Background: The relationship between older citizens’ participation in outdoor activities and their health is well-documented. In this project, we aimed to integrate "outdoor rehabilitation" as part of municipal reablement service. This service model introduces new standards and roles for physiotherapists, prompting us to explore how physiotherapists' professional roles and identity are developed and challenged within an interdisciplinary team. Method: In 2021, three municipalities in Northern Norway conducted a co-creation project to implement outdoor rehabilitation as part of reablement. Three focus groups with reablement team staff were conducted in the spring of 2021 (N=8), followed by two additional focus groups in the spring of 2024 (N=7). The data were thematically analyzed, and interpretations were supported by theory of professionalism. Findings: The analyses resulted in two main themes: 1) Catalyst for meaningful activities, and 2) Generalist role with an unclear professional mandate. Physiotherapists perceive their contribution as enhancing activity and participation among older citizens, while simultaneously questioning their unique professional contributions. Conclusion: Through outdoor rehabilitation, physiotherapists can promote meaningful aging; however, this approach may also lead to blurred professional boundaries and a diminished sense of professional identity. The study raises questions about professionalism and highlights the need for a specialized theoretical foundation to support physiotherapists' contributions and professional identity in interdisciplinary outdoor rehabilitation.
Purpose: The aim of the study was to gain deeper insight into how municipal physiotherapists experience collaboration with other healthcare services around frail older adults, and to identify factors that promote effective collaboration. Design, material, and method: The data was collected through individual interviews with seven physiotherapists from different municipalities within the same health trust. The analysis was conducted using Interpretive Description, an inductive, qualitative methodology Findings: The analysis identified three main themes: (1) Frailty – easy to recognize, but the term is difficult to use, (2) Comprehensive needs – cannot be met alone, and (3) Meeting points and communication – key factors for improved collaboration. The findings highlight the ambivalence physiotherapists experience when using the term "frailty." Furthermore, the findings indicate that good communication and relationships characterized by face-to-face contact significantly influence the perception of effective collaboration and continuity of care. These aspects are further elaborated in the discussion, with reference to Erlend Vik’s typology of collaboration in healthcare services. Conclusion: Municipal physiotherapists emphasize relational cooperation as a prerequisite for effective collaboration in services for frail older adults. Strong collaborative relationships were associated with regular meeting points and relational continuity, while a lack of structure and appropriate collaboration tools contributed to fragmentation and distance between services.
Aim: The aim of this study was to investigate the knowledge status of health-related quality of life in women who have received physiotherapy for postpartum pelvic girdle pain. Design and method: Scoping review following the framework of Arksey and O'Malley was used as method. Systematic searches were conducted in the databases MEDLINE, EMBASE, Cochrane Library, CINAHL and PEDro with a time limitation from 01.01.12-15.08.24, supplemented by manual searches. Study selection and data extraction were conducted by the two first authors. Covidence was used to ensure structure and blinding. Data analysis and synthesis were conducted using Braun and Clarke's reflexive thematic analysis. Included studies were assessed for quality using checklists from JBI. Results: Out of 1128 identified studies, six studies were included. Among these were one mixed-method study with interview, one expert opinion with a case study, three qualitative interview studies and one RCT study. A deductive thematic analysis identified seven subthemes within the main themes of pain, function, and psychosocial factors. The subthemes were pain provocation and relief, the understanding of pain, participation and disability, fatigue and sleep, roles and identity, emotions, and coping. Conclusion: The findings indicate that postpartum pelvic girdle pain is a complex condition that affects many aspects of women's lives. Health-related quality of life thus appears to be an important outcome measure in future research. There is particularly a need for further research on the effect of physiotherapy on health-related quality of life in women with postpartum pelvic girdle pain. Additionally, there is a need for qualitative studies that explore women's experiences with physiotherapy and the clinical importance that physiotherapy may have on health-related quality of life in women with postpartum pelvic girdle pain.
Research question: How do adolescents with asthma relate to their illness, and what reflections do they have on taking increased responsibility for their own health as they grow older? Design: Qualitative design. Material: Eight adolescents aged 12-15 with asthma, recruited from a children’s hospital. Method: Individual semi-structured interviews were conducted, and the data were analysed using reflexive thematic analysis. Findings: The analysis resulted in three themes: "I would say I’m healthy, but...", "With and without mom and dad", and "Understanding and being understood". The adolescents did not perceive themselves as very different from their peers but were conscious of others' perceptions of their illness. They have developed strategies for managing their condition. They are confident that they can take more independent responsibility but rely on their parents when interacting with healthcare professionals and feel particularly uncertain in encounters with doctors. They emphasize the importance of being seen and heard. Conclusion: The adolescents in this study manage their illness but highlight the need for improved communication and involvement from healthcare professionals toward adolescents with asthma. More research and the development of guidelines for the transition from paediatric to adult healthcare services are needed.
