to its practice and a cornerstone of physiotherapy education.

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“…Respecting recent calls for more critical social science and reflexivity in health‐related research (Setchell et al., 2018), we present here a short exploration of the assumptions, biases and potential for unintentional harms resulting from this work. This study was predicated upon an assumption that a better understanding of the variables that drive a patient's score on a standardized self‐report tool will lead to more informed pain and disability management, possibly through more personalized, patient‐centric and trauma‐informed care decisions.…”

Section: Discussionmentioning

confidence: 99%

Effects of childhood trauma on pain‐related distress in adults

Walton

Tremblay

Seo

et al. 2021

European Journal of Pain

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Background Much of the work in post‐musculoskeletal (MSK) trauma and distress has been conducted through frameworks that start from the injury and go forward to better understand the trajectories and predictors of recovery. However, stress–diatheses models suggest that reactions to trauma are shaped by pre‐existing experiences of the person more than the parameters of the event itself. In this study, we explore the effects of adverse childhood experiences (ACEs) on traumatic threat appraisal, distress and pain‐related functional interference in adulthood. Methods Adult participants with acute, non‐catastrophic musculoskeletal trauma completed a battery of questionnaires that included the Adverse Childhood Experiences Questionnaire (ACEQ), the Brief Illness Perceptions Questionnaire (BIPQ), the Traumatic Injuries Distress Scale (TIDS) and the Brief Pain Inventory (BPI). An a priori model was evaluated through path analysis to determine the variance in BPI Interference scores explained through direct or indirect pathways between these variables (ACEQ‐>BIPQ, BIPQ‐>TIDS, TIDS‐>BPI). The analysis was repeated for the sample when disaggregated by sex. Results In n = 114, the base model was saturated. After removing non‐significant pathways, the ACEQ‐>BIPQ‐>TIDS‐>BPI paths were significant and in the expected direction, explaining 57.1% of variance in acute BPI Interference score. When disaggregated by sex, the effect of ACEs on threat appraisal was only significant in men and not women, although this analysis was exploratory. Conclusions Acute pain‐related interference could be predicted by post‐traumatic distress and threat appraisal. Threat appraisal could be further predicted through ACEs, more childhood adversities were associated with more threatening appraisal of trauma in adulthood. The disaggregated finding that the effects of childhood adversities were only significant in males requires further exploration. Significance This study explores the potential pathways of the stress–diathesis model while focusing on adverse childhood experiences as a novel contribution to the field of acute post‐trauma pain. The findings may inform future research design and interpretation of acute‐to‐chronic pain risk stratification tools.

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Infusing Rehabilitation with Critical Research and Scholarship: A Call to Action

Cited by 18 publications

References 13 publications

Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis

Physiotherapists Both Reproduce and Resist Biomedical Dominance when Working With People With Low Back Pain: A Qualitative Study Towards New Praxis

The fundamental violence of physiotherapy: Emmanuel Levinas’s critique of ontology and its implications for physiotherapy theory and practice

Effects of childhood trauma on pain‐related distress in adults

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