Introduction: Vestibular rehabilitation (VR) is the international, exercise-centered approach recommended for individuals with symptoms (dizziness, visual problems, unsteadiness) of vestibular origin. Treatment availability is currently insufficient in Norway, and number of patients in need of treatment is expected to increase. The aim of this study is to shed light on: What is VR today? Who are treated with VR? What is the evidence for VR? Main text: VR exercises promote vestibular compensation and learning/relearning in loss of vestibular function. Self-initiated exercises that promote gaze stabilization, reduce dizziness, and strengthen balance/postural control are central. Systematic reviews (N:22) show that patients with vestibular disorders (N:10), central and neurological disorders (N:3), and elderly (N:2) are treated with VR in real and virtual environments (N:4). VR is also tested in some other groups (N:3). The evidence for VR is strong in peripheral vestibular disorders. For other conditions with similar symptoms, the evidence is moderate but still recommended. More research is needed. Conclusion: VR is a low-cost initiative which can be recommended. Physiotherapists have co-responsibility for offering patients and other groups with vestibular symptoms evidence-based treatment, which is what VR represents.
Objective: Long-term residents in nursing homes (NH) have complex health needs requiring interdisciplinary follow-up. In NHs in Norway, physiotherapy services are mandated to be available in long-term care units, yet knowledge about actual use remains limited. The aim of the study is to map the organization, time use, and scope of physiotherapy services in long-term care units in nursing homes. Design: Cross-sectional study Methods and Materials: A digital survey assessing time use, extent, and organization of physiotherapy services in long-term care units was distributed to the heads of municipal physiotherapy services in all Norwegian municipalities. Results: A total of 262 out of 357 municipalities responded. Most (n = 214, 82%) had not allocated dedicated physiotherapy positions for residents in long-term care units. The national median was 2,9 (0–50) minutes of physiotherapy per resident placement and 0,3 (0–2,1) referrals per resident placement per year. Municipalities with designated physiotherapy positions for long-term care (n = 48) and smaller municipalities provided more physiotherapy than those without dedicated positions and municipalities with larger populations. The most common reasons for referral were fractures and other fall-related injuries, as well as functional decline following illness or hospital admission. Conclusion: Physiotherapy in long-term care units is typically organized through referrals to municipal physiotherapy services. There are substantial variations between municipalities in both scope and use. Overall, the number of referrals and time allocated appears low relative to the functional level of residents nursing homes and their need for interventions such as rehabilitation, mobilization, and guidance for care staff.
Aim: Many children with cerebral palsy (CP) experience fatigue in their daily lives. The aim of this study is to explore how fatigue affects children's participation and what strategies children and their parents develop to balance energy in everyday activities. Method: This qualitative substudy used semi-structured interviews with 20 children with CP aged 4–15 years and their parents, recruited from the Walking Easier with CP study. Data were analyzed using reflexive thematic analysis. Findings: The analysis identified three main themes: The body’s limits – When energy is not enough; The hidden fatigue – When others don’t see or understand; and Living in balance – Regulating energy in everyday life. Fatigue emerged as an unpredictable and embodied experience that restricted children’s physical capacity and participation. Everyday life required continuous adaptation, with parents taking an active role in planning and managing the child’s energy use. Because fatigue was often invisible to others, it could lead to misunderstandings and social challenges. Conclusion: Increased awareness of fatigue in children with CP can help improve support for participation and quality of life. A holistic approach that includes both the children's and parents' perspectives is recommended to support everyday coping.
Introduction: Sleep disturbances are a significant public health concern and are highly prevalent among individuals with musculoskeletal pain. Given the link between sleep disturbances and various health issues, this article aims to explore the association between pain and sleep disturbances in patients with musculoskeletal disorders. Main Part: A systematic search was conducted in PubMed and Embase, resulting in the inclusion of four studies. Three out of four studies reported an association between shoulder pain and sleep disturbances in patients with rotator cuff tears. However, the relationship between pain and sleep is complex and bidirectional, influenced by both physiological and psychological factors such as sensitization, immune system alterations, and affective states. Furthermore, sleep disturbances have a substantial impact on treatment outcomes in patients experiencing pain. Conclusion: Physiotherapists are well positioned to identify underlying causes of sleep disturbances and provide appropriate treatment. Therefore, assessing sleep quality in clinical practice deserves greater emphasis in the management of musculoskeletal pain.
Introduction: The digital transformation of health and care services demands a more proactive role from health professions education. Educational institutions must go beyond preparing students for existing technologies, they must also support innovation and critically shape the use of emerging technologies such as generative AI. Main body: This position paper argues that health education institutions should act as drivers of digital change. Using the OsloMet physiotherapy program as an example, the paper highlights how digital competence, service innovation, and generative AI are embedded across curricula through new interdisciplinary courses and research-based initiatives. A conceptual framework is presented to illustrate the dynamic relationships between health education, government strategies, and healthcare services. The paper also identifies key challenges, such as insufficient infrastructure for educational-practice collaboration and narrow understandings of digital competence. Conclusion: We conclude that health professions education has untapped potential to shape responsible and practice-relevant digital transformation. Realizing this potential requires structural support for cross-sector collaboration, critical thinking, and innovation capacity.
Purpose: Norway has an aging population and an increasing prevalence of hip fractures, which is associated with high mortality rates. Rehabilitation guidelines for this patient group apply to specialist health services, and there is a lack of knowledge about physiotherapists’ experiences from a municipal perspective. The aim of this study was to gain knowledge about municipal physiotherapists’ experiences with the follow-up of frail older adults after hip fracture. Design, material and methods: The study has a qualitative design, based on individual semi-structured interviews of eight municipal physiotherapists. The data was analyzed thematically. Findings: The physiotherapists experienced frail older adults after hip fracture as a diverse group with complex needs. Follow-up was perceived as a complex task, and the physiotherapists experienced fragmented collaboration across services. The study highlights variations in follow-up, where the most frail patients often received the least care. Nevertheless, the follow-up was generally characterized by a health-promoting and secondary preventive approach. Conclusion: The study emphasizes physiotherapists’ key role in rehabilitation and preventive health care for frail older adults after hip fracture. The study indicates a need for rethinking resource allocation and promoting a shared framework for understanding of function across professions and levels of care.
Purpose: To provide insight about physiotherapists' experiences with the rehabilitation of patients with patellar instability, including management of patients fear and avoidance behaviour. Method: The study employed a qualitative approach to explore physiotherapists' experiences in working with patients with patellar instability. Data were collected through individual, semi-structured interviews with nine experienced physiotherapists. The interview data were analyzed using systematic text condensation. Findings: The analysis in this study generated four main categories: 1) The rehabilitation process, 2) Fear and avoidance behaviour, 3) Coping and motivation and 4) Return to sport. Conclusion: The physiotherapists in this study adopt a holistic approach to the rehabilitation of patients with patellar instability, considering both the physical and mental aspects of the condition. The study highlights the need for further research examining the effects of various training interventions and cognitive measures for patients with patellar instability, which will contribute to the development of rehabilitation guidelines for this patient group.
Purpose: This study seeks to explore the experiences of youth with physical disability after attending VHC and examine how these experiences impact their understandings of themselves and their physical activity participation. Methods: A qualitative design was employed; data was collected through observation during activities at VHC followed by individual interviews after youth returned home. Analysis was inspired by phenomenological thematic analysis. Findings: Youth experience acceptance of differing participation and being offered adjustments in physical activity while being given the opportunity to influence their own participation at VHC, unlike their experiences in their home environments. These experiences promote developing understanding of oneself and own activity participation. Conclusion: Accepting differences in physical activity participation promotes youth adapting their physical activity participation and allows them to influence their participation, promoting learning in activity and developing understanding of oneself and one’s own needs. These experiences do not impact experiences of activity participation in the home environment.
Background: This article highlights the characteristics of breathing pattern disorders at rest and during physical activity. It discusses the mechanisms that may lead to, maintain or result from changes in the breathing pattern, including the musculoskeletal system, biomechanical and psychological factors, as well as stress. Main part: Breathing pattern disorders have a breathing pattern component, such as breath-holding and thoracic breathing, and an upper airway component, in which "exercise-induced laryngeal obstruction (E-ILO)" may be a part. Thoracic breathing is often present when both the breathing pattern and upper airway components are most prominent in young athletes, and are characterized by reduced diaphragm movement, overactivation of respiratory muscles, and postural deviations. These changes may over time affect breathing in general, impact the function of the upper airways, and make the work of breathing more demanding. Disrupted breathing patterns in teenagers and young adults can be triggered and exacerbated by psychological factors, such as persistent worries and stress. If the breathing pattern is the main issue, it will also cause symptoms at rest, but symptoms typically worsen with physical activity. Disrupted breathing patterns can also be confused with or coexist with asthma. Conclusion: A thorough medical history, examination, and assessment are crucial to ensure accurate diagnosis and treatment. It is also important to understand the biomechanical and muscular processes involved in breathing pattern disorders so that this can be addressed in treatment.
Purpose: The purpose of this study is to gain more knowledge about the extent to which psychomotor physiotherapists work with patients who have traumatic life experiences, how they adapt treatment and how they experience the frames of their work. Method: A web-based questionnaire, with closed and open questions, was developed for psychomotor physiotherapists particularly adapted for those working in the primary health care services. Those working in the specialist health care services were only asked to describe the extent to which they are involved in treating patients with such experiences. The questionnaire was sent by e-mail via the psychomotor physiotherapy professional group in the Norwegian Physiotherapist Association to all the 445 members. The closed and open questions were analysed separately. Results: 91 physiotherapists from the primary health care and 29 from the specialist health care, responded to the questionnaire. The results indicate that psychomotor physiotherapists work extensively with patients who have traumatizing life experiences, including refugee background. Those working in primary health care describe how, with this bodily approach, they place great emphasis on developing a sense of safety in the treatment relationship. They often feel left alone with the responsibility for patients with complex conditions and high symptom burden. They call for better interdisciplinary cooperation, more guidance and expertise, and more resources. Conclusion: Psychomotor physiotherapists play a part in the treatment of patients with traumatic life experiences. The study suggests that more research and competence development in the field and better interdisciplinary collaboration may reinforce the health care services for traumatised patients and improve working conditions for physiotherapists.
Aim: To investigate how different types of knowledge are articulated and emphasised in the programme plan for the bachelor’s degree education in physiotherapy at OsloMet – Oslo Metropolitan University. Methods: A qualitative document analysis in which the coding was conducted by means of a predetermined conceptual framework consisting of four categories of knowledge: interaction, personal competencies, professional demands and scientific areas. Findings: Theoretical knowledge from scientific areas held a predominant position in the programme plan and took precedence over the other knowledge categories. At the same time, emphasis was placed on the personal competencies of and professional demands towards the prospective physiotherapist, which were evident many places. Nevertheless, practical knowledge was predominately outlined as the application of theory. The interaction and collaborative relationship between patient and physiotherapist were scarcely articulated and received limited attention. Conclusion: Considering that good communication and a trusting collaborative relationship between patient and physiotherapist constitute essential components of the treatment, it appears to be a shortcoming that interaction was given little emphasis in the programme plan.
Background: Non-surgical treatments have proven to be just as effective for long-term shoulder problems as surgical interventions. Despite this, surgeries still constitute a significant portion of the treatment options. “Skulderskolen” (shoulder school) is a newly established, interdisciplinary teaching program for patients with long-term shoulder problems. There is a need to study how patient education is perceived as a contribution to self-care within this patient group. Method: We conducted semi-structured interviews with one to two participants per session, for a total of eight participants. Systematic text condensation was used to analyze the data. Findings: The analyses identified three main findings: 1) Knowledge provides confidence, 2) Awareness and behavioural change strengthens the ability to execute and 3) Group-based patient education is a resource. The teaching program contributed to reduced fear avoidance and gave participants a sense of proficiency despite the pain. This was uplifting and strengthened their self-efficacy and self-care. Participants had varying levels of competence and needs, and they expressed a desire for more practical and individual guidance, as well as follow-up after the education. Conclusion: Participants at Skulderskolen experienced the patient education as a relevant positive contribution to their self-care for long-term shoulder problems. Skulderskolen increased self-efficacy and helped participants live better with their shoulder problems. A more individualized approach and further follow-up may enhance the beneficial effects of patient education and strengthen Skulderskolen’s contribution to the participants’ self-care.
Purpose: Many women experience physical late effects after surgery and radiotherapy as part of breast cancer treatment and need physiotherapy. Myofascial therapy is a commonly used treatment for these late effects, though scientific evidence is limited. This systematic review aimed to evaluate and summarize the existing research on the effects of myofascial therapy on physical late effects after breast cancer treatment with surgery and radiotherapy. Method: Systematic literature searches for randomized controlled trials investigating the effect of myofascial therapy on late effects after breast cancer were conducted in the databases Amed, Embase, Cinahl, Medline, PEDro, and Pubmed on February 27th, 2020, and February 6th, 2023. The Cochrane Collaboration ́s tool for assessing risk of bias (RoB) was used. Meta-analyses of outcome measures on shoulder abduction and flexion (degrees), shoulder function (Disabilities of the Arm, Shoulder and Hand questionnaire, 0-100), and pain (log-transformed visual analogue scale, 0-100) were conducted to estimate mean differences with 95% confidence intervals (CIs). Results: 233 studies were identified, of which five were included in the meta-analyses with 245 participants. Myofascial therapy improved shoulder abduction immediately after intervention (13.0; 6.3 to 19.6; p=0.001) and at last follow-up (10.4; 3.0 to 17.8; p=0.006), improved shoulder function at last follow up (-5.8; -10.7 to -1.0; p=0.020), and reduced pain intensity at last follow up (-0.33; -0.54 to -0.12; p=0.003). Conclusion: This review indicates that myofascial therapy can have positive impact on late effects after breast cancer treatment regarding, shoulder abduction, shoulder function, and pain. More studies are needed to compare myofascial therapy with relevant alternative interventions, as well as investigating long-term effects, timing, frequency and duration of myofascial therapy, and other outcomes such as quality of life.
Introduction: The aim of the evidence-based guideline is to identify measurement tools to assess fatigue and interventions to treat fatigue in children and adolescents with pediatric rheumatic diseases (PRD). The purpose is to systematize the care and improve the quality of occupational therapy and physiotherapy for this patient group. The guideline is developed according to The Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Main section: In the guideline, 17 studies were included. Clinical expertise from both specialist and municipal health services as well as patient experiences and preferences were obtained. The guideline is based on a biopsychosocial understanding of fatigue. It is divided into two parts; assessment and intervention. The assessment part emphasizes how fatigue affects participation in everyday life, activity registration, and assessment of different factors that influence fatigue. The intervention part consists of patient education to raise awareness of fatigue, regulation of activity level, enhancing self-efficacy, treatment of factors contributing to fatigue and collaboration with other professionals involved in the care of the patient. Conclusion: Fatigue is complex. Scientific evidence is limited for assessment and interventions of fatigue in children and adolescents with PRD. The evidence-based guideline is mainly based on clinical experience and patient preferences.
Aim: To investigate the potential for using video as a method of documentation in physiotherapy for children and adolescents, and potential facilitators and barriers for use and implementation. Design: The study followed physiotherapists from six collaborating locations in private, municipal, and specialist healthcare services, from project start and early testing and over a period of three years, to gather the physiotherapists' experiences with the use of video over time. Material & Methods: The material includes semi-structured interviews, a survey, workshops, observations, minutes from meetings and follow-up conversations with physiotherapists and a supplier of software for video editing and storage. Data was analysed using thematic analysis. Findings: The physiotherapists found video to be a useful tool that supports their current practices by providing better documentation and an "extra set of eyes". Video allows for new practices, including opportunities for sharing videos with other health care professionals, parents and institutions. Several facilitators and barriers for use and implementation were identified, including challenges related to time consumption, privacy concerns, the need for training and technical support and accessible and relevant technology. Conclusion: There is great potential for the use of video in physiotherapy. Using video is in line with the need for better tools for documentation that physiotherapists experience. Yet, further adaptation is needed before implementation into clinical practice. Moreover, unclear data protection regulations create insecurity. As a result, using video becomes cumbersome and non-attractive, despite its potential. Key-words: physiotherapy, clinical documentation e-health, video, communication.
Aim: To explore physiotherapists' experiences with recruiting, training, and supervising volunteer instructors responsible for leading Sterk og stødig (English: Strong and Steady) exercise groups as part of the municipality's fall prevention services for home-dwelling older adults. Method: Four individual in-depth interviews with physiotherapists employed across various municipalities were analysed using systematic text condensation. Findings: Five themes were identified: (1) A natural role that provides variety in the workday, (2) Recruitment – a new role, (3) Volunteers as bridges for knowledge sharing, (4) Continuous supervision to ensure correct exercise dosage, and (5) Strong and Steady for the target group? The study shows that the training and supervisory roles in Strong and Steady were perceived as natural, characterised by confidence, competence, and a positive attitude towards preventive work with the target group. Volunteer instructors served as knowledge facilitators on exercise and fall prevention for group participants. Recruiting suitable volunteer instructors was essential for both training effectiveness and program continuity but was also resource-intensive for the physiotherapists. There were differing views on including group participants outside the target group. Conclusion: Physiotherapists find that tasks related to the Strong and Steady program align well with their professional roles. Despite the resource-intensive nature of recruitment, collaboration with volunteer group instructors serves as a valuable resource in fall prevention efforts. Identifying appropriate solutions related to recruitment work is essential.
